按照学校教学计划安排,《人体解剖和组织胚胎学》确定为南京大学生物医学工程专业的医学基础课和必修专业基础课,由于该专业与医学专业学生的背景知识的不同和关注焦点的不同,其教学内容、教学方法和考核方式有其自身要求与特点.本文根据三年来从事该课程的教学实践,从教学内容、存在问题和相应解决方法几方面探讨教学改革和创新,更加完善适用于生物医学工程专业的《人体解剖和组织胚胎学》教学实践,撰此文提供给全国各高校基础医学同仁讨论、争鸣和参考.

目的 探讨丙泊酚复合酮咯酸氨丁三醇麻醉用于无痛人工流产(人流)手术患者的临床效果.方法 无痛人流手术患者180例,随机均分为三组,采用丙泊酚中/长链脂肪乳注射液分别复合酮咯酸氨丁三醇30 mg(麻醉诱导前30 min静脉注射,A组)、雷米芬太尼(B组)或氯胺酮(C组)麻醉.记录麻醉前、麻醉后患者的MAP、HR、RR、SpO2.观察术中呼吸抑制和术中肢动发生情况;计算丙泊酚用量及意识恢复时间;术后询问患者对手术操作过程有无记忆和术毕30 min有无宫缩痛.结果 三组患者镇痛均满意.A、C两组术中MAP、HR、RR、SpQ平稳;B组术中MAP、HR、RR、SpO2均低于麻醉前(P＜0.05).A组患者无术中一过性呼吸抑制,亦无术后宫缩痛病例;B组患者术中均有一过性呼吸抑制,术后官缩痛45例(75℃),C组仅有2例(3℃)发生一过性呼吸抑制.C组术毕意识恢复时间长于A、B两组[(15.21±0.97)min in vs.(7.19±1.05) min、(7.11±1.04) min](P＜0.05).结论 丙泊酚复合酮咯酸氨丁三醇用于无痛人流手术是一种良好的选择.

目的 观察三七总皂苷(Panax Notoginseng Saponins,PNS)对麻醉大鼠的意识状态和大鼠海马内神经递质表达的影响.方法 取80只Sprague-Dawley(SD)大鼠,将其随机分成6组,其中空白组5只,生理盐水对照组(对照组),模型组,高、中、低3个剂量PNS组分别15只,PNS组预先腹腔注射相应剂量的PNS溶液.给药3天后,除空白组外,所有大鼠用10％水合氯醛麻醉后记录翻正反射消失及恢复时间.采用免疫组织化学方化和western blot方法,分析PNS预处理对麻醉大鼠海马内GABA、Glu、β-EP表达的影响.结果 PNS预处理可以延长麻醉大鼠的翻正反射消失时间,缩短其翻正反射恢复时问;免疫组织化学检测和western blot方法检测发现,各组大鼠大脑海马内均有GABA、Glu、β-EP表达;PNS预处理能够降低GABA在麻醉大鼠海马(P＜0.01或P＜0.05),上调β-EP在麻醉大鼠海马内的表达(P＜0.01或P＜0.05),但对Glu无影响.结论 PNS改善麻醉大鼠意识状态可能与PNS降低GABA、上调β-EP在麻醉大鼠海马内的表达相关.

Objective To provide anatomical data of radiofrequency thermocoagulation in the treatment of V2 trigeminal neuralgia through inferior orbital fissure and foramen rotundum approach.Methods The approach through inferior orbital fissure and foramen rotundum as well as its neighboring structures were observed and measured on 160 sides of 80 adult cranium and 20 adult cadavers.Results In 160 cases of adult cranium,the number of success into foramen rotundum was 122(76.25％).The distance of the puncture point to the lateral of infraorbital margin was (0.41 ±0.11)cm.The distance from the puncture point to the outer edge of the foramen rotundum was (4.45 ± 0.18) cm; the distance from the puncture point to the inner front edge of the foramen rotundum was (4.99 ± 0.17) cm; the distance from the puncture point to the lateral of Carotid artery groove was (5.52 ± 0.35) cm.The safe and effective depth in the adult cadavers was (5.38 ± 0.25) cm ; the angle between needle and median sagittal plane was 32.2° ± 2.3° and between needle and coronal plane was 57.2° ± 2.5° when it entered the foramen rotundum; the angle between needle and median sagittal plane was 26.0° ± 1.5° and between needle and coronal plane was 64.5° ± 1.6° when it entered the end of the superior orbital fissure.Conclusions According to the anatomical data,CT guided radiofrequency thermocoagulation in treatment of V2 trigeminal neuralgia through inferior orbital fissure and foramen rotundum approach is safe and effective.

Objective:To explore puncture depth in percutaneous radio -frequency thermocogulation of tri-geminal ganglion and provide anatomic basis to avoid intracranial puncture lesion of vessels and nerves .Methods:21 cranial base specimens of the adult were selected .The distance between the midpoint of the medial border of the fora-men ovale and the midpoint of the lateral border of the foramen lacerum was measured by vernier caliper ( A) and the distance between the midpoint of the medial border of the foramen ovale and the highest point of the superior margin of the trigeminal impression ( B) on the internal surface of the cranial base specimens;At the same time ,the distance between the medial border of the foramen ovale and the lateral border of the foramen lacerum at the same direction on the external surface of the cranial base specimens was measured (C) and the vertical diatance of the lateral wall of the foramen lacerum(D) scan horizontally the cranial base with spiral CT , then measure the distance between the medial border of the foramen ovale and the lateral border of the foramen lacerum at same direction on the maximum intensity projection(MIP) images(E) the distance C and the safe distance and the distance E was analyzed to deter-mine whether the distance E can be used to indicate the individual and safe needle depth into the skull at different pa -tients who were treated by PRT .Results:The distance between the midpoint of the medial border of the foramen ovale and the midpoint of the lateral border of the foramen lacerum on the internal surface of the cranial base specimens was 1.19 ±0.15cm(right) and 1.20 ±0.14cm(left);②The distance between the midpoint of the medial border of the foramen ovale and the vertex of the trigeminal impression on the internal surface of the cranial base specimens was 1. 51 ±0.17cm(right) and 1.49 ±0.16cm(left);③The distance between the midpoint of the medial border of the fora-men ovale and the midpoint of the lateral border of the foramen lacerum on the external surface of the cranial base specimens was 0.92 ±0.09cm(right) and 0.92 ±0.10cm(left);④The vertical distance of the lateral wall of the fo-ramen lacerum was 0.55 ±0.07cm(right) and 0.55 ±0.07cm(left); ⑤The distance between the midpoint of the medial border of the foramen ovale and the midpoint of the lateral border of the foramen lacerum at same direction on the maximum intensity projection(MIP) imaging was 1.00 ±0.17cm(right) and 1.00 ±0.17cm(left),there was no statistical significance between the distance C and the distance E .Conclusions:The intractanial needle depth should be shorter than 1.00cm.In clinic we can display the accordance to the distance between the medial border of the fora -men ovale and the lateral border of the foramen lacerum at the same direction on the maximum intensity projection ( MIP) imaging by scanning the cranial base horizontally with spiral CT , then use it to indicate the individual safe needle depth into the skull at different patients treated by PRT .

目的:总结卵圆孔的应用解剖研究成果,探索卵圆孔最佳穿刺方法.方法:查阅近几年来国内外关于卵圆孔的形态、位置的解剖研究及三叉神经痛卵圆孔穿刺术临床研究的相关文献,总结卵圆孔的位置、形态、开口方向,及卵圆孔穿刺术的不同方法、成功率及并发症.结果:卵圆孔位于颅中窝,可分为椭圆形、肾形、梨形、圆形、长条形5种形状,其位置恒定,内有三叉神经下颌支穿过.临床上常采用CT引导下卵圆孔穿刺半月神经节射频热凝术治疗三叉神经痛,其穿刺路径有前路和侧入路两种.结论:半月节穿刺射频温控热凝术是目前治疗原发性三叉神经痛的常规方法,卵圆孔是穿刺路径中的一个重要骨性标志；掌握卵圆孔的相关解剖知识,对射频温控热凝治疗三叉神经痛适应证的选择以及指导穿刺具有重要意义.

目的:探讨睫状神经节的应用解剖及神经阻滞麻醉的临床研究进展.方法:查阅近期有关此项研究的文献资料,总结睫状神经节的形态及毗邻结构,比较各种临床麻醉术的优缺点及并发症.结果:睫状神经节是眼科手术麻醉的一个重要解剖结构,传统的球后麻醉并发症较多.改良的球后麻醉效果较好,并发症少,但这些新方法仍需进一步临床观察.结论:掌握睫状神经节的解剖与麻醉要点,提高麻醉质量,减少并发症.

目的:探讨翼腭窝的解剖结构和神经阻滞应用进展.方法:通过pubmed、中国知网等平台查询1990年～2010年国内外有关翼腭窝的解剖结构以及神经阻滞临床应用方面的文献资料,并进行统计分析.结果:根据相关文献分析,通过翼腭窝进行神经阻滞可有效地应用于治疗三叉神经痛、蝶腭神经痛、丛集性头痛、变应性鼻炎、肿瘤疼痛等.结论:了解翼腭窝的解剖结构和神经阻滞方法,为翼腭窝的神经阻滞提供理论基础.

目的:观测面神经颞颧支及其分支的正常局部解剖,旨在为颧骨颧弓骨折开放复位内固定手术入路提供解剖学参数.方法:对11例(22侧)成人尸体面侧区及颞额区进行层次解剖,观察面神经颞颧支在颧弓区域分布与走向,测量面神经颞颧支各分支与颧弓间位置和距离.另对10例(10侧)颧骨颧弓联合骨折患者手术进行临床观测.结果:22侧颞支及分支均跨颧弓后端浅面上行,其中14侧含1～2分支位于颧弓后1/3段上缘0.8～2.0 cm处,呈20°～35°角斜向上行.颧支分支多且粗大,22侧中19侧(86.4%)颧支及分支位于颧弓后段下缘0.5～1.2 cm处前行,并于颧弓前中1/3段上跨颧弓表面,呈28°～45°角斜向上行,3侧(13.6%)位于颧弓表面或上缘0.5～0.8 cm 处向前行并斜向眼外眦.上颊支位于颧弓中1/3段下缘最短距离1～1.5 cm,最长距离2.3～2.8 cm.10侧手术野见颞支均位于颧弓根部上方跨过,沿后1/3段上缘1.2～2.5 cm斜向前上方;颧支位于颧弓后1/3段下缘前行,并于前中1/3段跨过颧弓斜向外眦.结论:掌握面神经颞颧支及其分支的解剖层次、分布走行以及与颧弓的位置关系,对于经头皮冠状切口入路颧骨颧弓骨折开放内固定复位术中避免损伤面神经颞颧支具有重要意义.

目的:探讨翼腭窝神经阻滞相关解剖及其临床意义.方法:在33个干性颅骨标本上对翼腭窝相关孔道和穿刺路径进行解剖观测.应用SPSS17.0分析并比较相关解剖数据.结果:不同穿刺测量法测量翼腭窝的长度,分别为:颧弓下法之侧入法,左侧为(54.87±3.44)mm、右侧为(54.79±2.81)mm;颧弓下法之侧前入法,左侧为(52.90±3.39)mm、右侧为(52.98±2.76)mm;颧骨上法,左侧为(47.59±2.93)mm、右侧为(47.34±3.05)mm.穿刺针与颅骨正中矢状面的角度上述3种方法依次为:左侧(75.5±6.4)°、右侧为(73.4±4.7)°,左侧(83.0±7.1)°、右侧(82.7±5.2)°,左侧(101.4±7.4)°、右侧(101.9±6.6 )°.结论:翼腭窝神经阻滞术以颧骨上法、颧骨下法应用较多.以颧骨上法风险较小,效果较好.

The use of percutaneous Kirschner wires for fixation of unstable fractures of the distal radius has been widely accepted as the least invasive procedure. However, the injury to the superficial branch of the radial nerve (SBRN) is common. Our purpose in this study was to develop a reliable technique to avoid damaging the SBRN.

目的:从几何学角度对国人正常膝关节的参数进行测量,探讨其与某些膝关节疾病的关系.方法:选取国人无明显损坏的干燥股骨标本和胫骨标本各83例,测量股骨长度(G),股骨内、外侧髁宽度(G1、G2),股骨髁间窝宽度(G3)及深度(G4),股骨内、外侧髁倾斜角(GD1、GD2),胫骨近端平台内、外侧后倾角(JD1、JD2),胫骨近端内、外侧平台的前后经(J1、J3)、左右径(J2、J4),胫骨近端平台髁间隆起的宽度(J5)及高度(J6).测量后对有关参数进行统计学分析.结果:除J2对J4外,其余膝关节几何参数测量值之间配对检验其差异存在统计学意义(P＜0.05).线性参数之间呈正相关关系(P＜0.05),而线性参数与角度参数之间无相关关系(P＞0.05).结论:根据所测得的结果,建立了国人正常膝关节几何参数的数据库,为某些膝关节疾病的病程分型与治疗提供参考.

目的:研究星状神经节阻滞术及其相关应用解剖,从而更好地指导临床工作.方法:查阅国内外相关文献,阐述星状神经节及其毗邻结构的解剖关系,分析星状神经节阻滞术式的发展过程及其并发症.结果:星状神经节毗邻众多重要结构,星状神经节阻滞术有一些比较严重的并发症.结论:术者需熟悉星状神经节周围结构以减少并发症,解剖学研究是一个必需的基础.

目的:观察星状神经节形状、大小、位置及其与周围组织结构的毗邻关系,为临床进行星状神经节阻滞术提供确切的数据支持.方法:用新鲜成人尸体17具,逐层解剖星状神经节周围结构,暴露星状神经节,测量其大小及与周围结构的距离.结果:星状神经节长为(12.3±3.3)mm,宽为(3.9±1.1)mm,厚为(2.1±0.5)mm,神经节下缘距胸膜顶垂直距离为(55.1±1.5)mm, 内侧缘距离颈正中线直线距离为(27.1±5.6)mm, 星状神经节和椎动脉在冠状面上的最近距离为(7.6±4.8)mm, 星状神经节和椎动脉在矢状面上的最近距离为(1.8±2.0)mm.结论:星状神经节周围组织结构复杂,星状神经节阻滞术易误伤周围结构产生并发症.

Particle size analyzer, scanning electron microscope were used to investigate the dynamic membrane composition and filtration performance under optimal operation parameters. Energy dispersion spectroscopy was used to determine the elemental composition of the dynamic membrane. The results indicated that the mass concentration of cake layer was 39.27 g·m-2, with contents of colloid, volatile suspended solids and inorganic matter 5.75 g·m-2, 26.5 g·m-2 and 7.02 g·m-2 respectively. Self-generated dynamic membrane mainly consisted of porous structure with high porosity. Filamentous bacteria which acted as matrix of dynamic membrane structure could be obviously observed. Most of the particle size range from 70 μm to 130 μm. O, K, Na, Ca, P, S, Cl, Mg, Si were the main elements in the dynamic membrane. © All Rights Reserved.

Objective:To develop a reliable technique to avoid damage to the superficial radial nerve(SBRN) due to percutaneous K-wire fixation of the distal radius fracture.Materials:In Cadaver Study-1,twenty cadaver forearms were dissected to identify the SBRN distribution.In Cadaver Study-2,eighteen forearms were involved.One K-wire(K-A) was inserted percutaneously into the tip of radial styloid(TRS),and the other(K-B) was placed into the distal radius just under the radiolunate joint.In the true anterior-posterior radiography image of the wrist,the two insertions of K-A and K-B formed a curve AB.The third K-wire(K-C) was placed along the curve AB and placed as far as possible in proximity to the TRS.The SBRN distribution and its relationship with the points of K-wire insertion were identified.In the Clinical Study,47 patients with unstable distal radius fracture were fixed with external fixator and augmented with 2~3 percutaneous K-wires.Over the distribution of SBRN,pain,numbness,dysesthesia and static two-point discrimination were assessed in the first and fourth week respectively after surgery.Results:In Cadaver Study-1,there is a no never area for K-wiring.In Cadaver Study-2,the nerve branch was displaced by K-wire only in 1 of 18 cadavers,the curve AB was located in theno never area .The mean distance of the three wires(A,C,B) to the closest nerve branch was 4.49 mm,4.48 mm,and 3.40 mm respectively.In the Clinical Study,2 of 47 patients had reduced sensation and numbness.Conclusion:When the K-wire is placed in the curve AB and as possible as in proximity to the TRS,the injury rate of SBRN can be effectively diminished.

Objective:To observe the anatomical characteristics of segmental vessels and collect anatomical parameters.Methods:Ten normal adult cadavers were selected randomly in the anatomical study.To observe the anatomical characteristics of segmental vessels in various segments.The distance from the left or right intervertebral foramen to the ipsilateral edge of aorta(SL or SR),which represent the length of left or right segmental vessel.,were measured.The value of SR/SL was calculated.Thirty patients without any spinal deformity adopted the thoracic CT scan.The transverse CT images provided the distance from the left or right intervertebral foramen to the ipsilateral edge of aorta(SL or SR),which represent the length of left or right segmental vessel.The value of SR/SL was recorded.Results:The SR/SL value decreased steadily from T5 to T12 of the spine in all two groups.No significant difference were found between anatomical group and the image group with respect to SR/SL(P>0.05).Conclusions:The length of segmental vessels could be measured in CT images,and the measurements could be used in dealing with segmental vessels by anterior approach.

<正>笔者在解剖一成年男性尸体标本时,见其左侧甲状颈干缺如,其分支肩胛上动脉与肩胛背动脉共干直接起于左锁骨下动脉及左、右肺叶变异,报道如下:

Objective: To study the relationship between trigeminal nerve,cerebellar arteries and petrosal veins, and provide anatomic bases for clinical diagnosis and treatment of trigeminal neuralgia. Methods: 20 head specimens (40 sides) were dissected. Calvaria and dura mater was opened and removed. After cleaning the cerebrum and exploring the tentorium of cerebellum carefully, the relationship between trigeminal nerve, cerebellar arteries and petrosal veins was analyzed and taken photos. The distances among above structures were measured lately. Results: The main trunk or tributaries of petrosal vein of 8 specimens (17.4%) contacted with trigeminal nerve,of 3 specimens (6.5%) compressed it. Superior cerebellar artery of 17 specimens (42.5%) contacted with trigeminal nerve,of 5 specimens (12.5%) compressed it. Anterior inferior cerebellar artery of 11 specimens (27.5%) contacted or compressed trigeminal nerve. Conclusions: Superior cerbellar artery and anterior inferior cerebellar artery are responsible for trigeminal neuralgia. Petrosal vein is one reason for trigeminal neuralgia, which must be dealt with clinical operation closely.

Objective:To study the relationship between facial nerve and surrounding vessels. Methods:Dissect skull of cadaver 40 sides of 20 cases: open the calvaria and clean the cerebrum, then open the tentorium of cerebellum, object and measure distance between the facial nerve and the nearest vessel, follow the course of it. Results:60%(24/40) of the arteries have the comprission with the facial nerve; among the nearest vessels, 87.5%(35/40) of them are anterior inferior cerebellar artery, and 12.5% (5/40) are posterior inferior cerebellar artery; the distances between facial nerve and the nearest vessels are from zero to 5.78mm, with an average of 1.14 mm; 94.3%(33/35) of the anterior inferior cerebellar artery emitted from the lower 2/3 of the basic artery. Conclusion:The most familiar vessel next to the facill nerve is the anterior inferior cerebellar artery, and the second is the posterior inferior cerebellar artery; most of the anterior inferior cerebellar artery emitted from the basic artery, exactly, the lower 2/3 of the artery.