正中神经返支血供的解剖学研究及其临床意义

目的:为修复正中神经返支提供带血管蒂神经桥接的理论基础和有关数据。方法:用体视学方法研究了60例灌注红色乳胶液的返支营养血管,观察其长度和内径、来源、进入神经干的方式。结果:营养动脉长度2.86±0.12mm,内径0.23±0.03mm,从返支主干的近1/3进入占88.8％,由神经的掌面,尺侧进入占74.5％。来源动脉起自掌浅弓凹侧的筋膜支,起占至“零点”的距离11.64±2.27mm,内径0.52±0.08mm,长度10.04±1.26mm。结论:返支营养动脉的来源动脉适宜做带血管蒂神经移植的受体血管。     

正中神经返支和掌皮支血供的显微解剖

目的为修复正中神经返支提供带血管蒂神经桥接的有关数据和掌皮支血供的解剖学资料。方法用体视学方法研究了40侧灌注红色乳胶液的返支和掌皮支的营养血管。观察返支营养血管的来源、长度、外径和进入神经干的方式;观察掌皮支营养血管的来源和进入神经的方式。结果返支营养动脉主要发自掌浅弓凹侧筋膜支(称之来源动脉)。来源动脉起点至“零点”距离(11.62±2.30)mm,外径(0.95±0.10)mm,长度(10.12±1.30)mm。营养动脉主干长度(2.84±0.10)mm,外径(0.42±0.15)mm。营养动脉从返支主干近侧1/3段直入式进入神经者占86.5%;从返支中、远侧段伴入式进入神经者占14.5%;掌皮支营养动脉主要发自尺动脉(占52.5%)和桡动脉(占37.5%),以直式、伴入式和肌支式进入神经。结论返支营养动脉可作为血管蒂神经移植的受体血管。     

腋神经的血供

本文在25具(男13,女12)研究用经动脉灌注带色乳胶液的成人尸体上,应用显微外科解剖技术,解剖和观察了50侧腋神经干的营养动脉及其来源动脉.50侧腋神经中,有45侧有59支营养动脉进入,平均1.31±0.06支.营养动脉的外径和长度分别为0.35±0.01和8.74±0.47mm,多从神经干的前内侧进入(86.40%)和以升降支形式走行(76.27%).这些营养动脉的来源动脉是旋肱后动脉、肩胛下动脉、臂丛营养动脉、腋动脉、胸外侧动脉和旋肩胛动脉.     

臂内侧皮神经的血供

本文用15具专供研究用的成年尸体,在手术显微镜下解剖和观察了30侧臂内侧皮神经的营养动脉的数目、长度、口径、入神经干的部位、在神经干内走行形式以及来源动脉等。共观察到营养动脉52支,其口径和长度分别为0.34±0.19毫米和8.50±0.78毫米。来源动脉口径为0.69±0.04毫米。     

尺神经的血供

在20具(男10,女10)科研用成人尸体上,经动脉灌注带色乳胶液,在SXP-1型手术显微镜下解剖和观察了40侧尺神经的营养动脉及其来源动脉。共发现348支营养动脉,平均值为8.7±0.38(5-14)支。营养动脉的外径平均值为0.33±0.05(0.2-0.6)mm。营养动脉的来源:腋段来自腋动脉(15)和胸外侧动脉(2支);臂段来自尺侧上副动脉(105支)和肱动脉肱三头肌支(3支);前臂段来自尺侧返动脉(32支)、尺动脉(143支)和尺动脉尺侧(?)屈肌支(18支)。本文认为,在外伤性截肢或颈8,胸1脊神经根节前撕脱伤病人,可以尺侧上副动脉为蒂进行尺神经游离移植。     

桡神经臂部血供的显微解剖

目的为临床中修复桡神经长段缺损及利用该神经修复其他神经损伤提供形态学基础。方法对35侧经腋动脉灌注带色乳胶的成人上肢标本,解剖观察供给桡神经营养血管的来源、分布、微血管构筑、营养动脉的外径。结果桡神经接受的营养血管来源分为四种类型;营养血管分布在臂部中段较多;营养动脉起始处外径平均为(0.37±0.03)mm,入神经干处外径平均为(0.28±0.02)mm。结论35侧成人上肢的桡神经全段血供形式可分为3型。在臂部桡神经中,肱深动脉、桡侧返动脉为供给神经血液的主要血管,且大部分集中于中、下1/3段。     

带血管蒂阔筋膜张肌及腱膜转位修补巨型腹股沟疝的应用解剖

目的　为带血管蒂阔筋膜张肌及腱膜转位修补巨型腹股沟疝提供解剖学基础。方法　在 30侧成人下肢标本上解剖观测了阔筋膜张肌的动脉血管分布、神经支配、肌腹和肌腱的长度等。结果　阔筋膜张肌动脉来源有旋股外侧动脉和臀上动脉 ;该肌由臀上神经支配 ,肌腹长度为 (1 1 2 31± 3 1 3)mm ,髂胫束的长度为 (31 5± 6 8)mm ,髂前上棘水平至腹直肌外侧缘的距离 ,男性为 (1 68± 7 5)mm ,女性为 (1 76± 6 8)mm。结论　阔筋膜张肌血供丰富 ,肌腱膜长 ,位置邻近腹股沟区 ,可作为巨型腹股沟疝修补的供区     

正中神经掌皮支的应用解剖

目的:为预防腕、掌部手术损伤正中神经掌皮支和掌皮支损伤后修复提供解剖学资料。方法:对40侧成人上肢标本正中神经掌皮支的来源、走行、分支与分布进行解剖观测。结果:40侧标本均有掌皮支,在掌长肌腱桡侧距离远侧腕横纹中点(45.6±20.3)mm处发自正中神经桡侧,距离远侧腕横纹中点(19.3±11.6)mm处穿出前臂深筋膜,距离远侧腕横纹中点(8.2±3.5)mm处浅出掌腱膜。掌皮支长(49.4±24.8)mm,起点处宽(1.2±0.8)mm。掌皮支分3支者22例(占55%),分2支者12例(占39%),1支者6例(占15%)。掌皮支主要分布于鱼际区和掌中区。结论:掌皮支的来源、行程较恒定。腕、掌部手术应在掌长肌腱桡侧作纵行切口,可避免损伤掌皮支。     

桡神经及其深支的血供

在25具成人尸体(50例)上,观测了桡神经及其深支的血供。桡神经的营养动脉平均为4.36±0.26支,营养动脉和来源动脉的外径平均为0.38±0.08mm和1.65±0.05mm。桡神经深支的营养动脉平均为1.72±0.16支,营养动脉和来源动脉的外径平均为0.29±0.01mm和1.91±0.07mm。     

肌皮神经的血供

在25具(男14,女11)专供研究用中国成人尸体上,应用显微外科解剖技术,解剖和测量了50侧肌皮神经的营养动脉及其来源动脉。结果:营养动脉平均为2.8支,其外径和长度分别为0.29和7.91mm。营养动脉的来源动脉主要来自腋动脉喙肱肌支、肱动脉肱二头肌支和肱动脉肱肌支。     

第9、10、11肋间神经和肋下神经的血供

本文观察了25具成人专供研究用的尸体,对50侧第9、10、11肋间神经和肋下神经的血供进行了研究,对该四对神经的营养动脉数目、外径、长度、入神经干部位和来源动脉进行观察测量。发现营养动脉外径较细,长度亦较短,不宜作为肋间神经的血管蒂进行吻合,而肋间神经营养动脉的来源动脉——肋间后动脉,其外径较粗,并有足够长度,作为血管蒂进行吻合较为理想。     

人体颈椎椎弓的营养孔和营养动脉

1.观察了351个成人颈椎干骨(C_237、C_(3～5)196、C_639、C_779)椎弓营养孔的数目、大小、方向和位置。椎弓外面的营养孔以单孔多见,占64.96％,平均口径为0.34mm。指向椎弓根,多位于距峡部中线后方3～6mm范围的椎板中部。椎弓内面的营养孔为单孔者占47.01％,平均口径为0.26mm。指向后,集中于距椎弓根与椎板连线0～3mm范围的椎板中部。 2.用解剖、透明法,观察了20具不同年龄新鲜尸体颈椎椎弓的营养动脉。椎弓外面营养动脉发自颈深动脉;内面营养动脉发自椎动脉脊后支的升支和脊中间支的后根支。在每一椎弓的左、右侧半内,以1支营养动脉多见。它分成短而较细的前支和长而粗的后支。前支发出分支供应上、下关节突、横突和椎弓根;后支发支供应椎板和棘突。营养动脉在骨内的形态、走行和分布与骨化过程关系密切。 3.骨膜动脉从椎弓外面进入,在儿童和成人的椎管面,未见到此种小支的存在。     

Variations of the nutrient artery of the fibula

In this study the authors aimed to show variations of the nutrient artery of the fibula, which is important for more effective vascularized fibular grafts. Thirty intact legs were examined to determine the number, location, and diameter of the nutrient arteries in the shaft. In 27 of these specimens (90%) there was single nutrient artery; two legs (6.6%) had double nutrient artery. In one leg (3.3%) no nutrient artery was observed. The number of nutrient arteries found on each of the surfaces was summarized as follows. Most of the nutrient arteries pierced the fibula at its medial crest, while only one entered from the posterior surface. Most nutrient arteries were near the middle third of the fibula. The most frequent diameter of the nutrient artery was 0.9-1.5 mm. The authors think that their results about the variations of the nutrient artery supplying the fibula will contribute to the clinical and vascular anatomy knowledge.     

同种异体带血供肱骨移植的解剖学研究

目的为吻合血管同种异体肱骨移植提供解剖学依据。方法在40侧经动脉灌注红色乳胶的成人上肢标本上,着重观测肱骨上端及肱骨干滋养血管和骨膜血管的来源、分布、长度和外径;50根干燥成人肱骨,观察肱骨上端及肱骨干的滋养孔。结果肱骨上端外科颈周围平均有(7.7±2.0)个(4～12个)滋养孔,滋养支来自旋肱前动脉和旋肱后动脉。肱骨干滋养孔1～3个,主要位于肱骨中段前内侧面,距内上踝(11.7±2.2)cm(6.5～17.0cm)。滋养动脉主要来自肱动脉,长(2.6±0.7)cm(1.5～5.0cm),外径(1.3±0.6)mm(0.8～2.2mm)。结论选用旋肱前血管为蒂,可行肱骨上段移植,选用肱血管和肱深血管为蒂,可作肱骨中段移植。     

Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinic consequences

Background A large patent median artery can be involved in several clinical disorders like carpal tunnel syndrome, anterior interosseous nerve syndrome and pronator syndrome. Methods The frequency and variability in the expression of the median artery and the expression of the other forearm arteries were recorded during two dissection courses. The topography of the arteries with their ramifications was documented on diagrams and photographs. The outer diameters of forearm arteries were measured. Results A large median artery was found in 4 of 54 arms (7.4%). The median arteries took their origin from the ulnar artery or the common interosseous artery. In one case, the median artery pierced the median nerve in its course under the pronator teres. The outer diameters of the median arteries varied between 1.5 and 2.0 mm proximally and 1.5 and 2.0 mm distally. The diameters of the radial arteries varied between 3.0 and 5.5 mm proximally and 3.0 and 4.0 mm distally and were not reduced in any of the four cases with a large median artery. Conclusions Surgeons should be aware of other variations in the forearm when a persistent median artery is identified, for example high median nerve bifurcations. Furthermore, it should be kept in mind that additional structures leading to nerve compression may be present in the carpal tunnel.     

成人发育性髋关节发育不良患者股骨滋养动脉的X线影像学特点

目的 探讨成人发育性髋关节发育不良(DDH)患者股骨滋养动脉的X线影像学特点,为临床避免骨折误诊提供一定帮助。方法 回顾性分析解放军总医院第一医学中心2016年1月—2018年12月就诊的成人DDH患者髋关节X线片(含下肢全长)资料,163例共244髋,男20例、女143例,年龄 20~69(42±16.14)岁, CroweⅠ型72髋、Ⅱ型58髋、Ⅲ型46髋、Ⅳ型68髋。统计存在股骨滋养动脉影像的X线片,分别在正侧位X线片上观测其在股骨干内走行的方向、长度(D)以及股骨干全长(L),在侧位X线片上测量滋养动脉影与股骨长轴夹角(α),以及滋养动脉远端距离股骨大转子顶点的距离(d)、进入股骨干的位置比(R=d/L),并进行D、R、α之间的相关性分析。结果 在244 髋的影像学检查中,98髋(40.16%,95%置信区间33.97%~46.36%)可见滋养动脉影。D为1.22~11.08(4.75±2.21)cm;L为38.83~46.88(42.52±1.90)cm。在正位X线片上与股骨内外侧皮质不相交,侧位X线片上自股骨干后侧进入,向近端前方走行,α为8.20°(5.58°, 12.79°);d为10.82~26.82(19.13±4.09)cm;R为0.26~0.60(0.45±0.09)。 R与D、R与α、D与α之间均存在良好相关性(r=0.673,r_s=-0.690、-0.680;P值均＜0.01)。结论 成人DDH患者髋关节X线片中股骨滋养动脉影可见率较高,有其固有特点和规律,能为临床工作中骨折线的鉴别提供依据。     

Morphometric study of the human fetal heart. I. Arterial segment

This study measured the dimensions of the great arteries of normal human fetal hearts at an early fetal stage (between 13-20 weeks post-fertilization) in 103 fetuses obtained by necropsy. Different segments of the aorta and the pulmonary artery were dissected and their external diameters measured under stereoscopic magnification. All segments showed linear growth during this period of fetal development. Ranges in median values of external diameters associated with the pulmonary artery were: 2.1-4.2 mm for the valve ring; 2.2-4.2 mm for the main pulmonary trunk; 1.2-2.5 mm for the right pulmonary artery; 0.9-2.18 mm for the left pulmonary artery; and 4.0-8.0 mm for the length of the main pulmonary trunk. Similarly, in the aorta, median diameters were: 2.1-4.2 mm for the ascending aorta; 1.92-3.8 mm for the aortic arch; 1.45-3.0 mm for the aortic isthmus; and 1.75 -3.35 mm for the descending aorta. The diameter of the ductus arteriosus ranged between 1.2-2.45 mm. The growth rates of the pulmonary artery and the aorta were similar. The diameter of the ascending aorta was found to be greater than that of the descending aorta and the right pulmonary artery was wider than the left pulmonary artery. In addition, the magnitude of growth in the various aortic segments was different and the ratios obtained between the aortic isthmus and the ascending and descending aortae, ranged between 0.66-0.93. This study provides important morphometric reference information concerning the dimensions and growth of the great arteries of the fetal heart and has clinical application in pediatric cardiac surgery and echocardiography.     

颅内宽颈动脉瘤合并载瘤血管重度狭窄的血管内治疗

目的:探讨颅内宽颈动脉瘤合并载瘤动脉重度狭窄血管内治疗的安全性及疗效。方法:回顾性研究。纳入郑州大学人民医院脑血管病科2017年1月—2019年12月采用血管内治疗颅内宽颈动脉瘤合并载瘤血管重度狭窄的患者14例,共14个动脉瘤。14例中,男5例、女9例,年龄45～76(61.07±10.43)岁;8例为破裂动脉瘤,6例...