Anatomy of greater palatine foramen and canal and pterygopalatine fossa in Thais: considerations for maxillary nerve block

This study aims to investigate the anatomy of the greater palatine foramen (GPF), greater palatine canal (GPC) and pterygopalatine fossa (PPF) with special reference to the blockage of the maxillary nerve. A correlation between the length of GPC and PPF and the heights of the orbit and the maxilla was also studied using simple linear regression analysis. The morphology of the GPF, GPC and PPF as well as heights of the orbit and the maxilla were assessed in 105 Thai skulls. The thickness of the mucosa over the GPF was also measured from the dissection of 55 cadavers. The results showed that most GPF appeared as an oval foramen located at the palatal aspect of the upper third molar. The GPF was 16.2±1.3 mm lateral to the median sagittal plane of the hard palate, 2.1±1.3 mm anterior to the posterior border of the hard palate and 5.1±1.3 mm from the greatest concavity of the distolateral margin of the hard palate. The mean length of GPC and PPF was 29.7±4.2 mm. The mean angles of the GPC in relation to the hard palate and the vertical plane were 57.9±5.8° and 6.7±5.2°, respectively. In attempting to insert a needle to reach the foramen rotundum through the GPF, 31.7% passed into the orbit while 8.7% passed into the brain. The mean thickness of the mucosa over GPF was 6.7±2.3 mm. Two models for estimating the depth of needle injection in maxillary nerve block have been developed as follows: Length of GPC and PPF=19.038+0.314 (orbital height) and length of GPC and PPF=21.204+0.187 (maxillary height). The calculated length combined with the mucosal thickness was the estimated depth of needle injection. In conclusion, our results concerning the GPF, GPC and PPF will provide the useful reference for clinicians to anesthetize the maxillary nerve with a greater degree of success.     

Anatomical landmarks for the localization of the greater palatine foramen – a study of 1200 head CTs, 150 dry skulls,systematic review of literature and meta‐analysis

Accurate knowledge of greater palatine foramen (GPF) anatomy is necessary when performing a variety of anaesthesiological, dental or surgical procedures. The first aim of this study was to localize the GPF in relation to multiple anatomical landmarks. The second aim was to perform a systematic review of literature, and to conduct a meta‐analysis on the subject of GPF position to aid clinicians in their practice. One‐hundred and fifty dry, adult, human skulls and 1200 archived head computed tomography scans were assessed and measured in terms of GPF relation to other anatomical reference points. A systematic literature search was performed using the PubMed, Embase and Web of Science databases, and a meta‐analysis on the subject of GPF relation to the maxillary molars was conducted. On average, in the Polish population, the GPF was positioned 15.9 ± 1.5 mm from the midline maxillary suture (MMS), 3.0 ± 1.2 mm from the alveolar ridge (AR) and 17.0 ± 1.5 mm from the posterior nasal spine (PNS); 74.7% of GPF were positioned opposite the third maxillary molar (M3). Twenty‐seven studies were included in the systematic review and 23 in the meta‐analysis (n = 6927 GPF). The pooled prevalence of the GPF being positioned opposite the M3 was 63.9% (95% confidence interval = 56.6–70.9%). Concluding, the GPF is most often located opposite the M3 in the majority of the world's populations. The maxillary molars are the best landmarks for locating the GPF. In edentulous patients the most useful points for approximating the position of the GPF are the AR, MMS and PNS. This study introduces an easy and repeatable classification to reference the GPF to the maxillary molars.     

Palatal asymmetry during development: an anatomical study

The purpose of this study was to evaluate hard palate asymmetry during development. The palates of 248 dry skulls were photographed and evaluated digitally. The skulls were divided into seven groups: fetus, newborn, infant, child, adolescent, adult, and aged. Linear measures were obtained from great palatine foramen (GPF) to incisive fossa (INC) and to posterior nasal spine (PNS). Angular measures were obtained from the former landmarks plus the point on sutures intersection between maxillary and palatine bones. Asymmetry was evaluated intra and intergroups. All skulls showed some degree of right-left asymmetry in the hard palate. Regardless of hard palate asymmetry, none of the right-left side differences was statistically significant. For the intergroups assessment, none of the asymmetry index means were statistically different. The posterior part of palate (PNS x GPF) measures was more asymmetric than the anterior part (INC x GPF), showing, respectively, 4.6% and 2.8% of mean asymmetry index. Angular measures showed a more symmetric behavior than the linear ones. Hard palate asymmetry occurs even in the absence of masticatory function, showing that this feature begins early in fetal life and persists through development.     

Position of the greater palatine foramen: an anatomical study through cone beam computed tomography images

Purpose

The block anesthesia of the greater palatine foramen (GPF) is largely used in minor oral surgeries, periodontics and general dentistry. Furthermore, the area of the GPF serves as a donor of soft tissue graft. So, the aim of this study was to evaluate the position and characteristics of the GPF in Brazilian patients using cone beam computed tomography (CBCT) providing anatomical information for the greater palatine nerve block anesthesia and indicate site to collect palatal donor tissue.

Methods

Fifty CBCT exams of Brazilian patients with a mean age of 35.8 years (27 male/23 female) were evaluated. All patients had erupted first, second and third upper molars. A total of 100 GPF were evaluated bilaterally. The GPFs were assessed regarding position, diameter and distances to the midline maxillary suture (MMS) and to alveolar ridge (AR). Guidelines were drawn in the CBCT axial image depicting all molar interproximal surfaces, bilaterally. The guidelines were located between first, second and third molar and in the center of the second and third, performing five guidelines in each side. These guidelines and the molars were landmarks to assess the GPF anatomic position.

Results

From the 100 GPF analyzed, 92 were located in the third molar region (24 male/22 female). The 92 GPF were distributed as 47 in the left side and 45 in the right side. The average GPF diameter and the distance to both the AR and the MMS were 3.1 mm; 7.9 and 15.3 mm, respectively.

Conclusions

Within the limits of this study, we concluded that the in Brazilian patients studied, the GPF location was more closely related to third molar. Therefore, whenever the third molar is erupted, it could be used as landmark for successful GPN block anesthesia. Moreover, harvesting palatal mucosa graft around the third molar should be done cautiously to prevent damage to the GPF vascular-nerve complex.     

自前向后植入骶髂关节螺钉解剖参数的CT测量

目的： 利用CT扫描图像测量自前向后植入骶髂关节螺钉（SISIFATP）的应用解剖参数,为螺钉植入可行 性提供依据。方法：分析健康成人骨盆CT扫描图像。模拟SISIFATP 自髋臼后上缘附近,向后、内、上穿过骶髂 关节和骶椎侧块第1 骶椎上关节突基底。利用CT数字重建技术测量：在横断面内进钉点与髋臼边缘的距离（M）、 通道长度（L）、最小横径（W）、螺钉通道中心轴与矢状面成角（E）和最大偏离角（P）;在矢状面内通道的最 小纵径（H）,通道中心轴与第1 骶椎上终板平行线的成角（F）和最大偏离角（Q）。结果：M为5.13 mm±1.81 mm,L 为102.35 mm±7.45 mm,E 为43.79°±2.83°,F 为43.85°±5.57°。W 为16.27 mm±1.99 mm,H为18.31 mm±2.22 mm。P 为11.74°±1.76°,Q 为11.04°±1.59°。结论：SISIFATP 的进点位于髋臼后上边缘附近,出针 点位于第1 骶椎上关节突基底,进钉方向是向后、向上与第1 骶椎上终板平均成角44°、向内与躯干纵轴平均成角 44° ;国人骨盆可选择至少1 枚直径6.0 ～ 7.0 mm、长度90 ～ 100 mm 螺钉植入。     

外偏角对颈椎理想椎弓根螺钉置入的影响及变化规律

目的运用CT三维重建技术探讨不同外偏角对颈椎理想椎弓根螺钉置入的影响及变化规律。方法应用CT三维重建技术对60例颈椎(C3～7)模拟进行椎弓根内固定术,并测量外偏角在10°～60°时理想螺钉的直径和长度。结果C3～7椎弓根在外偏角为10°～60°时,随着外偏角度数的增加,理想椎弓根螺钉的直径和长度均先增大到峰值后逐渐减小;在C3～6,外偏角为50°时,理想螺钉的直径达到最大值,分别为(4.3±0.7)、(4.4±0.7)、(4.8±0.8)和(5.3±0.9)mm;C7理想螺钉的直径在外偏角为30°时达到最大值,为(6.3±0.9)mm。在螺钉外偏角为40°时,C3～7理想螺钉的长度达到最大值,分别为(30.2±2.1)、(29.6±2.0)、(30.6±2.5)、(31.7±2.5)和(31.7±2.0)mm。结论应用CT三维重建技术对不同外偏角时理想螺钉的直径和长度测量,可了解理想椎弓根螺钉的形态变化规律,对置入螺钉的形态和进钉角度的选择有指导意义。     

椎前髂静脉通道大小和下腰椎前凸角与性别、年龄的关系及其临床意义

目的 探讨椎前髂静脉通道矢状径(IVTD)和下腰椎前凸角(LLLA)与性别、年龄的关系及其临床意义。方法 收集2009年7月—2014年12月解放军第一七五医院(厦门大学附属东南医院)CT数据库中行腹盆部CT检查患者的资料进行回顾性分析。按年龄和性别分层简单随机抽样方法抽取320例为正常组,每年龄段(1～15,16～25,26～35,36～45,46～55,56～65,66～75及≥76岁)各40例,男女均等。收集同期55例(男18例,女37例)髂静脉压迫综合征(IVCS)患者的CT资料为IVCS组。分别在CT横断面和重建矢状面上测量椎前IVTD和LLLA。统计分析评估正常组LLLA和IVTD在男女性别间和各个年龄组间的差异采用方差分析和Bonferroni检验,Pearson相关分析LLLA和IVTD与年龄的相关性。在正常组中选择与IVCS组同年龄段者为对照组,采用独立样本t检验分别比较对照组与IVCS组中男性组、女性组间LLLA、IVTD的差异,分别建立预测男性和女性罹患IVCS风险的IVTD狭窄阈值。结果 正常组总体LLLA为128.1°±6.7°,椎前IVTD(4.9±1.2)mm,与年龄均呈负相关(r=-0.673、-0.662,P值均＜0.01);LLLA与IVTD呈正相关(r=0.812, P＜0.01)。其中,男性LLLA 为130.6°±6.1°、IVTD为(5.4±1.2)mm;女性LLLA为125.5°±6.0°、IVTD为(4.3±1.0)mm,男性LLLA和IVTD值均高于女性(t=7.426、9.103,P值均＜0.05)。IVCS组中,男性LLLA为123.3°±2.3°,IVTD为(2.5±0.3)mm ,与对照组男性的128.1°±2.7°、(5.0±0.8)mm比较,差异均有统计学意义(t=6.993、12.604, P值均<0.01);女性LLLA为122.1°±5.8°,IVTD为(2.3±0.4)mm,与对照组女性的125.1°±4.9°、(4.1±0.8)mm比较,差异均有统计学意义(t=2.898、12.906, P值均<0.01)。ROC预测IVCS的IVTD最适风险阈值,男性为2.98 mm,女性为2.96 mm,曲线下面积分别为0.99、0.98,其诊断敏感性分别为99%、93%,特异性均为100%。结论 LLLA和椎前IVTD在不同性别与年龄间存在差异, CT成像可以准确评估通道狭窄情况,预测罹患IVCS的风险。     

翼管、圆孔和蝶腭孔的CT三维重建解剖学观察

目的 使用三维高分辨率CT（HRCT）重建的方法,观察经鼻内镜至翼腭窝（PPF）的手术入路中的重要解剖结构,探讨翼管（VC）、圆孔（FR）和蝶腭孔（SPF）这些重要解剖标志的三维立体空间关系。方法 回顾性分析17例患者及1例尸体标本的HRCT扫描数据。在CT三维重建的影像中,观察 SPF、VC和FR的形态以及SPF和VC之间的三维立体空间关系。 结果 三维测量SPF,VC,和FR的平均直径分别为（6.26±1.59）mm,(2.35±0.77)mm和(2.75±0.77)mm。VC和SPF后下缘之间的平均距离为(4.03±1.15)mm。三维立体CT重建影像中VC和FR之间的平均垂直和水平距离分别为(4.94±1.35)mm和(9.22±3.07)mm。VC的全部或部分边缘92%(33/36)位于SPF的下缘以上,97%（35/36）位于SPF内缘外侧。结论 深入理解SPF、VC和FR之间的三维空间立体关系,有助于安全实行内镜下经鼻至翼腭窝的手术。     

西北地区国人正常髌股关节CT影像解剖学研究

目的 探讨西北地区国人正常髌股关节CT影像相关解剖学测量数据在不同性别间差异,为人工膝关节假体设计提供参考。方法 收集2017年5月—8月西安交通大学第二附属医院招募的78名志愿者156侧正常膝关节CT影像资料进行横断面研究。采用美国GE Revolution CT机,对78名志愿者自髂棘至足底进行CT扫描及三维重建,测量两侧髌骨厚度、髌骨关节面厚度、髌骨宽度、髌骨外侧关节面宽度、髌骨纵向长度、髌骨关节面长度、股骨左右径、股骨前后径、前股骨偏心距、滑车沟角。采用独立样本t检验分析不同性别间各观测指标的差异;应用线性回归模型控制年龄、身高、体质量偏倚,再次分析不同性别间各测量指标的差异,并对所有观测指标进行Pearson相关分析。结果 78名志愿者,不同性别间年龄、身高、体质量、BMI比较,差异均有统计学意义(t=6.270、17.602、11.366、4.377,P值均＜0.01)。在控制年龄、身高、体质量偏倚前,男性髌骨厚度、髌骨关节面厚度、髌骨宽度、髌骨外侧关节面宽度、髌骨纵向长度、髌骨关节面长度、股骨左右径、股骨前后径、前股骨偏心距分别为(22.39±1.53)mm、(11.75±0.94)mm、(47.04±2.81)mm、(27.18±2.16)mm、(45.18±2.74)mm、(30.60±2.28)mm、(86.31±3.94)mm、(66.76±3.26)mm、(6.37±1.38)mm,均明显大于女性的(19.75±1.29)mm、(10.91±0.95)mm、(40.47±2.30)mm、(23.37±1.61)mm、(38.74±2.51)mm、(26.76±1.70)mm、(74.28±3.00)mm、(60.07±2.89)mm、(5.63±1.36)mm,差异均有统计学意义(t=11.692、5.582、16.024、12.518、15.303、11.969、21.545、13.581、3.381,P值均＜0.01);控制偏倚后,髌骨关节面厚度和前股骨偏心距男性、女性之间差异均无统计学意义(P值均＞0.05),其他指标男性、女性之间差异仍均有统计学意义(t=2.057、6.581、5.207、4.673、3.045、8.053、2.331,P值均<0.05)。而滑车沟角男性为139.43°±4.78°,女性为138.29°±4.22°,无论是否控制年龄、身高、体质量偏倚,差异均无统计学意义(P值均＞0.05)。Pearson相关分析结果显示,滑车沟角与年龄、髌骨关节面厚度、前股骨偏心距之间呈负相关,其他观察指标之间均呈正相关。在呈正相关的指标中,前股骨偏心距与其他指标相关系数均＜0.30,呈弱相关性;滑车沟角除与髌骨外侧关节面宽度相关系数为0.32外,与其他指标相关系数均＜0.30,呈弱相关性。结论 不同性别间正常髌股关节CT影像相关解剖学测量数据存在差异,即使在同样大小的股骨或髌骨时,前股骨偏心距与滑车沟角也可能存在较大的变异性。因此,在设计膝关节假体时不仅要根据性别不同满足患者的需要,同时应注意股骨前髁设计的多样性。     

寰枢椎后方结构解剖学研究及临床意义

目的 测量寰枢椎后方结构相关数据,为设计寰枢椎后路内固定系统提供解剖学依据。 方法 测量30例寰椎和枢椎骨标本、50例男性和50例女性CT寰枢椎后方结构相关数据,分别比较骨标本、CT图像测量指标的侧别及性别统计学差异,比较骨标本数据和CT数据统计学差异。 结果 骨标本测得后中线处高（10.75±1.38）mm、厚（8.55±1.77）mm,内、外侧后中线到两侧椎动脉沟内侧缘距离分别为（13.45±0.73）mm、（20.28±2.20）mm,内、外侧缘后弓夹角分别为（141.00±3.43）°、（134.67±2.87）°。CT测量后中线处高（10.45±1.61）mm、厚（8.12±1.57）mm,内、外侧后中线到两侧椎动脉沟内侧缘距离分别为（13.60±1.26）mm、（20.48±2.05）mm,内、外侧缘后弓夹角分别为（141.23±9.64）°、（135.47±9.02）°,后弓外侧缘半径（26.77±2.14）mm,枢椎板斜率（58.34±7.60）°,寰椎后弓下缘至枢椎棘突上缘高（19.07±2.73）mm,寰枢椎后间隙高（6.83±2.01）mm。CT数据大部分性别差异有统计学意义（P<0.05）。骨标本和CT数据左右侧差异均无统计学意义（P>0.05）。骨标本与CT数据差异无统计学意义（P>0.05）。 结论 寰枢椎后方骨性结构解剖特征较为固定;CT能较好地反映该特征;本研究可为寰枢椎后路内固定系统设计提供解剖学依据。     

肠系膜上动脉压迫综合征多层螺旋 CT 的诊断价值

目的：探讨多层螺旋CT对肠系膜上动脉压迫综合征（SMACS）的诊断价值。方法：回顾性分析2009年1月至2012年7月我院临床确诊为SMACS,并已行上腹部CT增强扫描的13例患者的影像资料,并选取同期因肝脏或肾脏疾病行CT增强扫描的20例患者的影像资料作为对照组,将动脉期图像进行矢状位MPR重组并测量肠系膜上动脉（ SMA）与腹主动脉（ AA）的夹角及十二指肠水平段通过层面SMA和AA间距。结果：13例SMACS患者SMA与AA的夹角是14．7°～31．6°,平均19．1°±3．4°;十二指肠水平段通过层面SMA与AA的间距为3．1～10．2 mm,平均（7．1±2．0） mm。20例对照组患者SMA与AA的夹角分别为19．5°～60．4°,平均41．5°±9．3°;十二指肠水平段通过层面SMA与AA的间距为7．7～27．1 mm,平均（16．4±4．8）mm。两组间比较,SMA与AA夹角及间距的差异均有统计学意义（ P＜0．001）。结论：多层螺旋CT上腹部增强扫描的动脉期图像及MPR重组能够清楚显示SMA和AA的关系,并能够辅助诊断SMACS。     

面神经鼓乳段在斜矢状断面与HRCT上的定位及临床意义

目的　探讨面神经鼓乳段在斜矢状位最佳显示的扫描基线,为面神经鼓乳段疾病的影像诊断和耳显微外科手术治疗提供解剖学依据。 方法　利用HRCT对16例(32耳) 外观无异常的成人颅骨标本行斜矢状位扫描获得层厚为0.625 mm的HRCT图像后,再用火棉胶包埋技术将颞骨标本切制层厚为1mm的连续斜矢状断面标本,选取面神经鼓乳段显示良好的CT图片与对应的切片标本对照观测。 结果　16例（32耳）在斜矢状位均可完整显示面神经鼓乳段全程,面神经鼓乳段全长为（23.58±1.44）mm,鼓室段到外半规管的距离为（0.75±0.12）mm,面神经鼓室段到鼓室的距离为（0.34±0.08）mm,鼓室段和乳突段的夹角为（108.88±2.49）度。 结论　颞骨斜矢状位HRCT图像结合对应切片标本能良好显示面神经鼓乳段及其周围结构的解剖位置和毗邻关系,以与正中矢状面成（21.40±4.35）度为扫描基线作斜矢状位扫描显示面神经鼓乳段最佳,对颞骨的影像诊断和耳显微外科手术治疗具有重要意义。     

Development of a biodegradable bone cement for craniofacial applications

This study investigated the formulation of a two-component biodegradable bone cement comprising the unsaturated linear polyester macromer poly(propylene fumarate) (PPF) and crosslinked PPF microparticles for use in craniofacial bone repair applications. A full factorial design was employed to evaluate the effects of formulation parameters such as particle weight percentage, particle size, and accelerator concentration on the setting and mechanical properties of crosslinked composites. It was found that the addition of crosslinked microparticles to PPF macromer significantly reduced the temperature rise upon crosslinking from 100.3°C ± 21.6°C to 102.7°C ± 49.3°C for formulations without microparticles to 28.0°C ± 2.0°C to 65.3°C ± 17.5°C for formulations with microparticles. The main effects of increasing the particle weight percentage from 25 to 50% were to significantly increase the compressive modulus by 37.7 ± 16.3 MPa, increase the compressive strength by 2.2 ± 0.5 MPa, decrease the maximum temperature by 9.5°C ± 3.7°C, and increase the setting time by 0.7 ± 0.3 min. Additionally, the main effects of increasing the particle size range from 0-150 μm to 150-300 μm were to significantly increase the compressive modulus by 31.2 ± 16.3 MPa and the compressive strength by 1.3 ± 0.5 MPa. However, the particle size range did not have a significant effect on the maximum temperature and setting time. Overall, the composites tested in this study were found to have properties suitable for further consideration in craniofacial bone repair applications.     

新疆维吾尔族人群正常膝关节参数的CT测量及其临床意义

目的 探讨应用CT测量新疆维吾尔族人正常膝关节参数在膝关节假体设计中的临床价值。方法 根据纳入标准招募新疆维吾尔族成年志愿者100名进行前瞻性研究,男53名,女47名;年龄18~68岁,平均34.07岁。行膝关节伸直中立位CT扫描,扫描图像用AW4.4进行3D重建处理,抛币法选取左侧或右侧膝关节,分别测量记录髌骨厚度、胫骨平台内翻角(PT角)、小腿机械轴垂直线与双侧股骨髁远端切线的夹角(FT角),以及胫骨内侧平台最低点至腓骨头尖端高度的差距(DPF)等膝关节参数。将所得数据分别按男女组进行统计学处理,并将所得数值同文献报道的汉族人相关数据进行统计学比较。结果 新疆维吾尔族人正常膝关节髌骨厚度、PT角、FT角、DPF男性分别为(22.67±1.40)mm、4.64°±0.61°、4.85°±0.84°、(9.75±1.70)mm,女性分别为(20.70±1.41)mm、4.23°±0.55°、4.33°±0.58°、(8.13±1.80)mm,男性与女性之间的差异均有统计学意义(t值分别是7.006、3.512、3.543、4.634,P值均<0.01)。与相关文献报道的汉族人群相比,维吾尔族正常膝关节髌骨厚度、PT角、FT角之间的差异均无统计学意义(t值分别是1.056、0.844、0.572,P值均>0.05),DPF之间的差异有统计学意义(t=3.996,P<0.01)。结论 对新疆维吾尔族人进行全膝关节置换术,包括髌骨置换术等操作时,为确保操作精确性,不能直接参考其他人群相关数据;设计国人膝关节假体时应该考虑到不同人群及性别的差异。     

基于足负重位CT影像应用Mimics软件测量拇外翻相关指标

目的 探讨基于足负重位CT图像应用Mimics软件测量拇外翻相关角度的准确性及可靠性。方法 前瞻性选择昆明医科大学第一附属医院2016年7月—2017年3月收治的30例(36足)拇外翻患者,应用Mimics软件对患者足负重位CT图像行拇外翻3D重建。应用Mimics软件拟合区域功能自动分析计算生成近节趾骨轴线和第一、二跖骨轴线,并重建第一跖骨远端实际关节面,通过近节趾骨与第一跖骨3D模型进行修正;采用以上解剖学参数实现对拇外翻角(HVA)、跖骨间角(IMA)、跖骨远端关节面夹角(DMAA)的精确测量。由4名测量者分别使用上述计算机辅助CT建模测量法与常规X线测量法对30例拇外翻患者进行测量,比较各组观察指标测量结果的统计学差异,并行Bland-Altman分析一致性。结果 4名测量者采用常规X线法和CT建模重建法测量结果的ICC值分别为0.89和0.91,可靠性优。传统X线测量法测量患者HVA、IMA分别为29.10°±10.04°、13.98°±4.38°,CT建模法测量患者HVA、IMA分别为30.02°±10.62°、13.83°±4.29°,差异均无统计学意义(P值均＞0.05);传统X线测量法测量患者DMAA为12.57°±3.96°,CT建模法测量患者DMAA为16.21°±3.65°,差异有统计学意义(P＜0.01);Bland-Altman结果显示对于HVA、IMA角的两种测量方法一致性较好,DMAA的测量结果一致性较差。结论 基于足部模拟负重CT图像应用Mimics软件测量拇外翻HVA、IMA、DMAA可以精准生成上述3个角的边线,进而实现角度的精确测量;重建第一跖骨远端关节面,使DMAA测量的准确度和可靠性明显优于常规X线测量法。该方法是一种可行、可靠并且精准的测量方法,为拇外翻精准化、个体化治疗提供了可靠的基础。     

先天性外耳道狭窄和闭锁患者卵圆窗、圆窗的空间方位特点及其临床意义

目的：研究先天性外耳道狭窄、外耳道闭锁患者卵圆窗和圆窗的空间方位特点,探讨其临床意义。方法： 将先天性外耳道狭窄、先天性外耳道闭锁患者和正常人的CT数据三维重建后,计算圆窗龛口平面、圆窗膜平面、 卵圆窗平面、圆窗龛中轴线的空间方位。结果：圆窗膜与法兰克福平面的夹角在外耳道狭窄组（42.43°±25.58°） 小于正常组（66.72°±45.18°）。圆窗膜与矢状面的夹角在外耳道狭窄组（74.70°±17.94°） 小于正常组 （91.62°±21.36°）。圆窗膜与冠状面的夹角在外耳道狭窄组（72.14°±20.10°）和外耳道闭锁组（71.38°±27.59°） 均小于正常组（92.39°±29.36°）。卵圆窗与冠状面的夹角在外耳道狭窄组（103.38°±20.52°）大于外耳道闭锁组 （88.43°±20.14°）和正常组（82.40°±17.25°）。圆窗龛中轴线与矢状面的夹角在外耳道闭锁组（25.38°±7.63°） 大于正常组（17.14°±7.50°）。结论：在先天性外耳道狭窄患者圆窗膜后半部分向外下方倾斜,卵圆窗后半部分 向内下方倾斜。在外耳道闭锁患者,圆窗龛整体向前倾斜。本研究可为经卵圆窗区和圆窗区手术提供解剖学基础, 以避免损伤面神经、圆窗膜和椭圆囊等内耳重要结构。     

基于防腐标本的胫腓连结解剖特点及临床意义

目的 基于防腐标本胫腓连结的解剖特点，探讨胫腓连结的临床意义。方法 选取西南医科大学的51份胫腓连结防腐标本，通过对标本进行解剖，观察其结构解剖特点，并测量胫腓连结相关几何数据。结果 分别测量胫腓前、后、下横韧带的几何数据，用均值±标准差描述，包括：胫腓前韧带近端长度、远端长度、宽度分别为（8.53±0.69、19.06±1.34、15.99±1.44）mm；胫腓后韧带近端长度、远端长度、宽度分别为（9.34±0.63、16.92±1.76、14.36±0.89）mm；胫腓横韧带近端长度、远端长度、宽度分别为（18.42±2.48、21.93±2.59、4.56±0.17）mm；胫腓前韧带与冠状面夹角、与水平面夹角分别为（20.49±4.86、42.20±3.42）°；胫腓后韧带与冠状面夹角、与水平面夹角分别为（13.2±2.06、40.92±3.13）°；胫腓横韧带与冠状面夹角、与水平面夹角分别为（13.45±1.57、32.73±3.70）°；数据分析显示，胫腓前、后、横韧带在男女之间差异存在统计学意义，而在左右足之间差异无统计学意义。结论 胫腓连结对踝关节的稳定性具有重要意义，其解剖结构对临床治疗有重要指导意义。     

双侧股骨近端对称性及解剖形态的三维重建研究

目的建立正常成人双侧股骨近端的三维模型,分析双侧股骨近端形态并测量解剖形态的相关参数,研究双侧股骨近端的对称性及解剖形态。方法选取50例正常成人双侧股骨近端CT扫描数据,其中男性27例,女性23例;年龄20～65岁,平均年龄44.52岁。扫描参数:扫描层厚0.625 mm,扫描电压120 kV,扫描电流100 mA。扫描范围:自双侧股骨头上10 mm至小转子中点平面下50 mm。将双侧股骨近端CT薄层扫描数据利用Mimics 10.01软件进行三维重建,将左侧股骨与右侧股骨镜像模型相配准,对配准后模型进行三维测量,并测量左右股骨近端的形态参数,使用SPSS 16.0软件对测量结果进行统计分析。结果股骨近端形态和髓腔内部结构有明显的个体差异性,双侧股骨近端形态及内部结构具有高度对称性。股骨头直径为(45.71±4.08)mm,股骨头高度为(53.61±5.43)mm,偏心距为(39.91±5.07)mm,股骨颈中央直径为(36.71±3.75)mm,颈干角为(127.88±6.28)°,股骨颈长度(46.61±4.74)mm,小粗隆中点所在平面的髓腔内径为(26.21±4.59)mm,其中偏心距、颈干角与白种人形态参数相比,差异有显著统计学意义(P<0.01);提供了一种验证双侧股骨对称性的新方法。结论正常成人双侧股骨内外部形态存在一定的对称性,变异较小,为股骨形态的测量提供理论依据;三维重建更利于对股骨近端形态参数的测量;新配准方法的提出对于临床中股骨近端骨折的诊治具有重大意义。     

Use of MRI images to measure tissue thickness over the ischial tuberosity at different hip flexion

The goal of this experiment was to investigate changes in the thickness of the soft tissue overlying the ischial tuberosity (IT) due to changes in hip flexion angle and the addition of a sitting load. Eleven healthy subjects were tested. An apparatus constructed from foam blocks and an air bladder was used to position the subjects in different postures within an MRI tube. MRI images of the buttocks and thigh were obtained for four postures: Supine, 45° Hip Flexion, Non-Weight-Bearing 90° Hip-Flexion, and Weight-Bearing 90° Hip-Flexion. The thickness of muscle, adipose tissue, and skin was measured between the IT tip and skin surface, perpendicular to the cushion placed beneath the thighs. The tissue overlying the IT was found to be significantly (P < 0.001) thinner in 90° Hip-Flexion (73.8 ± 9.0 mm) than in the supine position (135.9 ± 8.1 mm). Muscle thickness decreased significantly from Supine to Non-Weight-Bearing 90° Hip-Flexion (59.1 ± 8.5%, P < 0.001), and further decreased from Non-Weight-Bearing to Weight-Bearing 90° Hip-Flexion (46.2 ± 7.9%, P < 0.001). Under Weight-Bearing 90° Hip-Flexion, the muscle tissue deformed significantly (P < 0.001) more than the adipose tissue and skin. We concluded that the tissue thickness covering the IT significantly decreased with hip flexion, and further decreased by nearly half during loading caused by sitting. In addition, the muscle tissue experienced the largest deformation during sitting. The results of this study may improve our understanding of risk factors for pressure ulcer development due to changes in tissue padding over the IT in different postures.     

腰椎棘突及其间隙的解剖学测量*

目的利用三维重建技术为棘突间撑开的设计、优化、国产化及临床应用提供解剖学依据。方法选取50例志愿者采用连续螺旋CT断层扫描T12~S1,将获得图像导Materialise Mimics10.01软件,采取轮廓和区域增长分割出腰椎骨组织,采用表面遮盖显示法进行三维表面重建,选择去除椎旁组织的最佳三维角度,由同一名研究者选择适合测量的图像进行测量,测量棘突厚度、棘突长度、棘突间距。各解剖结构连续测量3次,取其均值。数据进行正态性检验、检验。结果①棘突厚度:一般每个腰椎的棘突厚度均前部>后部>中部,下缘>中央>上缘。但L5较特殊,棘突中部和后部的中央厚,上、下缘薄。相邻上位腰椎棘突下缘厚度大于下位腰椎棘突上缘厚度。②棘突长度以L3最大,男性:上缘26.62±2.98mm,中央25.59±2.33mm,下缘22.73±2.40mm;女性:上缘23.76±2.47mm,中央24.49±2.48mm,下缘19.70±2.49mm;男女均以L5最小。③棘突间距:男性以L2∕3最大,向下依次减小,前部>中部>后部。前部10.39±2.70mm,中部11.15±2.20mm,后部9.35±2.17 mm。女性以L1∕2最大,向下依次减小,前部>中部>后部。前部10.32±2.10mm,中部12.18±2.58mm,后部10.80±2.43mm。男女均以L4∕5最小。结论棘突间距从上向下逐渐减小,前部>中部>后部,在矢状面棘突间隙呈前高后矮的楔形。棘突长度以L3最大,L5最小。棘突长度均上缘>中央>下缘,相邻上位腰椎棘突下缘长度<下位腰椎棘突上缘长度。棘突厚度前部>后部>中部,且下缘>中央>上缘。相邻上位腰椎棘突下缘厚度>下位腰椎棘突上缘厚度。本研究利用三维CT重建技术初步获得了国人腰椎棘突及棘突间隙的解剖学参数,为适合国人特点的腰椎棘突间撑开器的设计和临床应用提供了解剖学数据。