肱骨远端的解剖观测与肱骨假体的设计

目的:为临床肱骨远端假体的设计与安放提供相关数据。方法:测量120块(男35对、女25对)成人干燥肱骨远端相关结构,对所测得结果用SPSS软件处理。结果:(1)肱骨远端前倾角和肱骨滑车外旋角,男女分别为(35.78±5.12)°、(36.33±5.06)°和(5.35±1.13)°、(5.55±1.22)°。(2)内上髁至外上髁最大宽度、滑车最内侧缘至小头最外侧缘宽度、肱骨滑车和肱骨小头宽度男女分别为(58.92±4.03)、(55.75±3.85);(45.34±3.15)、(42.18±3.01);(24.82±1.74)、(21.78±1.51)和(17.69±1.23)、(16.39±1.21)mm。(3)肱骨滑车和肱骨小头最大矢径男女分别为(23.35±2.06)、(23.13±2.15)和(19.47±1.38)、(19.13±2.19)mm。男女之间和左右之间各测量数据无显著性差异(P>0.05)。个体间有较大差异。结论:肱骨远端各项目的测量值,可供设计与安放肱骨假体提供解剖参数。     

咀嚼肌的应用解剖学研究——I.咬肌的动脉与神经

在30具(男23.女7)共60例成人尸体上观察与测量了咬肌的动脉与神经来源、咬肌神经的分支以及肌内构筑、咬肌由上颌动脉咬肌支和邻近动脉肌支供血,面动脉与面横动脉的咬肌支为其主要营养动脉.咬肌神经在肌内可分成单干和双干两型,前者居多,两型中其肌内分支间均有吻合.就结果对有关颌面外科应用问题进行了探讨.     

足背内侧皮神经营养血管皮瓣修复足远端创面应用解剖

目的：为远端蒂足背内侧皮伸经浅静脉营养血管皮瓣修复足远端皮肤缺损提供解剖学基础。方法：在31侧成人下肢标本f：解削观察足背内侧皮神经分支分布特点，6侧新鲜足标本观测皮神经血供分规律。结果：足背内侧皮神经及其分支恒定的血供来源，近端主要来自胫前动脉末端或足背动脉发m的皮支，外径0．8～1．0mm，内、外侧支远端来自南足底内侧动脉的皮支和第2跖背动脉末端的皮支，皮动脉外径在0.5—0．8mm。皮动脉分支营养神经及神经及浅静脉，在神经和静脉旁分支间形成链式吻合，与筋膜皮肤的血管互相吻合。结论：足背内侧皮神经浅静脉营养血管足背皮瓣可设计两种远端蒂修复足远端创面，(1)以第1跖趾关节内侧近端1．3～1．5cm为旋转轴点。(2)以距第2趾蹼游离缘1．5cm为旋转轴点。     

腕关节关节囊内韧带的解剖观察及其创伤学意义

本文描绘了腕关节关节囊内韧带的解剖,其中首次描述了中腕关节的韧带连结,即大、小多角骨,头状骨至舟状骨的韧带和钩骨至三角骨的韧带.本文还论述了与这些韧带连结方式密切相关的腕骨生理运动特点及维持腕关节稳定性的因素.文章还讨论了与腕关节关节囊内韧带有关的腕部创伤学特点.     

The juxtaglomerular apparatus in malignant hypertension of man

Summary Investigation of the behaviour of the renal Juxtaglomerular apparatus in 19 patients with malignant hypertension has shown that in kidneys fixed immediately after operation the Juxtaglomerular granulation index is twice as high as in autopsy kidneys. The formation of renin by the epitheloid cells begins with the appearance of osmiophilic substances in the region of the endoplasmic reticulum. The first stages of granule formation are small rhomboid particles in the Golgi cisternes, which aggregate to form bigger round or polymorphic granules in the Golgi area.In pathological conditions the substances synthesized may be set free and become active locally as a result of fibrinoid necrosis of the vascular wall. The rate of production is increased firstly by forcing rhe production of active agents in the preexistent epitheloid cells, secondly by transformation of the so-called bivalent cells and finally, by cell division.In accelerated hypertension the production of renin also takes place in nephrons whose glomeruli, tubules and macula densa, are damaged. There is a correlation between blood pressure elevation and the Juxtaglomerular granulation index.

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Zusammenfassung Untersuchungen über das Verhalten des juxtaglomerulären Zellkomplexes der Niere bei 19 Patienten mit maligner Hypertonie haben folgendes ergeben: In operativ gewonnenen und sofort fixierten Nieren ist der juxtaglomeruläre Granulationsindex doppelt so hoch wie in Nieren aus dem Sektionsgut. Die Reninbildung der epitheloiden Zellen beginnt mit dem Auftreten osmiophiler Substanzen im Bereich des endoplasmatischen Reticulums. Kleine rhomboide Gebilde in Golgizisternen sind Vorstufen von reifen Sekretgranula, die sich im Golgifeld zu größeren runden oder vielgestaltigen Sekrettropfen zusammenlagern.Unter pathologischen Bedingungen können infolge fibrinoider Gefäß- wandnekrosen Sekretsubstanzen lokal frei und lokal wirksam werden. Vermehrte Arbeitsleistung erfolgt zunächst durch Forcierung der Sekretproduktion in den präexistenten epitheloiden Zellen, sodann durch Transformierung sogenannter bivalenter Zellen und schließlich durch Zellneubildungen.Reninproduktion findet bei akzelerierter Hypertonie auch in solchen Nephronen statt, deren Glomerula und Tubuli samt Macula densa strukturell geschädigt sind. Es besteht eine Korrelation zwischen Höhe des Blutdruckes und Höhe des Granulationsindex.

     

Morphological changes in the internal organs in chronic streptococcal infection

A histological and histochemical study was made of the internal organs of albino mice at various times (from 24 h to 27 weeks) after a single intraperitoneal injection of L-forms of -hemolytic group A streptococci. A progressive pathological process (myocarditis, hepatitis, glomerulonephritis) against a marked allergic bacground and leading to systemic lesions of the tissues was discovered.Institute of Human Morphology, Academy of Medical Sciences of the USSR. N. F. Gamaleya Institute of Epidemiology and Microbiology, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR A. P. Avtsyn.) Translated from Byullten' Éksperimental'noi Biologii i Meditsiny, Vol. 80, No. 9, pp. 111–115, September, 1975.     

Vascular anatomy of gracilis muscle arterial findings to enhance graciloplasty

Dynamic graciloplasty has recently been developed for reconstruction of anal function in patients who are fecally incontinent in preference to permanent abdominal colostomy. Since the muscular portion of gracilis is wrapped around the neoanus, the length of the gracilis arc influences the functional outcome of graciloplasty. Although dissection of the main pedicle (i.e. the main artery and vein) can facilitate gracilis to have enough muscle arc, it has been unclear whether there are any vessels proximal to the main pedicle or through the origin of the muscle which could support blood flow into the whole of gracilis. In this study, the vascular anatomy of gracilis in both legs of 26 Japanese cadavers was examined. All muscles had a main pedicle, mean maximum diameter 1.08 mm, entering at the proximal one-third of the muscle. However, only 18 muscles (34.6%) had an accessory artery in the proximal portion in addition to the main pedicle. Some arteries always exist at the origin of the muscle, having a mean maximum diameter of 0.34 mm, suggesting that they might be able to support the whole gracilis without supply from the main pedicle.     

Die Beanspruchung des menschlichen Ellenbogengelenks

Zusammenfassung Bei 80 Objekten werden die Gelenkflächen des menschlichen Ellenbogengelenks untersucht. Die Trochlea und das Capitulum humeri sowie das Caput radii zeigen keine nennenswerten Unterschiede in der Ausdehnung der mit typischem Gelenkknorpel bedeckten Flächen. Dagegen lassen sich für die Ulnazange drei charakteristische Formgruppen abgrenzen: In 3 Fällen kann eine einheitliche Knorpelfläche beobachtet werden. Bei etwa zwei Drittel der untersuchten Objekte liegt im mittleren Bereich der Incisura trochlearis in horizontaler Richtung ein 2–5 mm breiter knorpelfreier Streifen, der den Gelenkknorpel in 2 vollständig getrennte Flächen unterteilt. Das restliche Drittel der Objekte besitzt eine unvollständige Trennung der Gelenkfläche. Unter Berücksichtigung der Vorstellungen von Pauwels über die causale Histogenese der mesenchymalen Stützgewebe sowie der Materialverteilung im Knochengewebe in Abhängigkeit von der einwirkenden Spannungsgröße werden die morphologischen Befunde den für die jeweiligen Skeletelemente von Pauwels ermittelten Spannungsdiagrammen gegenübergestellt. An der Trochlea und dem Capitulum humeri und am Caput radii findet sich eine geradezu ideale Übereinstimmung in der Ausdehnung der Knorpelfläche und der Knochendichte unter den Gelenkflächen mit den entsprechenden Spannungsdiagrammen. An der Ulna trifft dies nur für einen geringen Teil der Objekte zu. Für die unterschiedliche Ausgestaltung der Incisura trochlearis werden zwei mögliche Ursachen diskutiert: 1. die Resultierende R verharre während des Bewegungsablaufes in einzelnen Positionen innerhalb der Incisura trochlearis verschieden lange; 2. der Krümmungsradius der Trochlea humeri sei größer als derjenige im mittleren Bereich der Ulnazange, so daß hier wegen des fehlenden Kontaktes der Gelenkflächen keine Druckübertragung möglich ist.

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The stress of the human elbow jointI. Functional morphology of the articular surfaces

Summary The articular surfaces of 80 human elbow joints are analysed. The trochlea and capitulum humeri and the caput radii of the investigated individuals show no particular differences in the extent of their surfaces covered with typical articular cartilage. On the other hand the form of the incisura trochlearis is rather variable. Three characteristic formgroups are to be discerned. In three objects a continuous cartilage surface has been observed. In 50 of the investigated joints there is a small intersection free from cartilage in the midst of the incisura trochlearis, dividing the articular cartilage in two isolated surfaces. In the rest of the analysed objects the articular surface is divided only partially. According to Pauwels' hypothesis on the causal histogenesis of the mesenchymal supporting tissues and of the density distribution of the bone dependence upon the magnitude of the local unit stress the morphological findings in the single investigated parts of the elbow joint are confronted with the corresponding stress diagram as described by Pauwels. In the trochlea and capitulum humeri and in the caput radii a nearly ideal correspondence of the extent of the articular surface and the density of the bone tissue with the unit stress diagrams are found. In the ulna this correspondence exists only in few of the analysed objects. For the different form of the incisura trochlearis two possible explanations are discussed: 1, during the motion the resultant of forces may stay for a different time in their single positions in the incisura trochlearis; 2. the curvature radius of the trochlea humeri may be greater than that one of the incisura trochlearis in the central area. So no pressure occurs in this part of the articular surface.

Mit freundlicher Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula

In a cadaveric instability model that leaves all muscles intact initially, we studied anteroinferior glenohumeral dislocation behavior after section of the ligaments on the humeral side of the joint. In this study, the latissimus dorsi seemed to play a role when complete section did not result in a locked anteroinferior dislocation. We therefore initiated a study to test the hypothesis that the latissimus dorsi may, in certain circumstances, depending on variations in its anatomy, influence dislocation behavior. Here, in Part I, we present the results of the anatomic study of latissimus dorsi and its tendons. The anatomy of the latissimus dorsi pertaining to the scapula and humerus was studied in 100 cadaver specimens. The distance between the uppermost part of the tendon of both the latissimus dorsi and the teres major and the edge of the articular cartilage of the humeral head (tendon-cartilage distance, TCD) as well as the width and length of the tendons were measured. Furthermore, the relationship between latissimus dorsi and the inferior angle of the scapula was studied. The tendon of the latissimus dorsi inserted at a variable distance from the cartilage of the humeral head: the TCD ranged from 12.6 to 31.6 mm (mean 21.06 mm+/-5.11 mm). The latissimus dorsi can have muscular fibers arising from the inferior angle of the scapula (type 1 scapular connection, 43%). Alternatively, there may be only a few fibrous strands between the muscle and the scapula or there may be an intervening bursa (type 2 scapular connection, 57%). This variability in the morphology of the latissimus dorsi may be a factor explaining the differences observed in a study of humerus-based sequential cutting of the glenohumeral capsule. This possibility is explored in Part II of the study. The latissimus dorsi may also complete the tendinous protection of the humeral side of the capsule generally provided by the rotator cuff.     

咽下缩肌的形态特征及其临床意义

目的：为提高全喉切除术后患者用发音管发音重建的成功率，选择最能影响发音重建成功的咽下缩肌进行研究。方法：对４０具正常成人尸体标本咽下缩肌的解剖结构进行了详细的观察和测量。测量咽下缩肌各起点处的宽度，在甲状软骨板后缘的厚度；止点的长度；环咽肌后壁的测量；并用组织切片法观察咽缝的结构。结果：发现咽下缩肌不仅有起于甲状软骨和环状软骨的肌纤维，而且有起于第１气管环的肌纤维和肌腱。咽缝不是呈线状，而是呈条带状。结论：对发音重建行咽缩肌切断术有重要的临床意义。