【摘要】： 【目的】以側(cè)腦室后角作為研究對象,模擬神經(jīng)內(nèi)窺鏡手術(shù)入路,旨在設計一條安全、理想的穿刺路徑,為神經(jīng)內(nèi)窺鏡手術(shù)減少并發(fā)癥、擴展適應癥提供解剖學依據(jù)。 【材料和方法】1.實驗對象:分別對由昆明醫(yī)學院解剖教研室提供的10%甲醛常規(guī)固定的成人顱腦標本15例(30側(cè))進行分層解剖觀測,男女不限,左右側(cè)隨機。2.實驗方法:在尸頭上模擬神經(jīng)內(nèi)窺鏡手術(shù),定位穿刺。剝離頭皮,暴露顱骨,以大腦中線旁開3cm,枕外隆突上分別3cm、4cm、5cm、6cm、7cm、8cm為模擬穿刺點,依次命名為Z1、Z2、Z3、Z4、Z5和Z6點。在顱骨上鉆孔以顯露硬腦膜,并將標記針刺入。沿枕外隆突、外耳門和眉弓連線將顱骨鋸開,去除顱蓋骨,于小腦幕裂孔處切斷中腦,取出大腦半球,沿正中面分為兩半,切除部分丘腦,顯露側(cè)腦室后角。在不同的定位點分別進行側(cè)腦室三角區(qū)、中央部以及下角的模擬穿刺。將穿刺點至三角區(qū)的穿刺徑線命名為A線,穿刺點至中央部的穿刺徑線命名為B線,穿刺點至下角的穿刺徑線命名為C線。3.解剖參數(shù)的測量:從不同的穿刺點出發(fā),觀測各穿刺經(jīng)線與硬腦膜血管、大腦淺靜脈、頂枕溝動脈、距狀溝動脈、角回、視輻射的關系,并比較各個徑線穿經(jīng)的大腦實質(zhì)的厚度,各徑線所成角度以及穿刺針前端所能到達的位置。采用SPSS11.5軟件對實驗數(shù)據(jù)進行統(tǒng)計分析,計量資料以均數(shù)±標準差(Mean±SD)表示,兩組采用成組t檢驗,組內(nèi)比較采用方差分析,計數(shù)資料采用卡方檢驗,P＜0.05認為差異有統(tǒng)計學意義。 【結(jié)果】1.穿刺點與硬腦膜血管的關系:所有穿刺點在硬腦膜上都未鄰近大血管。2.剝離硬腦膜后觀察穿刺點與大腦淺靜脈的關系:Z5點位于大腦上吻合靜脈后方(4.54±0.84)mm,Z6點位于大腦上吻合靜脈后方(5.98±1.89)mm,其余各點與大腦淺靜脈無毗鄰關系。3.穿刺點在大腦表面的定位與角回的關系:Z1和Z2點距角回較遠,而Z3～Z6點與角回相距較近(P＜0.05),尤其是Z3點距角回最近:(8.44±5.29)mm。4.頂枕溝動脈和距狀溝動脈是大腦后動脈的兩終末支,分別深入腦溝底部走行,其最深處與正中矢狀面的距離為:頂枕溝動脈:(18.00±2.01)mm,距狀溝動脈:(24.02±3.16)mm,經(jīng)各點進行側(cè)腦室后角穿刺時,均與該兩條動脈鄰近。5.Z1、Z2和Z3穿刺點在進入側(cè)腦室三角區(qū)的同時都相應的與視輻射形成交角,大多交在其上部或中部,而Z4、Z5和Z6點都不與視輻射相交。6.以穿刺點至三角區(qū)的穿刺徑線,即A線為基線,當穿刺針從三角區(qū)轉(zhuǎn)移至中央部或下角時,必定與A線成一定的夾角,經(jīng)Z5和Z6點的穿刺,AB線所成夾角較大(P＜0.05),而經(jīng)Z1和Z2點的穿刺,以AC線所成的夾角則較大(P＜0.05)。7.從各個穿刺點出發(fā),穿刺針所經(jīng)過的層次依次為皮膚、淺筋膜、帽狀腱膜、腱膜下疏松結(jié)締組織、顱骨外膜、顱骨、腦膜(硬腦膜、蛛網(wǎng)膜和軟腦膜)和腦實質(zhì)。我們測量了從皮膚至顱骨的厚度是(22.24±1.81)mm。當通過腦實質(zhì)到達側(cè)腦室時,不同的穿刺經(jīng)線,不同的穿刺點,該段的厚度并不相同,經(jīng)Z1到Z6點穿刺分別至三角區(qū)、中央部、下角的腦實質(zhì)厚度,即A、B、C三線,差異無統(tǒng)計學意義(P＞0.05),三線比較B＞C＞A。8.通過觀察側(cè)腦室后角與穿刺點的位置關系,Z4、Z5和Z6點更易到達側(cè)腦室的前角,而Z2、Z3和Z4點則利于進入側(cè)腦室的下角。 【結(jié)論】1.神經(jīng)內(nèi)窺鏡下側(cè)腦室后角手術(shù)入路最適宜處理側(cè)腦室三角區(qū)的病變。 2.側(cè)腦室后角神經(jīng)內(nèi)窺鏡手術(shù)入路的體表定位是:大腦中線旁3cm、枕外隆突上方6～7cm。穿刺方向指向同側(cè)眉弓中點,穿經(jīng)的腦實質(zhì)深度在(45.10±6.60)mm之間,該路徑并發(fā)神經(jīng)、血管損傷的風險較小,不但可直接進入側(cè)腦室的三角區(qū),同時也可以處理側(cè)腦室中央部和側(cè)腦室下角的病變,利于臨床上在手術(shù)過程中進行另外兩個部位的探查。 【目的】將光學測量法應用到股骨干骨折鋼板內(nèi)固定治療的生物力學研究中,并分析內(nèi)固定物斷釘?shù)脑蚝臀稽c,為鋼板內(nèi)固定術(shù)的優(yōu)化方案提供力學依據(jù)。 【材料和方法】1.實驗對象:選用昆明醫(yī)學院人體解剖教研室提供的10%甲醛常規(guī)固定的成人離體股骨標本6根,男女不限,左右側(cè)隨機。2.實驗模型的建立及分組:將標本解剖后剔除所有軟組織,分別測量股骨干的全長,定出中點位置后以線鋸垂直于骨干長軸橫行截斷,制造股骨干中段骨折模型。模擬各種受力情況的差異性,設計實驗模型進行對比分析。分別設計成10種狀態(tài):a.模擬骨折愈合后的受力狀態(tài)(未鋸斷);b.骨折后加壓鋼板堅強內(nèi)固定組(鋸斷后);c.在b組的基礎上近端去一枚螺絲釘;d.在c組的基礎上遠端去一枚螺絲釘;e.在d組的基礎上近端去一枚螺絲釘;f.在e組的基礎上遠端去一枚螺絲釘:g.在f組的基礎上近端去一枚螺絲釘;h.在g組的基礎上遠端去一枚螺絲釘;i.在h組的基礎上近端去一枚螺絲釘;j.在i組的基礎上遠端去一枚螺絲釘。將各組實驗模型固定在力學測試儀上,股骨頭夾在上端,股骨髁夾在下端。安裝好載荷,首先進行預載荷50N,以消除骨的松弛、蠕變等時間效應影響,再軸向加載0～500N,加載速度為10N/s,計算機自動記錄應變情況,再利用數(shù)字散斑法計算出螺絲釘在受力狀態(tài)下的位移和平均應變,并加以比較。采用SPSS11.5軟件對實驗數(shù)據(jù)進行統(tǒng)計分析,計量資料以均數(shù)±標準差(Mean±SD)表示,兩組采用成組t檢驗,組內(nèi)比較采用方差分析,P＜0.05認為差異有統(tǒng)計學意義。 【結(jié)果】(1)10枚螺絲釘在a、b兩種狀態(tài)所產(chǎn)生的位移和平均應變表現(xiàn)出顯著性差異(P＜0.05),b狀態(tài)尤為顯著(P＜0.05)。(2)在b狀態(tài)下,10枚螺絲釘在加載力的作用下均發(fā)生微小位移和平均應變,且隨加載力的增大而增大。其中,位于骨折線兩端的兩枚螺絲釘,即第5、6枚螺絲釘?shù)奈灰谱兓^其他螺絲釘顯著(P＜0.01),進一步進行兩兩比較,螺絲釘1與10、2與9、3與8、4與7、5與6的比較差異無統(tǒng)計學意義(P＞0.05),余兩兩比較差異有統(tǒng)計學意義(P＜0.05)。(3)第5、6枚螺絲釘在c至j狀態(tài)下所發(fā)生的位移和應變在加載力的作用下隨著狀態(tài)的改變逐漸增大(P＜0.01),其中,g至j狀態(tài)較其他狀態(tài)顯著(P＜0.01)。 【結(jié)論】1.采用鋼板進行股骨干骨折內(nèi)固定治療時,應選擇6孔以上的鋼板,以減少由于鋼板的強度損失所引發(fā)的螺絲釘斷裂。其中,骨折線兩端的2枚螺絲釘是承受較多應力的部位,易于發(fā)生斷裂,所有螺絲釘?shù)墓潭☉M量在一條直線上,成對稱分布的螺絲釘應保證穿釘方向的一致性,以避免釘與釘之間產(chǎn)生扭力,引發(fā)負荷不平衡而導致斷裂。另外,病人術(shù)后的功能鍛煉要在骨痂形成后進行。 2.數(shù)字散斑相關方法是一種有效的物體表面變形場全場測量的光力學測量技術(shù),它通過圖像采集、圖像數(shù)字化、處理物體在不同變形狀態(tài)或者不同變形時刻的兩幅圖像從而得到面內(nèi)位移分量和面內(nèi)位移梯度。將此方法應用到生物醫(yī)學實驗研究中,能更精確的指導實驗結(jié)果,從而推動醫(yī)學研究的發(fā)展,是一種值得推廣的研究手段。
[Abstract]:[Objective] To design a safe and ideal puncture route by simulating the neuroendoscopic approach in the posterior horn of lateral ventricle, and to provide anatomical basis for reducing complications and expanding indications of neuroendoscopic surgery.
[Materials and Methods] 1. Subjects: 15 adult brain specimens (30 sides) fixed by 10% formaldehyde were dissected and observed in different layers. The left and right sides were randomly divided into two groups. 2. Experimental methods: Simulated neuroendoscopic surgery was performed on the cadaveric head, the scalp was dissected, the skull was exposed and the brain was dissected. 3 cm apart from the middle line, 3 cm, 4 cm, 5 cm, 6 cm, 7 cm, 8 cm on the occipital eminence were used as the simulated puncture points, named Z1, Z2, Z3, Z4, Z5 and Z6 points respectively. The dura mater was exposed by drilling holes in the skull, and the markers were inserted. The skull was sawed along the occipital eminence, the external ear portal and the arch of the eyebrow, the cranium was removed, and the middle brain was cut off at the tentorium cerebelli hiatus. The sphere is divided into two halves along the median plane. The thalamus is removed and the posterior horn of the lateral ventricle is exposed. Anatomical parameters measurement: from different puncture points, observe the relationship between the puncture meridians and dural vessels, superficial cerebral veins, parieto-occipital sulcus arteries, talus sulcus arteries, angular gyrus, visual radiation, and compare the thickness of cerebral parenchyma through each diameter, the angle of each diameter line and the position that the puncture needle can reach. SPSS11.5 software statistical analysis of the experimental data, measurement data in the mean (+ SD) expression, two groups using group t test, group comparison using analysis of variance, count data using chi-square test, P < 0.05 that the difference was statistically significant.
[Results] 1. The relationship between puncture point and dural vessels: All puncture points were not adjacent to large vessels on the dura mater. 2. The relationship between puncture point and superficial cerebral vein was observed after removal of dura mater. Z5 was located behind superior cerebral anastomotic vein (4.54.84) mm, Z6 was located behind superior cerebral anastomotic vein (5.98.89) mm, and the rest was located behind superficial cerebral venous anastomosis (5.98 The relationship between puncture points and angular gyrus: Z1 and Z2 points were farther away from angular gyrus, Z3-Z6 points were closer to angular gyrus (P The distances from the median sagittal plane to the occipitoparietal sulcus artery were (18.00 (2.01) mm and (24.02 (3.16) mm, respectively. The puncture points of the posterior horn of the lateral ventricle were all adjacent to the two arteries. 5.Z1, Z 2 and Z3 intersected with the optic radiation at the same time, mostly at the upper or middle part of the lateral ventricle triangle. The puncture diameter from the puncture point to the triangle, i.e. line A, is the baseline. When the puncture needle is transferred from the triangle to the central or lower corner, it must be at a certain angle with line A. The puncture angle of line AB is larger (P < 0.05) after the puncture at Z5 and Z6, but the puncture angle of line AC is larger (P < 0.05). From each puncture point, the needle passes through skin, superficial fascia, cap-shaped aponeurosis, subaponeurotic loose connective tissue, epicranium, skull, meninges (dura mater, arachnoid and pia mater) and brain parenchyma in turn. We measured the thickness from skin to skull (22.24 (1.81) mm. Different meridians and different puncture points have different thicknesses of the segment. Puncture through Z1 to Z6 points to the triangle, the central part, the lower horn of the brain parenchyma thickness, namely A, B, C three lines, there is no significant difference (P > 0.05), three-line comparison B > C > A.8. By observing the relationship between the posterior horn of lateral ventricle and the puncture point, Z4, Z5 and Z6 points are easier to reach the side. The anterior horn of the ventricle, while Z2, Z3 and Z4 points are beneficial to enter the inferior horn of the lateral ventricle.
[Conclusion] 1. Endoscopic approach to the posterior horn of the lateral ventricle is the most suitable approach to treat the lesions of the lateral ventricle triangle.
2. Surface localization of endoscopic neurosurgery approach in the posterior horn of lateral ventricle is 3 cm beside the middle line of the brain and 6-7 cm above the occipital eminence. To deal with the lesions of the central part of the lateral ventricle and the inferior horn of the lateral ventricle is helpful to explore the other two parts during the operation.
[Objective] To apply optical measurement method to the biomechanical study of internal fixation of femoral shaft fracture with plate, and to analyze the causes and locations of screw breakage.
[Materials and Methods] 1. Six adult femoral specimens fixed with 10% formaldehyde were selected from the Department of Human Anatomy, Kunming Medical College. The model was established and grouped. All soft tissues were removed from the specimens and the femoral shaft length was measured, and the midpoint position was determined. Wire saw perpendicular to the long axis of the shaft transversely cut, making the middle femoral shaft fracture model. Simulate the differences of various stress conditions, design the experimental model for comparative analysis. Removing a screw at the proximal end; D. removing a screw at the distal end on the basis of group c; E. removing a screw at the proximal end on the basis of group d; F. removing a screw at the distal end on the basis of group e: removing a screw at the proximal end on the basis of group f; h. removing a screw at the distal end on the basis of group g; I. removing a screw at the proximal end on the basis of group H Fixed the experimental models on the mechanical tester, the femoral head was clamped on the upper end, the femoral condyle was clamped on the lower end. Firstly, the load was preloaded 50N to eliminate the time effect of bone relaxation and creep. Then the axial load was 0-500N, the loading speed was 10N/s, and the computer automatically recorded. The displacement and average strain of the screw were calculated by digital speckle method and compared. The experimental data were statistically analyzed by SPSS11.5 software. The measurement data were expressed by Mean (+ SD). The two groups were tested by group t test. The analysis of variance was used in the comparison between the two groups, P < 0.05. There was statistical significance.
[Results] There was a significant difference in the displacement and average strain of 10 screws in the state of a and B (P The displacement of the 5 and 6 screws was significantly different from that of the other screws (P < 0.01). There was no significant difference between screw 1 and 10, 2 and 9, 3 and 8, 4 and 7, 5 and 6 (P > 0.05). There was significant difference between the other two screws (P < 0.05). (3) The displacement of the 5 and 6 screws in the state of C to J occurred. The displacement and strain of G to J increased gradually with the change of state under the action of load (P < 0.01), and the G to j state was more significant than other states (P < 0.01).
[Conclusion] 1. In the treatment of femoral shaft fractures with plate fixation, more than 6 holes of plate should be selected to reduce the screw breakage caused by the loss of plate strength. Symmetrically distributed screws should be kept in the same direction so as to avoid torsion between screws and lead to unbalanced load resulting in fracture.
2. Digital Speckle Correlation (DSC) is an effective photomechanical measurement technique for measuring the deformation field of an object in the whole field. It processes two images of the object in different deformation states or at different deformation times by image acquisition and digitization, and then obtains in-plane displacement components and in-plane displacement gradients. In the experimental research, it can guide the experimental results more accurately, thus promoting the development of medical research, which is a research method worth popularizing.
【學位授予單位】：昆明醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R651;R322

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