前后挤压型骶骨Ⅱ区骨折与骶丛神经损伤的关系

目的 探讨前后挤压致骶骨Ⅱ区骨折造成骶丛神经损伤的机制。方法 经甲醛短期（1年内）浸泡固定的国人尸体6具，12侧。解剖保护骶丛神经，制成前后挤压型暴力致骶Ⅱ区骨折模型，定量测量不同骨折移位时骶丛神经被拉长的距离。另外，利用X线片观察骶从神经受压情况。结果 随耻骨联合分离逐渐增大，骶丛神经张应变呈直线相关逐渐加大，以S1，S4为最显著，且可造成神经的刺伤，多见于L5和S1，X线未发现骶丛神经受压表现。结论 前后挤压型暴力致骶骨Ⅱ区骨折神经损伤以牵拉伤为丰，以S1，S4为主，且与骨折移位程度成正相关关系。神经的刺伤，多见于骨折移位较大的L5和S1。     

Hybrid Anterior Cruciate Ligament Reconstruction: Introduction of a New Technique for Anatomic Anterior Cruciate Ligament Reconstruction

Recently, anatomic or double-bundle reconstruction of the anterior cruciate ligament (ACL) has been presented in an effort to more accurately restore the native anatomy. These techniques create 2 tunnels in both the femur and tibia to reproduce the bundles of the ACL. However, the increased number of tunnels, particularly on the femoral side, has raised some concerns among authors and surgeons. We describe a technique to reconstruct the 2 distinct bundles of the ACL by using a single femoral tunnel and 2 tibial tunnels, the “hybrid” ACL reconstruction. The femoral tunnel is drilled through an anteromedial arthroscopy portal, which allows placement in a more anatomic position. Fixation in the femur is achieved with a novel device that separates a soft-tissue graft into 2 independently functioning bundles. Once fixed in the femur, the anteromedial and posterolateral bundles of the graft are passed through respective tunnels at the anatomic footprint on the tibia. These bundles are independently tensioned, which creates a reconconstruction that is similar to the native ACL. The technique presented provides surgeons with an alternative to other double-bundle techniques involving 4 tunnels.     

生物胶复合物加解剖钢板内固定治疗胫骨平台骨折

目的探讨生物胶复合物加解剖钢板内固定治疗胫骨平台骨折的临床效果。方法采用切开复位、生物胶复合物植骨加解剖型支撑钢板内固定治疗胫骨平台骨折28例,受伤至手术时间5～10d,植入复合物量为3～8g。结果所有患者均获随访,随访6～24个月,全部骨折均获得临床愈合,未见关节面下陷,生物胶复合物中羟基磷灰石未见移动及吸收,治疗效果参照M echant评分标准,优13例,良11例,可3例,差1例,总优良率达85.3%。结论生物胶复合物加解剖钢板内固定治疗胫骨平台骨折的临床效果良好。生物胶复合物具有较强的成骨能力,可修复骨缺损。     

The external laryngeal nerve: surgical and anatomic considerations. Report of 50 total thyroidectomies

This surgical anatomy study aimed to evaluate the possibility of identifying the external laryngeal nerve during thyroid surgery and the possible variations of nerves at risk. Fifty patients underwent total thyroidectomies during a period of 12 months. Using a neurostimulator, the distal motor branch of the external laryngeal nerve was searched. Electrical stimulation of a nervous branch aimed to provoke a global contraction of the cricothyroid in order to identify with certitude the external laryngeal nerve. The external laryngeal nerve was identified in 20% of cases. Its course was, with almost equal frequency, either (1) between the vessels of the superior thyroid pedicle or (2) superficial and anterior to the fascia of the cricothyroid muscle. The external laryngeal nerve is hard to find during thyroid surgery, even with a neurostimulator. It can be vulnerable during thyroid surgery but only in cases of anatomic variations. Searching for the nerve systematically during thyroid surgery does not seem to be useful. Several precautions when dissecting the superior pole of the thyroid gland seem to be necessary and sufficient to respect the external laryngeal nerve.     

Three-dimensional modeling of the anatomy of the heart and great vessels

Summary The anatomic constraints imposed on a total artificial heart (TAH) require specific anatomic studies. A thoracic anatomic study was performed with a scanning device equipped with three-dimensional (3-D) reconstruction software on 15 male patients, between the ages of 41 to 63 years (52 ± 6 years). All were candidates for heart transplantation. The 3-D reconstructions of the cardiovascular structures obtained from surgical anatomy data specific to TAH implantation allowed a volumetric measurement of these structures. A modeling diagram of these structures permitted reproducible quantitative measurements of the 35 geometrical parameters which characterized shape, orientation, and position of these structures within the thorax. Most of the measured parameters were characterized by low variability (coefficient of variation from 10 to 25%).

---

Modélisation tridimensionnelle de l'anatomie du cur et des gros vaisseaux

Résumé Les contraintes anatomiques imposées au cur artificiel total (CAT) nécessitent des études anatomiques spécifiques. Une étude anatomique thoracique a été réalisée avec un scanner doté d'un logiciel de reconstruction tridimensionnelle (3-D) chez 15 patients, tous de sexe masculin, agés de 41 à 63 ans (52 ± 6 ans), et candidats à une transplantation cardiaque. Les reconstructions 3-D des structures cardio-vasculaires réalisées selon les données de l'anatomie chirurgicale propre à l'implantation du CAT ont permis la mesure volumétrique de ces structures. Un schéma de modélisation de ces structures a permis des mesures quantitatives reproductibles de 35 paramètres géométriques caractéristiques de la forme, de l'orientation, de la position de ces structures dans le thorax. Les résultats de ces mesures ont pu être exprimés en termes statistiques. La plupart des paramètres mesurés étaient caractérisés par une faible variabilité (coefficients de variations de 10 à 25%).

     

Anatomic study of the tricuspid valve in children

We performed an anatomic study of the right atrioventricular valve in children under one year of age using a conservative method of dissection of the heart valve. The main aspects studied were the number of cusps and their morphometric characteristics, such as the width of the base and the depth of the cusps. Other parameters studied were the number of papillary muscles, number of tendinous cords, and diameter of the fibrous ring and the last one were divided in three regions, anterior, posterior and septal for localization of cusps. Our results showed that the number of cusps varied from two to four. Three cusps was the commonest finding and the fourth cusp, if present, was classified as anterolateral in location. The anterior and septal cusps had bases bigger than those of the posterior and anterolateral cusps; the septal cusp was deeper than the others; and the number of tendinous cords was greater for the anterior and septal cusps than for the posterior and anterolateral cusps. In addition, the posterior region showed great variability: in 35.7% it was occupied by undeveloped valve tissue and the posterior valve in these cases was located anteriorly.     

相关解剖定位标志在经单鼻孔-蝶窦垂体腺瘤显微外科切除术中的应用

目的：探讨相关解剖定位标志在经单鼻孔-蝶窦入路垂体腺瘤显微外科手术中的应用。方法：62例垂体腺瘤经单鼻孔-蝶窦入路显微手术，术中根据蝶嵴、蝶窦开口、蝶窦中隔、鞍底隆凸等解剖标志进行定位。结果：蝶嵴是术中确认手术入路中线的可靠标志，蝶窦开口是蝶窦前壁的重要标志，鞍底隆凸可作为蝶窦腔内鞍底定位标志。62例术中依靠相关解剖标志，均准确定位蝶窦及鞍底，未出现偏差。肿瘤全切除52例，次全切除5例，大部分切除4例。1例部分切除，无死亡病例。结论：熟悉相关解剖标志，有助于该术式的准确定位，从而安全实施手术。     

MR imaging of posteromedial and posterolateral stabilisers of the knee: anatomic basis and patterns of lesions in knee injuries

Summary The angular points are the ligamentous and tendinous structures that reinforce the posteromedial and posterolateral capsule of the knee and share in fixation of the posterior horns of the menisci. They are often damaged in acute injuries and this is usually associated with ruptures of the cruciate and collateral ligaments and may add to the degree of laxity. We describe the normal appearance of these structures in terms of the sectional anatomy, correlated with the lesional appearances of complete and incomplete ruptures and associated meniscal detachments as shown by clinical testing and arthrotomy findings.

---

IRM des points d'angle du genou : bases anatomiques et applications aux genoux traumatiques

Résumé Les points d'angle sont des structures ligamentaires et tendineuses qui renforcent la capsule postéro-médiale et postéro-latérale et participent à la fixation des cornes postérieures des ménisques. Leurs lésions, fréquentes au cours des traumatismes aigus, sont généralement associées à des ruptures des ligaments croisés et des ligaments collatéraux et peuvent être source d'une aggravation de la laxité. Nous rapportons, en corrélation avec l'anatomie en coupe, l'aspect normal de ces structures, et en corrélation avec les données de l'arthrotomie et du testing les aspects lésionnels observés au cours des traumatismes : ruptures complètes, incomplètes et désinsertions méniscales associées.

     

妇科恶性肿瘤腹股沟区转移淋巴结解剖分布和CTV边界

目的 明确妇科恶性肿瘤腹股沟区转移淋巴结的解剖分布,探讨CTV的勾画边界。方法 回顾分析34例妇科恶性肿瘤并腹股沟淋巴结转移患者。基于腹股沟淋巴结的解剖分布,应用CT和MRI的血管增强扫描影像和Eclipse计划系统的三维重建图像,分析腹股沟区淋巴结与股静脉、大隐静脉及其分支、股部浅筋膜和深筋膜的关系,以及包含95%以上腹股沟淋巴结的CTV边界。结果 34例患者共145个腹股沟转移淋巴结。浅组淋巴结131个,在腹股沟韧带下方,129个位于股部浅筋膜和深筋膜之间。浅组增大淋巴结上群25个在耻骨联合上1 cm以上,沿旋髂浅静脉分布;中群85个在耻骨联合水平,邻近隐静脉汇入股静脉处,11例单个浅组淋巴结转移均在该组;下群21个在耻骨联合下缘以下,沿大隐静脉和股内、外侧浅静脉分布。14个深组转移淋巴结,在股静脉内侧,缝匠肌内侧缘与股静脉后外侧缘连线的后外侧未发现肿大淋巴结。上界:142个淋巴结在耻骨上支上缘以下,3个达股骨头上缘;下界:143个在小转子下缘以上,2个下界达小转子下缘下2 cm。结论 包含98%腹股沟区转移淋巴结CTV边界:前界为浅筋膜,内侧界为腹股沟韧带和股血管后内侧肌肉边缘,后外侧界为股静脉后外侧缘与缝匠肌内侧缘连线,上界为股骨头上缘,下界为小转子下缘。     

全膝关节置换术中下肢对线方式的研究进展

膝骨关节炎已成为当今老年人常见疾病之一,目前,对于终末期膝骨关节炎,行全膝关节置换术(total knee arthroplasty,TKA)是最为有效的治疗手段。在TKA中,下肢力线的有效恢复则是手术成功的关键因素之一,极大影响患者术后的临床效果及假体存活率。最早被提出、认可并被广泛应用于TKA的对线方式是机械对线。近年来,随着对下肢力线的深入研究及计算机技术的迅速发展,TKA对线技术实现了由“统一化”向“个性化”,二维向三维的转变,调整机械对线、解剖学对线、运动学对线、反向运动学对线、限制运动学对线及功能学对线等新的对线方式被相继提出,为外科医师提供了更多选择。但对于何种对线方式是最佳选择,目前尚未有定论。本文对目前TKA中各种对线方式的研究现状及优缺点进行总结阐述,旨在为临床上TKA中对线方式的选择提供一定参考。