难复性寰枢椎脱位的治疗进展

难复性寰枢椎脱位治疗是高难度、高风险的领域,难复性寰枢椎患者往往合并不同程度脊髓损伤症状或体征,且X线片动态位和术前颅骨牵引均未能获得复位,手术治疗为唯一治疗方案。手术治疗以松解、减压、复位和内固定为原则,目前手术治疗方案以前路松解结合前路或后路内固定为主,绝大多数手术疗效满意,本文就难复性寰枢椎脱位手术治疗的进展作一综述。     

太行山猕猴第Ⅶ颈椎变量的异速生长分析

以肱骨最大长为参照,对成年太行山猕猴第Ⅶ颈椎变量进行了异速生长分析。结果表明,椎体后高、椎体上矢径、全宽呈正异速生长;椎体下横径接近等速生长;椎体前高、椎体下矢径、椎体上横径、椎孔矢径、椎孔横径、矢径呈负异速生长。     

太行山猕猴寰椎桥的类型与特征

为了确定太行山猕猴(Macaca mulatta)的椎动脉沟上3种骨桥（腹桥、侧桥和背桥）的分布特征，以期理解在人类寰椎上观察到的变异，并推测灵长类动物可能的进化趋势。本文分别测量57例（雄性17例，雌性40例）猕猴寰椎标本（成年骨骼标本）3个寰椎桥的宽度。并采用SPSS统计软件进行数据处理，性别之间差异采用方差分析，观察寰椎桥的出现率、形态特征和组合类型。统计结果显示，猕猴寰椎桥变量性差显著(P<0.05)，猕猴的腹桥和背桥是恒定出现(100%)，侧桥基本恒定，但也有一些缺失个案(90.3%)，表明腹桥和背桥是猕猴稳定的特征；猕猴寰椎桥的主要类型为原始的A型，与主要类型为D型的人科动物发生分离。我们基于以上特征后得出结论，猕猴的3个寰椎桥是一种稳定性状，其出现率明显高于类人猿。     

寰椎的测量、相关与性别判别分析

本文对85例(男46,女39)国人寰椎进行了四项测量,其性差均非常显著,但两性重迭率≥38.9％。另算出两项指数,其性差不显著。从中挑选全宽(X_1)和矢径(X_2)两个变量经计算得判别式Z=X_1+2.21098x_2,临界值Z_0=172.9102。经组内外回代误判率分别为18.5％和12.9％。对四项测量作了相关分析,其中寰椎矢径与椎孔横径、全宽与椎孔矢径均呈中度正相关。并用寰椎矢径(X_2)推算椎孔横径(y),其男性Y=18.01±0.2579X_2,女性Y=4.88±0.5505X_2。     

数字化骨科理念辅助椎弓根置钉在寰枢椎不稳中的临床应用

目的:探讨3D打印辅助置钉技术用于寰枢椎不稳椎弓根置钉的安全性及准确性。方法:收集2013年1月到2015年1月西安交通大学第一附属医院收治的寰枢椎不稳病例,术前采用3D打印技术构建个体化3D打印模型,在模型上模拟置钉,获取最佳置钉点、置钉角度等个体化置钉数据,并于术中辅助椎弓根螺钉置入。通过CT扫描评价置钉准确性,测量术前、术后患者寰齿间隙判断寰枢椎复位情况,测量颈延角评价脊髓压迫改善情况,并采用日本骨科学会(JOA)评分判断患者脊髓功能改善情况。术后定期随访观察固定效果、稳定性、神经损伤等手术并发症的发生情况。结果:13例患者均采用3D打印辅助置钉技术进行内固定治疗,手术顺利,术中及术后无血管、神经损伤等并发症,复位及内固定效果满意。共置入椎弓根螺钉31枚,其中29枚完全在椎弓根内,置钉准确率为93.5%。寰枢椎较术前明显复位,术后寰齿间隙、颈延角和JOA评分较术前明显改善,差异具有统计学意义(P0.05)。结论:3D打印技术辅助上颈椎椎弓根置钉的准确性及安全性均较高。     

雄性黄山短尾猴颅骨变量的异速生长研究

对雄性黄山短尾猴颅骨标本的36项主要形态变量指标进行定点测量,并进行了初步的统计分析和异速生长分析。结果表明,大多数变量的统计值在雄性个体间的变化范围都比较大,2/3的变量表现为正的异速生长,1/3的变量表现为负异速生长。颅骨变量的生长存在年龄及部位间的差异,这些差异与雄性的不同生长发育时期、在社群中的不同地位和竞争压力以及取食习性有关。     

内镜辅助经口咽前路减压后路融合一期手术治疗寰枢椎脱位

目的:探讨显微内窥镜下经口咽入路前路减压同时一期后路融合治疗寰枢椎脱位的手术方法,评价该手术方法的临床效果。方法:2005年2月至2006年6月对11例有手术指征的寰枢关节脱位患者,其中外伤齿状突骨折畸形愈合4例、先天性寰枕融合畸形1例、齿突发育不良并不连6例。全组均有不同程度的颈脊髓压迫引起的不同程度的肢体运动、感觉障碍;ASIA分级C级3例、D级8例。行显微内窥镜辅助下经口咽入路前路减压,术中颅骨牵引复位后一期后路融合。结果:11例均获得脊髓充分减压,9例获解剖复位、2例部分复位,无术中和术后并发症;所有患者的临床症状均有明显改善,四肢运动功能不同程度的恢复,A- SIA分级1例C级恢复至D级,2例C级恢复至正常,8例D级恢复至正常。内固定无松脱、无断裂及再脱位,植骨融合良好均获得骨性融合。术后随访6月-18个月,平均12个月,效果良好。结论:显微内镜下经口咽入路前路减压,具有视野清晰、操作精确、损伤小的优点;充分前路减压可以术中即刻复位、一期后路融合,避免了二次手术。     

生长标度——腕足动物异速生长研究中的定量指标

"生长标度"定义了在研究腕足动物异速生长时所需的个体生长发育定量指标,其数值大小受到壳长、壳宽、壳厚以及相对应权重的共同控制。将腕足动物待研究性状的测量值与其生长标度作为两个变量进行二元回归分析,可判断该性状是否存在与腕足动物个体发育不等的生长速率,即异速生长。该指标对凯迪期(Katian)(晚奥陶世)腕足动物无洞贝类Rongatrypa xichuanensis的定量分析表明,该种腕足动物的壳宽与个体发育保持同步,壳长呈负异速生长,壳厚呈正异速生长,指示出该种生物在生长过程中总体向横宽方向伸展,并伴随着壳体的加快增厚。     

齿状突骨折手术方式的选择及治疗效果分析

目的:通过回顾性分析齿状突骨折不同术式的疗效,从而指导后期临床治疗。方法:回顾分析齿状突骨折26例,对比观察前、后路手术时间、出血量、平均住院时间及术后疼痛数字评分、颈椎功能障碍指数评分(NDI)等指标。结果:前路齿状突螺钉内固定手术时间105.7±35.3 min、出血量62.1±18.5 mL、平均住院时间7.0±1.9天、疼痛数字评分3.6±1.7分、NDI 24.3%±11.7%,后路寰枢椎融合手术时间148.2±36.2 min、出血量338.4±143.3 mL、平均住院时间11.2±2.1天、疼痛数字评分5.1±1.4分、NDI33.6%±13.4%。结论:前路齿状突螺钉内固定术具有手术时间短、出血少、平均住院时间短、疼痛数字评分低、对颈椎活动功能影响小等优势,而后路寰枢椎融合术具有手术适应范围广、手术操作难度小等优势,而其对颈椎活动功能影响较大。     

枕骨-枢椎螺钉间撑开复位内固定术治疗CAAD

为了探讨枕骨-枢椎螺钉间撑开复位内固定术在先天性寰枢关节脱位(CAAD)治疗中的作用。本研究选择2014年4月至2016年4月在西南医科大学第一附属医院收治的经枕骨-枢椎螺钉撑开复位内固定术治疗的CAAD患者17例作为研究对象,根据术前和术后影像学检查考察齿状突下降程度、延髓颈髓角变化及日本骨科协会(JOA)评分,对比患者术前、术后短期及远期疗效,并计算术后功能改善率。随访时间为4~29个月,平均14个月。研究显示,术前齿状突尖端到Chamberlain线距离平均为(10.49±2.87)mm,术后平均为(4.47±2.62)mm,术后较术前下降(p0.05);术后的延髓颈髓角较术前增大(p0.05);疗效如下:2例治愈(11.8%),9例显效(52.9%),6例有效(35.3%),术后短期及远期功能较术前显著改善(p0.05);术后短期较术后远期疗效对比差异无统计学意义(p0.05)。枕骨-枢椎螺钉撑开复位内固定术在CAAD中是一种安全、有效的手术方式。     

The secular trend in the diameter of the femur of American Whites and Negroes

The transverse diameter of the adult femur at the level of its mid-bicondylar length is related to length, age and year of birth in American White and Negro skeletons of both sexes of the Terry Collection. The coefficients of correlation between age at death and birth year are significant in all four sex-race groups, as are also the regression coefficients of transverse diameter on length and on age. The regression of length on age is negative and on birth year positive, although statistically significant only in the Negro male group. The partial regression coefficients of transverse diameter on length, on age, and on birth year, each eliminating the effects of the other two variables, are significant for length, not significant for age except in the Negro male group, and significant for birth year except in the Negro male group. Thus, the statistics of three of the sex-race groups do not support the hypothesis that transverse diameter of the femur increases with age, but rather suggest a negative secular trend; the apparent inconsistency in these findings of the Negro male group can, however, be considered insignificant from a statistical point of view.     

Head‐turning morphologies: Evolution of shape diversity in the mammalian atlas–axis complex

Mammals flex, extend, and rotate their spines as they perform behaviors critical for survival, such as foraging, consuming prey, locomoting, and interacting with conspecifics or predators. The atlas–axis complex is a mammalian innovation that allows precise head movements during these behaviors. Although morphological variation in other vertebral regions has been linked to ecological differences in mammals, less is known about morphological specialization in the cervical vertebrae, which are developmentally constrained in number but highly variable in size and shape. Here, we present the first phylogenetic comparative study of the atlas–axis complex across mammals. We used spherical harmonics to quantify 3D shape variation of the atlas and axis across a diverse sample of species, and performed phylogenetic analyses to investigate if vertebral shape is associated with body size, locomotion, and diet. We found that differences in atlas and axis shape are partly explained by phylogeny, and that mammalian subclades differ in morphological disparity. Atlas and axis shape diversity is associated with differences in body size and locomotion; large terrestrial mammals have craniocaudally elongated vertebrae, whereas smaller mammals and aquatic mammals have more compressed vertebrae. These results provide a foundation for investigating functional hypotheses underlying the evolution of neck morphologies across mammals.     

Wood anatomy reflects the distribution of Krascheninnikovia ceratoides (Chenopodiaceae)

Wood anatomy characters of the Eurasian/North American half-shrub Krascheninnikovia ceratoides were investigated on plants from different parts of the wide distribution area. The secondary xylem is developed as result of anomalous secondary thickening. The vessels are small (commonly <50 μm) and the secondary xylem is rayless. Differences in vessel diameter exist between the main axis, basal branches and flowering shoots. The maximum as well as the minimum vessel diameter in the flowering shoots is significantly smaller compared to the basal branches, as well as in the main axis in all provenances. The length of thick-walled libriform fibre cells varies between the main axis and the basal branches of the same plant individual, but in the short main axis the length of libriform fibre cells is relatively constant (193-217 μm), independent of provenance and climate. Obviously, the length of libriform fibre cells is a conservative character and dependent on plant size. The vessel diameter is a more sensitive parameter for ecological studies. It varies more clearly, considering the vessel position in the plant axis system, in relation with climate differences of the provenances of the examined plants.Plants from a temperate, semi-humid climate have the largest vessel diameter in basal branches and flowering shoots, while the vessel diameter of plants from an arid temperate climate in Central Asia is smallest. The vessel diameters depend not only on climate, but also on the position in the axial system of the plants. There is a trade-off between average vessel number and their maximum diameter in flowering shoots of populations from Russia and Mongolia. Thus, vessel diameters depend on both, position in the axial system of the plant and climatic conditions.     

Sex determination from the radius in humans

The discriminatory capacity of the radius in sex determination was investigated in a Dutch skeletal collection of recent origin. Midshaft subperiosteal diameter, maximum length and maximum transverse distal width were measured from roentgenograms. The discriminatory capacity of the radius was found to be of the same order as that reported in the literature for the other long bones. Maximum transverse distal width showed the highest consistency (85%) between estimated and documented sex. This method requires only the presence of the distal fragment of the radius.     

The atlas–axis complex in Dibamidae (Reptilia: Squamata) and their potential relatives: The effect of a fossorial lifestyle on the morphology of this skeletal bridge

We report on the first detailed study of the atlas–axis complex in the lizard clade Dibamidae, a family of poorly known fossorial squamates distributed in tropical or subtropical climates. This skeletal bridge is characterized by several features, such as the complete absence of the first intercentrum or the appearance of the first free cervical rib on the axis (usually less developed in Dibamus relative to that in Anelytropsis). Our study shows morphological differences of the atlas–axis complex in the Mexican blind lizard Anelytropsis relative to those of Asian Dibamus, the only two known extant genera of this clade. With regard to taxonomy and phylogenetic topology of the Dibamidae within Squamata, a huge conflict exists between morphology versus molecules. The morphology of the atlas–axis complex is therefore compared with several potential sister clades + Sphenodon. Dibamids share several features with limbless Gekkota, Scincoidea, and Amphisbaenia. The complete absence of the first intercentrum is observed in Rhineura floridana and in Ateuchosaurus chinensis as well, and the free rib associated with the synapophyses of the axis is also present in Acontias meleagris. However, some of these features may result from a limbless, burrowing ecology and thus could represent homoplastic characters. In any case, the morphology of the atlas–axis shows that dibamids share most character states with skinks. Although the atlas–axis complex forms only an additional source of information, this conclusion is consistent with most morphological rather than molecular tree topologies.     

Sex determination of prehistoric central California skeletal remains using discriminant analysis of the femur and humerus

A large sample (n = 370) of Central California prehistoric skeletal remains was analyzed for sexual dimorphism of long bones using nine femoral and nine humeral dimensions. Sex of all individuals was assessed using traits of the os pubis. Discriminant analysis was done separately for the robust Early Horizon sample and the Middle/Late Horizon sample. Use of multiple variables did not produce appreciably better results over the use of several of the best variables, analyzed singly. Attention is focused on measurements of maximum diameter femoral head, femoral bicondylar width, and diameter of the humeral head (transverse or vertical). These variables produce excellent separation of the sexes with about 90% accuracy for the Middle/Late Horizon sample. They have been overlooked in the recent literature in which the relative values of length versus midshaft dimensions are debated. The measurements found to be superior in this study are taken at the ends of the bones where durability of these regions is indicated by large sample sizes found in this study. We suggest workers redirect their focus from the midshaft to the ends of the long bones. The discriminant analyses presented here have greater accuracy than most claims for either long bone or cranial sex determination. These standards, based on two samples with differing robusticity, may have applicability for workers in other areas who lack large skeletal samples.     

From lizard body form to serpentiform morphology: The atlas–axis complex in African cordyliformes and their relatives

The comparative vertebral morphology of the atlas–axis complex in cordyliforms, xantusiid and several skinks is studied here. These lizards are particularly interesting because of their different ecological adaptations and anti‐predation strategies, where conformation ranges from the lizard‐like body to a snake‐like body. This transition to serpentiform morphology shows several evolutionary patterns in the atlas–axis complex: 1) the zygapophyseal articulations are lost in the early stage of the transition. In contrast to mammals, the atlas is more or less locked to the axis in lepidosaurs, but the absence of zygapophyseal articulation releases this locking for rotation. However despite its serpentiform morphology, Chamaesaura is different, in possessing this articulation; 2) the first intercentrum of Chamaesaura and Tetradactylus africanus (serpentiform grass‐swimmers) is fully curved anteriorly, underlying the occipital condyle. While this limits ventral skull rotation beyond a certain angle, it locks the skull, which is a crucial adaptation for a sit‐and‐wait position in grassland habitats that needs to keep the head stabilized; and 3) in Acontias, most of the atlas articular surface with the occipital condyle is formed by the lateral aspect of the articulation area relative to the area located in the dorsal region of the slightly reduced intercentrum. A similar state occurs in amphisbaenians, most likely reflecting a fossorial lifestyle of the limbless lizards. Although Chamaesaura and Tetradactylus live sympatrically in grasslands, Chamaesaura differs in several ways in atlas–axis complex: for example, aforementioned presence of the atlas–axis zygapophyseal articulation, and long posterodorsal processes. Its occipital condyle protrudes further posteriorly, placing the atlas–axis complex further from the endocranium than in Tetradactylus. Hence, adaptation in the same niche, even among sister clades, can lead to different atlas–axis morphology due to different lifestyle strategies, for example, different foraging mode, while similar atlas–axis morphology can evolve in two lineages occupying different niches, as in Ablepharus and Scelotes. J. Morphol. 277:512–536, 2016. © 2016 Wiley Periodicals, Inc.     

A forebrain atlas and stereotaxic technique for the lizard,Anolis carolinensis

A forebrain atlas and stereotaxic neurosurgical techniques were developed for use in anatomical and behavioral experiments on the green anolis lizard (Anolis carolinensis). Green anoles are convenient and robust experimental subjects with a rich behavioral repertoire, the social components of which are partly under hormonal control. The technique and atlas were devised to conduct neuroethological investigations of the effect of lesions on species-typical display behavior. The atlas consists of 12 transverse sections from an average size adult male. The figures (4–15) are based on Nissl material and supplemented with fiber-stained material from adjacent sections. They appear at the end of the article. Limitations on the accuracy of stereotaxic coordinates are discussed and tables of correlative nomenclature for principal telencephalic and diencephalic nuclei are provided.     

Creation of a three-dimensional atlas by interpolation from Schaltenbrand-Bailey's atlas

A 0.5-mm step atlas was interpolated from Schaltenbrand-Bailey's atlas. By serial display of the atlas with the desired rotation on a three-dimensional axis, a three-dimensional atlas was created. The newly created atlas can be used for computer-processed stereotactic data display. Any three-dimensionally located point can be displayed within 0.25 mm distance from the point, and spatial understanding of anatomical structures and stereotactic data is facilitated by the three-dimensional display.