慢性阻塞性肺疾病是呼吸系统常见病与多发病,本病的患病率、致残率、病死率均高,且呈逐年增加趋势.现代医学认为机体的免疫功能低下是COPD发生、发展、转归的重要因素.中医学认为本病之所以反复发作,是由于正气虚弱,卫气不固,致外邪易侵,正气的抗病能力与免疫功能类似.中医药通过扶正祛邪治疗COPD,取得了较好的疗效.本文对近10年来有关气虚证与现代医学免疫指标相关性的文献进行了研究,本文对COPD气虚证与免疫功能的相关性研究从细胞因子、T淋巴细胞亚群、免疫球蛋白等方面进行综合阐述,以期为COPD临床辨证分型提供参考依据.

目的 蒙药阿嘎如-25对小鼠肺纤维化的影响及其作用机制.方法 选取健康SPF级C57BL/6小鼠72只,随机选取10只为正常组,其余62只小鼠麻醉后气管内注入博来霉素建立肺纤维化模型.造模第28天,死亡7只.造模成功后根据随机数字表法将小鼠分为模型组(10只)、西药组(9只)、蒙高组(9只,13 mg/ml)、蒙中组(9只,6.5 mg/ml)、蒙低组(9只)、中药组(9只,3.5 mg/ml),各组小鼠灌胃8周后处死取材.免疫组织化学染色及Masson染色观察小鼠肺组织病理改变及纤维化,Western blot法检测肺组织中转化生长因子-β1(TGF-β1)、受体磷酸酯细胞质蛋白(p-Smad3)、纤维连接蛋白(FN)、骨桥蛋白(OPN)的表达,Tunel法检测细胞凋亡率.结果 蒙高组、蒙中组、蒙低组肺组织病理形态均较模型组明显改善;模型组胶原纤维面积百分比高于正常组,各蒙药组胶原纤维面积百分比低于模型组,蒙高组胶原纤维面积百分比低于其他给药组,差异均有统计学意义(P<0.05).蒙药组TGF-β1、p-Smad3、FN、OPN蛋白表达低于模型组,蒙高组TGF-β1、p-Smad3、FN、OPN蛋白表达低于其他蒙药组,且蒙中组低于蒙低组,差异有统计学意义(P<0.05);各蒙药组细胞凋亡率低于模型组,蒙高组细胞凋亡率低于其他给药组,且蒙中组低于蒙低组,差异有统计学意义(P<0.05).结论 蒙药阿嘎如-25抗肺纤维化的作用机制可能与抑制TGF-β1/Smad3信号通路有关.

目的 通过对矫形后Lenke5型青少年特发性脊柱侧凸(AIS)患者T3～L5节段钛棒应力变化分析,为Lenke5型AIS手术改进提供参考.方法 建立1例2018年8月25日于内蒙古医科大学第二附属医院行侧凸矫形手术患者脊柱T3～L5节段三维有限元模型,随机采集前屈,后伸,左、右侧屈,左、右旋转六种工况下椎体与钛棒连接处5个应力点,利用SPSS 22.0进行统计分析,分析钛棒应力变化趋势.结果 在前屈,后伸,左、右侧屈工况下,钛棒应力呈"W"型变化;在左、右旋转工况下,钛棒应力呈"

背景:国内外对于成人大脑基底核团的研究较多,多借助影像学手段测量,而关于三四岁儿童基底核团形态学三维重建与测量甚少.目的:建立三四岁儿童基底核团的三维立体模式,与其他年龄段进行比较,为探讨基底核团的神经发育提供形态学依据.方法:选取三四岁儿童尸体15例,薄层切割基底核团,并完成其主要结构精确分割的图像数据集;分析各断面标本主要结构的横断面,在特定断面测量相关结构的径线和角度,比较侧别间差异;对原始数据进行重新采样,建立基底核团三维空间坐标系.测量基底核团主要结构的形态大小,明确解剖标识,量化空间信息,建立模型和公共参考系统;三维立体显示基底核团结构,对于各个结构赋以不同颜色,清晰显示其各结构间边界,并行任意角度旋转切割,观测其内部结构.研究方案的实施符合内蒙古医科大学的相关伦理要求.标本均为儿童监护人自愿捐献并签署“知情同意书”.结果 与结论:①获得儿童标本基底核团的连续横断面图像信息,通过重建获得其三维模型,重建结构不仅可显示其基底核团,测量基底核团体积、经线相关参数,侧别间差异无统计学意义;②所得三维重建结构可行任意角度、不同速度旋转,并可行相应的缩放及透明处理,使重建结构图像更加真实和逼真;③基于体绘制重建三四岁儿童基底核团为神经立体定向导航手术及癫痫等诊治提供形态学依据.

This study aimed to examine the differences in bone microarchitecture between different regions of the atlas in 28 dry atlas specimens using micro-CT, in order to explain the mechanism of the predilection sites of atlas fractures from the morphological point of view. A total of 28 dry specimens of intact adult atlas were randomly selected, scanned by micro-CT, and divided into a region from the anterior arch midpoint (AAM) to the lateral masses (LM), a LM region, and a region from the LM to the posterior arch midpoint (PAM). Trabecular thickness, separation, number, connectivity, and structure model index were measured for each of the three regions using the built-in software of the CT scanner. Trabecular thickness was all measured to be 0.11 +/- 0.00 mm for AAM to LM, LM, and LM to PAM. Trabecular separation: AAM to LM > LM to PAM > LM. Trabecular number: LM > LM to PAM > AAM to LM. Connectivity: LM > LM to PAM > AAM to LM. Structure model index: LM > LM to PAM > AAM to LM. A lower trabecular number and connectivity and higher trabecular separation were seen in the anterior and posterior arches of the atlas, in which higher fracture rates were reported. By contrast, a higher trabecular number and connectivity and lower trabecular separation were seen in the lateral masses, in which lower fracture rates were reported.

腰椎疾病如腰椎间盘突出症(lumbar disc herniation,LDH)、腰椎椎管狭窄(lumbar spinal stenosis,LSS)等退行性疾病是引起下腰痛的常见病因,发病初期其治疗方式为保守治疗,当疼痛严重、反复发作、经保守治疗无效时需采用手术治疗.随着技术的革新,由最早的传统椎间盘切除术发展到现在的内窥镜技术,经皮椎间孔镜间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)因创伤小、恢复快、手术时间短、疼痛轻、提高腰椎脊髓功能等优势在临床应用广泛[1],并以其安全、微创的优势不断扩大手术适应症范围[2].本文从椎间孔镜技术临床应用解剖学基础入手,对椎间孔镜技术发展历程及经皮椎间孔镜手术适应证、手术入路和并发症等方面进行综述.

BACKGROUND:Microscopic structures of the ossification centres of the odontoid process were studied from the micro-computed tomography (CT) images of the axis, and the potential influence of the ossification centres with different microscopic structures on odontoid process fractures was analysed.MATERIALS AND METHODS:Eighteen odontoid process specimens were randomly collected and scanned by micro-CT. The obtained images were then input into the software for further observation and measurement. Incomplete absorption of the ossification centres in the base was observed, along with the anatomic structure of the regions with incomplete ossification and structural parameters of the trabecular bones.RESULTS:The microscopic structures of the trabecular bones in the ossification centres in the base of the odontoid process could be clearly visualised from the micro-CT images. Among the 18 odontoid process specimens, 11 specimens were found with incomplete absorption of the ossification centres in the axis, the prevalence reaching up to 61%. Regions with incomplete ossification varied in size and morphology, and their three-dimensional morphology was predominantly oval. Of all structural parameters examined for the trabecular bones, there were only significant differences in the degree of anisotropy between the regions with incomplete absorption of ossification centres and the average vertebral trabecular bones (p < 0.05).CONCLUSIONS:Incomplete absorption of the ossification centres in the base of the odontoid process is a relatively prevalent condition. The cavitation effect of the trabecular bones may be the primary cause for odontoid process fractures.

Background: Based on standard computed tomography (CT) and micro-CT scan axis images, our study aims to analyse the incidence of variation of non-fusion ossification centre in the base of the odontoid and its anatomical structure characteristics, to compare ossification centre images and analyse the possible features of the ossification centre that can influence adult odontoid fractures. Materials and methods: Fifty cases were selected for standard cervical CT of the normal axis bone (second cervical) anatomy to calculate the incidence of variation of the non-fusion ossification centre in the base of the odontoid and the indexes of associated anatomical structure. In addition, five dry bone samples with the odontoid were chosen for micro-CT to analyse the clear anatomic structure of the trabecular bone in the ossification centre. Results: Incidence of variation of non-fusion ossification centre in the base of the odontoid was 28%. In the non-ossification group, the mean sagittal diameter of the base of odontoid (SDBO, mm) was 7.64 ± 1.29 mm, the mean transverse diameter of the base of odontoid (TDBO, mm) was 7.14 ± 1.55 mm, and the SDBO:TDBO ratio was 1.1 ± 0.22. In the ossification group, the mean SDBO was 7.7 ± 1.15 mm, the mean TDBO was 7.38 ± 1.32 mm, and the SDBO:TDBO ratio was 1.07 ± 0.21. There was no significant difference in the associated indexes between the ossification and non-ossification groups (p > 0.05). Micro-CT revealed the micro-structure of trabecular bone in the ossification centre and the close relationship between the trabecular bone and the odontoid. One existing non-ossification centre in the base of the odontoid was found in the five odontoid images. The trabecular bone indexes chosen in the target area of the ossification centre were weaker than those in other areas. Conclusions: The variation rate of the non-fusion ossification centre in the base of the odontoid is relatively high and may be an important factor in the aetiology of type II and III odontoid fractures.

Thoracic disc herniation (TDH)has high technical difficulty and serious complications, and the clinical anatomy of thoracic intervertebral foramen is less. Collecting 10 adult male cadavers, measuring the longitudinal diameter of the dorsal root ganglion (D-1), the transverse diameter of the dorsal root ganglion (D-2), horizontal sagittal diameter of the upper edge of the intervertebral disc (S-1), the high of intervertebral foramen (H-1), the height of articulationes costovertebrales (H-2), the height of intervertebral disk (H-3), the angel of the dorsal root ganglion (a). The aim of this study is to explore the safe area of middle and lower thoracic section and provide anatomical basis for the selection of operative cannula. Mastering the certain rules of the anatomical structure of the middle and lower thoracic segments, and referring to the above parameters in clinical, is conducive to the selection of the working casing during surgery.

This study aimed to investigate the sagittal spinal-pelvic morphological changes, as well as the relationship between pelvic anatomical changes and the spinal-pelvic plane in patients with adolescent idiopathic scoliosis (AIS), in order to provide guidelines for orthopedic surgery in AIS. X-ray data were collected for retrospective analysis from 30 patients diagnosed as AIS in the Departments of Radiology at the Second Affiliated Hospital of Inner Mongolia Medical University and the Inner Mongolia International Mongolian Medical Hospital from April 2014 to November 2018, along with 30 normal adolescents as control. Pelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), a spinal parameter, lumbar lordosis (LL), and anatomical parameters, including sacral width (SW) and femoral head-sacrum distance (FH-S), were measured. The spinal-pelvic parameters were compared between AIS patients and normal controls and also between male and female AIS patients. Pearson correlation was performed to analyze correlation between spinal-pelvic parameters and between spinal-pelvic parameters and anatomical parameters in both AIS patients and normal controls. PT was significantly lower in AIS patients than in normal controls (P < 0.05), whereas no significant difference was found in the other spinal-pelvic parameters, i. e., LL, PI, and SS. There was a significant difference in PT between sexes in AIS patients. SS was significantly correlated with LL in EIA patients (P < 0.05, r > 0.5). SS was significantly correlated with LL and PI, and PT with LL, PI, and SS in normal controls (all P < 0.05), and there was no significant correlation between the other sagittal spinal-pelvic parameters (P > 0.05). FH-S was significantly correlated with LL, PI, SS, and PT in AIS patients (all P < 0.05). AIS affects some of the sagittal spinalpelvic parameters and anatomical parameters. In AIS, there is a significant correlation between the spinal-pelvic parameters, and the anatomical parameter is significantly correlated with multiple spinal-pelvic parameters.

BACKGROUND:The typical imaging finding of MM is bone destruction in the form of diffuse patchy osteolytic lesions or punctate destruction. However, it is difficult to accurately determine the fine structure of bone affected by MM with these techniques due to low specificity and sensitivity.INTRODUCTION:This study aimed to investigate the microscopic anatomical morphology and analyze the microstructure changes of trabeculae affected by multiple myeloma (MM) based on micro-CT.METHODS:MM-affected and normal trabecular bone samples were imaged by micro-CT to obtain bone structure parameters to assess statistical differences between them and evaluate the degree of microstructural damage of MM-affected trabeculae.RESULTS:Micro CT images clearly showed the microstructure of MM-affected trabeculae. The degree of trabecular osteoporosis varied with the severity of MM. There were significant differences in the structural parameters between MM-affected and normal trabeculae (P < 0.05).CONCLUSION:Micro-CT clearly reveals the microstructure of MM-affected trabeculae. The obtained bone structure data will help to determine the degree of bone damage caused by MM and assess the efficacy.

背景:青少年特发性脊柱侧凸为青少年脊柱侧凸的最常见类型,畸形所导致的脊柱解剖学变化使得临床螺钉固定风险较高.目的:针对青少年特发性脊柱侧凸患者建立数字化虚拟仿真手术设计方案.方法:内蒙古医科大学第二附属医院脊柱外科收治的17岁青少年特发性脊柱侧凸患者1例行术前16排螺旋CT扫描,将CT资料利用Mimics 16.0软件进行三维重建,测量经椎弓根固定螺钉直径,长及固定角度后进行导航模板设计和3D打印,利用导航模板进行手术螺钉固定,术后CT扫描后评估置钉疗效.结果与结论:对该位患者脊柱进行三维重建,利用软件逆向工程设计功能设计导航模板,使得固定螺钉避免穿透椎体前缘皮质和椎弓根内外侧皮质骨,对设计导航模板畸形3D打印,并利用其进行脊柱矫形手术矫形,术后评估,未见螺钉穿出皮质,置钉准确率达100％.结果证实,对于特发性脊柱侧凸患者利用三维数字化重建设计导航模板进行手术置钉具有较高置钉成功率.试验方案经已患者本人及家属知情同意并于2014年4月通过内蒙古医科大学伦理委员会审核,批准号:20140408.

目的 观察并测量寰椎侧块滋养孔的临床解剖学参数,为降低寰椎侧块螺钉固定术中血管损伤风险提供参考.方法 随机选取38例正常干燥成人寰椎骨标本,观察寰椎侧块滋养孔(以直径≥1.0 mm为判定界限)的形态、数目、位置;测量滋养孔最大横径、纵径、深度,滋养孔外缘到横突孔内缘之间的距离等.结果 38例寰椎标本中,95％存在滋养孔,42％呈圆形、8％呈横椭圆形、45％呈纵椭圆形;5％无滋养孔;79％左右两侧滋养孔对称,16％不对称.滋养孔最大横径为(2.16±0.86)mm,最大纵径为(2.82±1.03)mm,最大深度为(1.75±0.71)mm,滋养孔外缘到横突孔内缘之间的距离(8.61±1.46)mm,各测量指标左右两侧无显著差异.结论 95％的寰椎左右两侧存在滋养孔,且均位于寰椎侧块的中间区域,椎弓根螺钉通道处;临床寰椎侧块螺钉固定时,螺钉的直径可参考(8.61±1.46)mm;螺钉通道距离寰椎侧块内缘(1.73±0.7)mm.

关于左肺3叶的报道,以往文献较少见,作者在解剖一具68岁男性尸体时,发现其左肺存在3叶变异.该尸体左肺呈浅灰褐色,表面光滑,质地和弹性良好,无粘连.从肋面观察:斜裂和“不完全水平裂”完整清晰,把左肺分为上、中、下3叶(图1);从内侧面观察:斜裂和“不完全水平裂”也非常完整清晰(图2).在左肺尖前缘下方17.8 cm处出现一“不完全的肺裂”,该肺裂在肺的肋面长5.6 cm,内侧面长4 cm,肺裂根部的肋面到内侧面距离3.1 cm,最大深度2.7 cm.该肺“中叶”前缘距离7.9 cm.

腰椎间盘突出症(LDH)被定义为中央的椎间盘(髓核)突出,LDH手术是脊柱外科最常见的手术之一.有症状的LDH的手术可以分为开放式手术与内镜手术.经皮内窥镜腰椎间盘切除术(PELD)主要有两种入路,即经椎间孔入路的经皮椎间孔镜椎间盘切除术(PETD)和经椎板间入路的经皮内窥镜椎间盘切除术(PEID).椎间融合术有微创经椎间孔腰椎椎间融合术(MIS-TLIF)、微创侧方腰椎椎间融合术(MIS-LLIF)等.本文从LDH微创手术的发展史、临床治疗效果、适应证、禁忌证及并发症等方面来论述国内外近五年来的研究进程,并探索LDH在微创手术治疗的新方向.

This study aimed to investigate the micro-anatomical morphology of ossicular chain in term fetus using micro-CT, in order to analyze the parameters of internal ossicular structure that may affect sound conduction. Four ossicular chains from two term fetuses were scanned by micro-CT. The related structural parameters of the trabeculae within the incus and malleus were calculated and compared. The fine anatomical structure of the auditory ossicles was analyzed. The microstructure of each auditory ossicles in term fetuses was clearly revealed by micro-CT. A marrow cavity was observed in the incus and malleus. In statistical analysis of the structural parameters of trabeculae in the incus and malleus, significant differences were found in BS/BV and Tb. Th (P < 0.05). Micro-CT enables the visualization of internal ossicular structure. The auditory ossicles in term fetus has good bone quality. The obtained bone structure data will help to clarify the physiological functions of normal fetal auditory ossicles.

青少年腰椎间盘突出症(adolescent lumbar disc herniation, ALDH)是引起青少年腰腿痛的主要原因,发病率为1％～5％,病因包括外伤、发育异常、遗传等[1].由于青少年处于生长发育的高峰时期,其症状、体征与成年人腰椎间盘突出症有所差异[2].ALDH不仅影响患者的生活质量和心理健康,还为家庭带来困扰、为社会增加负担."生物-心理-社会医学模式"理念的渗入,人们认识到,早期诊断ALDH十分重要,外科医生须熟悉ALDH的特点,避免造成漏诊或误诊而延误治疗.椎间盘镜和椎间孔镜治疗ALDH,可以减少脊柱周围结构的损伤和脊柱生物力学的破坏,缩短手术时间、减少术后并发症、减少创伤面积,是医生和患者认可的手术方式[3].本文主要综述椎间盘镜和椎间孔镜治疗ALDH的进展.

一具老年男性尸体,年龄不详,在其解剖过程中,发现主动脉弓分支变异及腹主动脉直径异常.其主动脉弓直径达3.50 cm,主动脉凸侧没有发出3个分支,而是2个分支,头臂干和左颈总动脉共干组成第一分支,共干长度1.20 cm,头臂干直径为1.80 cm,左颈总动脉直径为1.20 cm.第2支为左锁骨下动脉直径达1.30 cm.此外,我们还观察到该标本腹主动脉较粗,平均直径达2.41 cm(图1).

肾静脉变异在临床检查中很少见,多系尸检及影像学检查时偶然发现,且多以少数病例报道为主[1-3].肾静脉的变异多无临床表现,不易引起关注,但在活体肾移植方面具有重要的临床价值.左肾静脉主干比右肾静脉长,更利于进行肾移植手术,因此,左肾多被选为肾移植中的供肾[4-5].但左肾静脉的解剖变异比右肾更为复杂[6],左肾静脉主干走行于左肾动脉的前方,向右前方斜行,穿过腹主动脉与肠系膜上动脉的夹角,汇入下腔静脉.左肾静脉属支较多,收集肾上腺静脉、生殖静脉、腰静脉等静脉的血液,若在术中损伤腰静脉等属支,可能引起大出血[7-8].因此,在供肾切除术中,术前详细评估左肾静脉解剖结构有助于更好地游离肾静脉及其属支,减少术中肾静脉及其属支的出血[9-10].左肾手术前评估时要准确,尤其在腹腔镜微创手术中更要注意分辨,否则可能会引起血管损伤或大出血.左肾静脉行程长,发育过程复杂,可发生多种解剖变异[11].本文就成人尸体标本肾静脉以下的下腔静脉及其属支解剖结构进行了观测和研究,发现1例左腰静脉回流部位变异,现将此腰静脉及其伴行血管的位置毗邻及长度宽度进行简单描述,为临床手术及评估提供数据依据,且补充完善鲜有报道的腰变异的数据库,为临床腹膜后肿瘤、血管损伤、布加氏综合征、腰段脊柱手术、肾脏手术以及造影取栓术和其他介入性治疗等提供解剖学依据.

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)[1],或称迟发性脊柱侧凸,是由脊柱在冠状平面发生异常弯曲而旋转,伴随着椎体旋转,使得患者的脊柱形成弧度状态的一种疾病,没有任何明确病因.AIS是指一种结构性的、横向的弯曲,是脊柱的侧偏移[2],右侧胸廓曲线是其最常见的临床特征之一.青少年是AIS高危人群,许多临床医生和研究人员认为,AIS的高流行率是由于在青春期的生长速度变快而导致的脊柱异常生长.女性的患病率更高,表现更明显的曲线,平均而言,女性患脊柱侧凸的几率是男性的7倍[3].在10岁或之后的儿童中出现AIS,80％的诊断是女孩发病[4].