Table of Content

25 January 2025 Volume 43 Issue 1

  

Morphological observation and clinical significance of pressure bone trabeculae of femoral head and neck, posteromedial bone cortex of femoral neck and femoral calcar 

Li Haiyan, Li Meng, Du Xinru

Chinese Journal of Clinical Anatomy. 2025, 43(1):  1-8.  doi:10.13418/j.issn.1001-165x.2025.1.01

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Objective    To explore the morphological characteristics of pressure bone trabeculae of femoral head and neck, posteromedial bone cortex of femoral neck and femoral calcar, in order to provide morphological basis for the pathogenesis of femoral neck fracture.    Methods    A total of 102 femur specimens were collected. X-ray films of the upper end of the femur were taken at anteroposterior, lateral, 45° internal oblique and 45° external oblique, respectively. The position relationship of pressure bone trabeculae, calcar and posteromedial bone cortex of femoral neck were observed. Sixty cases of femoral specimens among them, there were 34 specimens in normal group and 26 cases in osteoporosis group. The head and neck of femur were scanned and reconstructed by CT. The morphological differences of pressure bone trabeculae and calcar were compared between the two groups. Six femur specimens were dissected along the vertical, coronal and sagittal surfaces of the femoral neck to observe the morphological characteristics of pressure bone trabeculae, posteromedial cortex of femoral neck and femoral calcar. The data were analyzed by Graphpad Prismv5.0 software.   Results   The pressure bone trabeculae of head and neck of femur concentrated inward and backward, and it stopped at posteromedial bone cortex of femoral neck and continued with the calcar. The greater intertrochanteric bone trabeculae of femoral calcar emerged outward from femoral calcar and thinned in osteoporosis group. The pressure bone trabeculae was cross-connected with femoral calcar, with an angle of (82.96±2.91)° in normal group and (116.40±3.23)° in osteoporosis group, and the difference was statistically significant. There was statistical difference  in the calcar angle on cross-section between two groups [(17.52±0.71)° in normal group and (13.09±0.90)° in osteoporosis group].    Conclusions    The pressure bone trabeculae of femoral head and neck, as well as the upper end of femoral calcar, are attached to the posteromedial bone cortex of femoral neck. The posteromedial cortex of femur neck and femoral calcar jointly bear compressive stress, and the migration site is the pressure transmission hubs. When osteoporosis occurs, femoral calcar becomes smaller, and the cortical bone at the junction between femoral calcar and pressure bone trabeculae is weaker. These may be one of the mechanisms of osteoporotic head-and-neck femoral neck fracture.

Anatomical observation and clinical significance of the adjacent relationship between the V₃ segment and the second cervical nerve 

An Leilei, Kong Xiangyu, Liu Pengfei, Zhang Bin, Ma Zhen, Du Xinru

Chinese Journal of Clinical Anatomy. 2025, 43(1):  9-13.  doi:10.13418/j.issn.1001-165x.2025.1.02

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Objective  To observe the adjacent relationship between V3v and C2N  so as to provide morphological basis for the pathogenesis of cervical spondylotic arteriopathy (CSA) and both occipitocervical  pain combined with vertigo.   Methods   Thirty-three sides of head-neck specimens were selected for this investigation. The anatomical dissecting and stripping methods were used to expose the C2N and V3v and the adjacent structure. The crossing part of C2N and V3v, range and morphology were observed. Results   The anterior branch of C2N run laterally and crossed with V3v posteriorly in all specimen (33/33, 100%). According to the degree of contacts between C2N and V3v, these crossing relations could be divided into as three types: ① Simple contact crossing type: The original cord-shape anterior branch of C2N crossed with V3v laterally, with a total of 6 sides accounting for 18.2% ; ②Indentation crossing type: The segment of anterior branch of C2N which was crossing with V3v was in flat or longitudinal indentation shape, with a total of 7 sides accounting for 21.2%; ③Semi-circular wrapped crossing type: the anterior branch of C2N become flattened and wrapped the V3v in semi-circular way, with a total of 20 sides accounting for 60.6% . The anterior branches of C2N and V3v crossed each other in 16 sides at right angles, accounting for 48.5%. The diameters of V3v approaching to the crossing part and the crossing part were (3.82±0.07) mm and (3.35±0.05) mm, respectively. The width- diameter of the anterior branch of C2N approaching to the crossing part and the crossing part were (2.38±0.05) mm and (3.53±0.09) mm, respectively. The distances between intersection part and central line was (23.25±0.39) mm, the distance from crossing part to the ipsilateral lateral atlantoaxial joint was (6.26±0.2) mm, and the distance to the ipsilateral zygapophysial joint of C2 and C3 was (11.78±0.3) mm.    Conclusions   The anterior branch of the C2N formed three transverse crossing relationships with V3v, the dominant one among them is the semi-circular wrapped crossing type, this closing adjacent relations may lead the anterior branch of C2N to compresse V3v and may reduce the blood supply to the brain, it may be one of the pathogenesis of CSA and/or may be the morphological basis of hypertension with occipitocervical pain.

Anatomical study on endoscopic expanded transnasal approach for clival region

Yin Du, Cen Bo, Chen Yang, Dai Liming, Zhou Junge, Hu Fei

Chinese Journal of Clinical Anatomy. 2025, 43(1):  14-17.  doi:10.13418/j.issn.1001-165x.2025.1.03

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Objective    To introduce the main anatomical structures of clivus and its adjacent structures, so as to provide guidance for endoscopic expanded transnasal approach for the removal of lesions on the ventral side of clivus and posterior fossa.    Methods    Anatomical studies were conducted on the heads of six cadavers, with blood vessels filling with red and blue silicone. The main anatomical markers were collected and measured under a microscope and an endoscope, respectively.    Results   The vertical distance between the upper edge of petrous bone apex and dural foramen of abducens nerve was (3.51±0.62) mm. The distance between posterior clinoid process and dural foramen of abducens nerve was (13.42±1.32) mm, the distance between dural foramen of abducens nerve and glossopharyngeal nerve was (21.53±1.73) mm, and the distance between hypoglossal nerve canal and glossopharyngeal nerve was (25.62±2.24) mm. The glossopharyngeal nerve foramen were (3.73±0.54) mm above the tip of pharyngeal tubercle. The  transverse distance between  eustachian tube foramen was (23.14±1.15) mm. Conclusions   Endoscopic extend transnasal approach is a feasible method for surgical treatment of ventral clival lesions.

Visualization study of three-dimensional reconstruction of sacral vertebra and its cartilage based on continuous thin sectional anatomy dataset in children

Zhang Fengzhen, Yin Zhaozheng, Yi Yuying, Li Lei, Zhao Jing, Wang Xing, Li Kun, Li Zhijun, Zhang Shaojie

Chinese Journal of Clinical Anatomy. 2025, 43(1):  18-25.  doi:10.13418/j.issn.1001-165x.2025.1.04

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Objective    To observe the reconstruction of sacral vertebra and its cartilage based on the continuous ultra-thin sectional anatomical dataset of children, providing 3D visualization models for clinical, teaching and research applications.    Methods   A continuous high-definition sectional anatomy dataset of a 3-year-old girl pelvi in China was obtained by milling the pelvi specimen using cryo-numerical control technology. Then, the software was used to segment the bone, cartilage and intervertebral discs of the sacrum and establish corresponding paths. On this basis, the sacral vertebra model in children was reconstructed and analyzed after reconstruction.Finally, the results of model were compared with the collected pelvic image data of 20 children aged 3 to 4 years to verify its accuracy and effectiveness.  Results    A dataset of ultra-thin and high-definition sectional anatomical images of the pelvic of girls was obtained, and a 3D visual digital model of sacral vertebra and cartilage was constructed in a 3-year-old Chinese girl. The measurement results showed that the anteroposterior diameters of S1-S4 Neurocentral Synchondrosis (NCS) varied from large to small, and the transverse diameters of S1 NCS were significantly larger than those of other sacral vertebra. From S1 to S3, the height of Vertebral Body and Costal Element Cartilage (VB-CEC), perimeter and anteroposterior diameter of VB-CEC gradually decreased from the beginning side to the tail end. The transverse diameter of VB-CEC in S1 was significantly larger than that of VB-CEC in other sacral vertebra. The 3D model was basically consistent with the measurement results of CT image data.    Conclusions   The three-dimensional visualization model of children's sacral vertebra can clearly show the structure and position of sacral vertebra and cartilage, and each cartilage of children's sacral vertebra has developmental anatomical characteristics.

Radiographic observation of cervical immature epiphyseal ring 

Xie Siyuan, Lin Yuanxun, Zhang Yunaolong, Feng Ziyu, Li Yikai

Chinese Journal of Clinical Anatomy. 2025, 43(1):  26-30.  doi:10.13418/j.issn.1001-165x.2025.1.05

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Objective    To investigate the normal developmental process of human cervical epiphyseal ring, so as to provide  basis for the diagnosis of disease and the determination of treatment plan. Methods   Two hundred and fifty patients (98 females and 152 males) who attended Nanfang Hospital of Southern Medical University to receive cervical X-ray lateral radiographs from January 2015 to December 2023 were retrospectively selected. The anterior and posterior epiphyseal rings below C2 to C7 were divided into four stages according to development stage: cartilage stage, ossification stage, fusion stage, and maturity stage. The height, length, distance from anterior/posterior margin of vertebral body (AP distance), and distance from the inferior margin of vertebral body (CC distance) of epiphyseal rings in the ossification stage were measured, and the correlation between these parameters and age was analyzed. Results    The ossification of epiphyseal ring first occurred on a 3-year-old child. All epiphyseal rings began to ossify in children over 15 years of age. The anterior side below C7 was the earliest to begin ossification, and anterior epiphyseal ring usually ossified earlier than posterior side, but posterior epiphyseal ring fused to vertebral body earlier. In the 25-year age group, 20 % of epiphyseal rings were still not completely fused to vertebral body. The mean height of epiphyseal rings during ossification stage was (0.7±0.3) mm, the mean length was (2.8±1.6) mm, the mean AP distance was (1.3±0.6) mm, and the mean CC distance was (0.4±0.2) mm. In 92 % of epiphyseal rings, the AP distance was not greater than 2.0 mm, and in 99 % of epiphyseal rings, the CC distance was not greater than 1.0 mm. There was no significant correlation between any of the parameters and age.    Conclusions    In this study, the normal developmental process of cervical epiphyseal rings in children in China was derived from the observation of cervical X-ray lateral radiographs, which is helpful for the assessment of individual development in clinical work and guiding the diagnosis and treatment of diseases.

MSCT evaluation and clinical application in anatomic classification of bilateral inferior pulmonary veins

Wang Juan, Guo Longjun, Teng Jiaqi, Chen Yukun, He Wen

Chinese Journal of Clinical Anatomy. 2025, 43(1):  31-39.  doi:10.13418/j.issn.1001-165x.2025.1.06

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Objective     To study the anatomy and drainage pattern of pulmonary veins in the lower lobes of both lungs in healthy people by using multi-slice spiral CT (MSCT), and to elucidate its characteristics, so as to provide basis for the anatomical classification of target veins in anatomic segmental pneumonectomy.    Methods    The CT image data of 200 cases with normal lung were collected, and the venous anatomy and drainage pattern were obtained by VR reconstruction. The occurrence rate of venous classification was observed and counted. Combined with the reconstructed 5 mm axial MIP map, three key observation planes were selected to identify the corresponding subtypes.    Results   V6 could be divided into two types according to the number of stems: single trunk (88%), which was the most common type, and double trunk (12%). In addition, there was an independent segment S* between S6 and S10. There were independent segmental bronchi (B) and arteries (A). The bilateral inferior pulmonary basal veins were characterized by radial arrangement. Most of the branches of the medial basal segment vein (V7) were thin in diameter. The branching patterns of anterior basal segment, lateral basal segment and posterior basal segment veins (V8, V9, V10) could be divided into the following four types: V8+V9 / V10 type, V8 / V9+V10 type, V8+V9+V10 / V10 type, and V8+V9 / V9+V10 type, with different proportion in each type.    Conclusions    The anatomical classification and drainage pattern of pulmonary veins can be used as a routine means of anatomical recognition, which provides basis for the fine anatomical evaluation of pulmonary veins before segmentectomy. The data obtained in this study can be used as a supplement to 3D-CT images, which can help to understand the fine anatomy of target veins and bronchi after segmentectomy.

Classification of the Kager fat pad and relationship between Kager fat pad and posterior ankle impingement syndrome

Zhang Lei, Tang Xiangyu, Jiang Lu, Yang Siyi, Zhou Xin, Liu Tianyu, Wang Guoyou

Chinese Journal of Clinical Anatomy. 2025, 43(1):  40-44.  doi:10.13418/j.issn.1001-165x.2025.1.07

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Objective    To classify the imaging morphologic features of the Karger fat pad (KFP) and to investigate its relationship with posterior ankle impingement syndrome (PAIS).    Methods   A total of 194 Chinese patients with ankle magnetic resonance imaging (MRI) scans between August 2018 and August 2021 were observed. Anatomical parameters included flexor hallucis longus-related length of KFP, KFP height, achilles-related length of KFP, the length of os trigonum, length of posterior inferior tibial process, the shortest distance between KFP and tibia, KFP sagittal area, and os trigonum-calcaneus-tibia angle were measured in T1-weighted MRI.    Results    A total of 194 subjects with os trigonum syndrome were enrolled in this study and there were 106 patients  without PAIS (control group) and 88 patients with PAIS. KFP was categorized into 3 types based on its shape, length, height and sagittal area: type I (triangular), type II (long trapezoidal), type III (short trapezoidal). Among the three KFP types, Type Ⅲ (72, 81.8%) accounted for the greatest number in PAIS group, while Type Ⅰ (43, 40.6%) and Type Ⅱ (55, 51.9%) accounted for the larger proportion in the control group.    Conclusion    There is significant difference in the morphology of the KFP between individuals with and without PAIS. It is assumed that the change of KFP is crucial in the progression of PAIS, and a better understanding of different types of KFP is helpful to study the characteristics of PAIS, which can provide certain basis for clinical diagnosis of PAIS in the early stage.

Morphological variation of L3 pedicle in patients with degenerative lumbar scoliosis and its clinical significance

Chen Yonglong, Wang Wei, Chen Jionghui, Zhang Zhenwu, Li Jun, Yang Zhichao, Huang Chunming, Li Xiaochuan

Chinese Journal of Clinical Anatomy. 2025, 43(1):  45-53.  doi:10.13418/j.issn.1001-165x.2025.1.08

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Objective    To compare the morphological parameters of L3 pedicles between patients with degenerative lumbar scoliosis (DLS) and patients without degenerative lumbar scoliosis (NS) and to analyze their clinical significance.    Methods    DLS imaging data of inpatient treatment in Gaozhou People's Hospital affiliated to Guangdong Medical University from 2018 to 2023 were collected, and patients with similar age, gender, height and weight were matched 1:1 as the control group. The pedicle length (PL), pedicle width (PW), pedicle screw trajectory length (PSTL), pedicle camber angle (PCA), pedicle height (PH) and Cobb angle of L3 vertebral body were measured and collected. The morphological parameters of L3 pedicles were compared between the two groups, and the correlation between lumbar Cobb angle and pedicle morphological parameters was analyzed.    Results    A total of 56 patients with DLS were collected as the DLS group, and 56 patients with NS were matched as control group (NS group). There were no significant differences in sex ratio, age, height, body weight and body mass index between two groups (P>0.05). Compared with NS group, the PL, PW, PCA, and PSTL of pedicles on the L3 convex side of the DLS group were significantly smaller (P<0.05), and PH was not statistically significant (P>0.05). PL and PW of concave pedicle were significantly smaller (P<0.05), while PCA and PSTL were significantly larger (P<0.05), and PH was not statistically significant (P>0.05). Compared with concave side, convex pedicle had longer PL, wider PW, smaller PCA and shorter PSTL than concave pedicles in DLS group (P<0.05), and PH was not statistically significant (P>0.05). Cobb angle in DLS group was negatively correlated with convex pedicle PL, PW, PCA and PSTL. It was negatively correlated with PL and PW in concave pedicles, but positively correlated with PCA and PSTL.  Cobb angle of patients in DLS group was also correlated with the difference of PL, PW, and PSTL on concave side of convex side.   Conclusions    Compared with NS group, the pedicles on L3 convex side of DLS group showed changes of "short", "thin" and "retracted", and the pedicles on concave side showed morphological changes of "short", "thin" and "extended". The concave and convex sides are asymmetrical, among which concave pedicle is the most slender and the camber angle is large, which makes DLS patients more prone to accidents when concave pedicle screw is inserted.

Identification and validation of miRNA hub target genes in esophageal cancer

Zhao Tingting, Song Shuang, Shi Ke, Li Xiaoying, Li Panyang, Li Ningning

Chinese Journal of Clinical Anatomy. 2025, 43(1):  54-62.  doi:10.13418/j.issn.1001-165x.2025.1.09

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Objective    To investigate miRNAs-mRNAs related to the occurrence and development of esophageal cancer, and study the effect of PALB2 on the biological characters of human esophageal cancer EC109 cells.   Methods   The data of esophageal cancer miRNAs were downloaded from GEO and TCGA databases to screen out the intersecting miRNAs. The potential target genes of intersection were predicted by starbase database, and the key target genes were identified by PPI network analysis. Functional enrichment analysis was performed for differential genes and hub target genes in GO and KEGG databases. PALB2 gene with significant prognostic difference was selected for cell test, and PALB2 specific small interfering RNA (si-PALB2) was synthesized and transfected into EC109 cells. The expression level of PALB2 in the cells was detected by RT-qPCR. The effects of PALB2 on cell viability, invasion, migration and apoptosis were investigated by MTT, Transwell and flow cytometry. The expression of cyclin CyclinD1, apoptosis suppressor Bcl-2 and matrix metalloproteinase MMP-9 were detected by Western blot.   Results   Bioinformatics analysis showed that miRNAs-mRNAs were involved in the development of esophageal cancer. After PALB2 knockdown, EC109 cell viability, invasion and metastasis ability were significantly decreased, apoptosis ability was significantly increased, and the expressions of cyclinD1, Bcl-2 and MMP-9 were significantly down-regulated.   Conclusions    MiRNAs-mRNAs are biomarkers for predicting the development of esophageal cancer. PALB2 plays a role in promoting cancer in esophageal cancer, and is closely related to the regulation of cyclin, anti-apoptotic protein and invasion and metastasis related protein, which is a potential target for diagnosis and treatment.

The mechanism of Zhuang Medicine Fuzheng Compound improving the efficacy of PD-L1 inhibitor by improving CD8⁺T cell depletion in Lewis lung cancer

Mo Juanmei, Zhang Shunrong, Li Jian, Wang Zhenning, Tang Weizhi, Liang Biqi, Pang Yuzhou, Zhou Jianlong, Zhou Shaozhang, Huang Guodong

Chinese Journal of Clinical Anatomy. 2025, 43(1):  63-68.  doi:10.13418/j.issn.1001-165x.2025.1.10

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Objective    To investigate the effect of Zhuang Medicine Fuzheng Compound on the exhaustion of CD8+ T cells infiltrated by lung cancer and the efficacy of PD-L1 inhibitors, and to clarify the possible mechanism.    Methods    MTT and plate cloning were used to detect the effect of Zhuang Medicine Fuzheng Compound on the proliferation of LLC cells of mouse lung cancer. Flow cytometry was used to detect the proportion of CD8+T and the expression level of PD-L1, and Western blot was used to detect the expression level of protein to preliminarily explore the relevant mechanism. Finally, the synergistic effect of Zhuang Medicine Fuzheng Compound and PD-L1 inhibitor was verified by animal experiments.    Results Zhuang Medicine Fuzheng Compound inhibited the proliferation of LLC cells in mice. In vivo experiments in mice, Zhuang Medicine Fuzheng Compound and PD-L1 inhibitor could play a synergistic anti-tumor effect. Zhuang Medicine Fuzheng Compound delayed the depletion of CD8+ T cells and inhibited the expression of PD-L1. Zhuang Medicine Fuzheng Compound could reduce the activity of PI3K/AKT pathway.    Conclusions    Zhuang Medicine Fuzheng Compound can delay CD8+ T cell depletion and inhibit PD-L1 expression, and enhance the efficacy of PD-L1 inhibitors in the treatment of lung cancer, which may be related to the reduction of PI3K/AKT signaling pathway.

Experimental study on the effect of autologous ligamenta flava on TGF-β1 /Smad3 signaling pathway on epidural fiber scar formation in rabbits

Wang Peng, Zhang Debao, Zhang Yang, Zhang Haibin, Shi Jia, Zhang Shaojie, Li Shuwen, Wu Yimin

Chinese Journal of Clinical Anatomy. 2025, 43(1):  69-75.  doi:10.13418/j.issn.1001-165x.2025.1.11

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Objective    To explore the relationship between the formation of epidural fiber scar and TGF-β1/Smad3 signaling pathway after lumbar spine surgery inhibited by autologous ligamenta flava by comparing the protein expression levels of TGF-β1 and Smad3, the corresponding mRNA expression levels of TGF-β1 and Smad3 at 3 and 6 weeks after laminectomy in different groups of rabbits.   Methods    Forty-eight old Japanese white rabbits, aged 6 to 8 months, purchased from the Experimental Animal Center of Inner Mongolia Medical University were divided into the following group: a retention of ligamenta flava group, an autologous fat replacement group and a non- retention of ligamenta flava group. Surgical modeling was performed for different groups. After operation, the experimental animals in each group were fed for 3 weeks and 6 weeks respectively and killed (8 animals in 3 weeks and 6 weeks, respectively). The protein content and mRNA expression levels of TGF-β1 and Smad3 in samples of each group were determined by Western-blot quantitative analysis and RT-PCR, and the above data were compared between groups to analyze their differences.   Results   ①Western-blot analysis results: The expression levels of TGF-β1 and Smad3 in the retention group were lower than those in the non-retention group and the fat group at 3 and 6 weeks (P<0.05), and there was no significant difference between the non-retention group and the fat group. ② RT-PCR results showed that the mRNA expression levels of TGF-β1 and Smad3 in the retention group were significantly lower than those in the non-retention group and the fat group at 3 and 6 weeks (P<0.05), and there was no significant difference between the non-retention group and the fat group.    Conclusions    After lumbar surgery, different degrees of epidural fiber scar will form. Intraoperative retention of autologous ligamenta flava can reduce the formation of epidural fibroblasts by the mechanism related to the TGF-β1/Smad3 signaling pathway.

Finite element analysis of different positions of TVT and TVT-O in the treatment of stress urinary incontinence in elderly women

Li Weijun, Zhou Yi, Wu Jianhui, Chen Lihua, Liu Haiying, Zhai Lidong

Chinese Journal of Clinical Anatomy. 2025, 43(1):  76-81.  doi:10.13418/j.issn.1001-165x.2025.1.12

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Objective   To simulate common sling surgeries for stress urinary incontinence (SUI) in elderly women using finite element analysis methods: tension-free vaginal tape (TVT) and tension-free vaginal tape - obturator (TVT-O), and to evaluate their therapeutic effects at different positions of urethra. Methods    A pelvic geometry model was constructed based on magnetic resonance imaging (MRI) images of a woman without pelvic floor diseases. The thinning of elderly vaginal tissue was considered as a reduction in tissue stiffness. Abdominal pressure was applied to simulate valsalva maneuver, and TVT and TVT-O were placed at the proximal, mid-distal, and distal parts of urethra, respectively, to obtain mechanical data. Results    The sling at the proximal part of urethra would lead to the α-angle and bladder neck displacement less than normal values. The "funnel" phenomenon disappeared when the sling was located at the proximal and mid-distal parts of urethra, but still existed when located at the distal part; the pressure magnitude between the sling and urethra at different positions was: proximal > mid-distal > distal.   Conclusions   The sling at the proximal part of urethra (30%) is prone to cause excessive tightness of urethra, leading to postoperative complications, the sling at the distal part of urethra (80%) has poor therapeutic effect, the sling at the mid-distal part of urethra (60%) has a good therapeutic effect and a low incidence of postoperative complications. The placement of TVT at the mid-distal part of urethra should be the preferred surgical method for elderly women with SUI.

Comparative study on the efficacy of retrograde and anterograde tibial intramedullary nails in the treatment of distal tibial extra-articular fractures

Xu Zunying, Liu Hui, Xu Weizhen, Zhang Jinhui, Xiong Yuanfei, Zhuang Ping, Lin Jinhe, Wu Jin

Chinese Journal of Clinical Anatomy. 2025, 43(1):  82-89.  doi:10.13418/j.issn.1001-165x.2025.1.13

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Objective    To compare the clinical efficacy of retrograde tibial intramedullary nail and antegrade tibial intramedullary nail in the treatment of patients with extra-articular distal tibial fractures. Methods    A retrospective review was conducted for 56 patients admitted to our department with extra-articular distal tibial fractures between August 2020 to August 2022. Twenty-three patients were treated with retrograde intramedullary nail fixation and 33 patients were treated with anterograde intramedullary nail fixation. Baseline characteristics, surgical time, fluoroscopy frequency, hospital stay, fracture healing time, complete weight-bearing time, distal tibial articular surface angulation, American Orthopedic Foot and Ankle Society (AOFAS) score at the last follow-up, and other complications were recorded and compared between the two groups.    Results    All patients were followed up for 12-20 months. In the retrograde intramedullary nail group, the average distance of the fracture line to the distal tibial articular surface was shorter than that of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.001). There was no statistically significant difference in other general clinical data between the two groups of patients. The average number of fluoroscopy times in the anterograde intramedullary nail group was higher than that in the retrograde intramedullary nail group, and the difference was statistically significant (P=0.001). The complete weight-bearing time and fracture healing time of the retrograde intramedullary nail group were better than those of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.002 and P=0.018). There were 4 cases of postoperative complications in the retrograde intramedullary nail group and 10 cases in the anterograde intramedullary nail group, with no statistically significant difference in the incidence of complications.   Conclusions    Both retrograde and antegrade intramedullary nails are effective methods for treating extra-articular distal tibial fractures. Retrograde intramedullary nails have the advantages of number of intraoperative fluoroscopy, complete weight-bearing time, and fracture healing time.

The application of digital positioning combined with 3D printed percutaneous puncture guide plate in the treatment of femoral neck fractures

He Yibo, Luo Zhangfeng, Tian Yu, Jiang Shuai, Xie Longhui, Shao Yiwen, Li Li , Rao Libing

Chinese Journal of Clinical Anatomy. 2025, 43(1):  90-96.  doi:10.13418/j.issn.1001-165x.2025.1.14

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Objective    To study the application value and clinical effect of digital positioning combined with 3D printed technology in the treatment of femoral neck fracture with screw internal fixation.  Methods    Thirty-six patients undergoing internal fixation for femoral neck fracture in our hospital between 2022 and 2023 were randomly divided into a 3D group and a traditional group, with 18 patients in each group. The traditional group used traditional freehand nailing, and the 3D group applied digital positioning combined with 3D printed guide plate for internal fixation surgery. Operation time, intraoperative blood loss, times of K-wire puncture, intraoperative X-ray exposure times, imaging index, and follow-up results were compared between the two groups.    Results    The intraoperative blood loss, mean surgical operation time, intraoperative X-ray exposure times and times of K-wire puncture in 3D group were lower than those of the traditional group (P<0.001). The imaging evaluation result showed that the screw spacing, angle between screw and femoral neck axis in the 3D group were lower than those of the traditional group. The ratio of screw distribution area and the distance from screw to cervical cortex in in the 3D group was higher than those of the traditional group, and the difference was statistically significant (P<0.05). There were no statistical differences in the length of hospitalization, time of complete weight-bearing activity, complete healing of the fracture, and occurrence of complications, no cases of femoral head necrosis at the last follow-up between the two groups (P>0.05). There were no statistical differences in Harris scores at 1, 3, and 6 months and the last follow-up (P>0.05).    Conclusions    Digital positioning technology combined with 3D printed percutaneous puncture guide plate in the treatment of femoral neck fracture internal fixation, can significantly improve the surgical accuracy and reduction quality, and reduce the operation time, intraoperative blood loss, fluoroscopy times and number of Kirschner needle puncture.

Surgical efficacy and prognosis follow-up study of electrophysiological monitoring microsurgical methods for the treatment of spinal cord intramedullary tumors

Liu Longqi, Shi Liang, Wang Keda, Su Yibing

Chinese Journal of Clinical Anatomy. 2025, 43(1):  97-101.  doi:10.13418/j.issn.1001-165x.2025.1.15

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Objective    To explore the impact of using neurophysiological monitoring during spinal cord intramedullary tumor resection surgery on surgical outcomes and patient prognosis.    Methods    A retrospective study was conducted on 92 patients with spinal cord intramedullary tumors who underwent microsurgical resection treatment at Beijing Jishuitan Hospital affiliated to Capital Medical University from January 2018 to December 2020. Among them, 48 patients received traditional microsurgical resection treatment (control group), while the other 44 patients received microsurgical resection treatment + neurophysiological monitoring (combination group). The surgical resection effects, spinal cord function evaluation at different times before and after surgery, clinical symptoms and postoperative occurrence at 3 years were compared between the two groups.   Results    There was no statistical difference in total tumor resection rate between the combined group and control group (P>0.05). Before surgery, there was no statistical difference in the incidence of sensory dysfunction, motor dysfunction, pain and sphincter dysfunction between the combination group and the control group (P>0.05). The incidence of sensory dysfunction and motor dysfunction in combined group patients at 6 months and 3 months after surgery were significantly lower than those in control group (P<0.05). Before surgery, there was no statistical difference in the composition of the McCormick grading of spinal cord function between combination group and control group (P>0.05). After 6 months of postoperative evaluation, the McCormick grading of spinal cord in combination group was better than that in the control group (P<0.05). After a 3-year follow-up, the recurrence rate in combination group was 6.82%, while the recurrence rate in control group was 12.50%. There was no statistical difference in the recurrence rate between two groups (P>0.05).    Conclusions    The use of neurophysiological monitoring during spinal cord intramedullary tumor resection surgery is more conducive to reducing spinal cord injury caused by surgery, promoting postoperative recovery of motor and sensory functions and spinal cord function in patients, but it has little impact on the prognosis of patients.

Research progress on ferroptosis-mediated intervertebral disc degeneration

Deng Zongyuan, Chen Chong, Liang Guoyan, Ye Yongyu, Yu Zhengran, Yu Tao, Wang Lutong, Liang Changxiang, Chang Yunbing

Chinese Journal of Clinical Anatomy. 2025, 43(1):  102-106.  doi:10.13418/j.issn.1001-165x.2025.1.16

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 Intervertebral disc degeneration (IVDD) is a common lesion in spinal surgery, which often leads to spinal degenerative diseases such as spinal stenosis and disc herniation. As age increases, its prevalence is on the rise. The pathogenesis of IVDD is complex and unclear, and there are currently no effective treatments. Ferroptosis is a novel form of cell death characterized by the accumulation of iron-dependent lipid peroxides and plays an important role in the development of many diseases. Recent studies have found that ferroptosis is closely related to the occurrence and development of IVDD, but its mechanism of action in IVDD has not yet been fully understood. This article reviewed the molecular mechanism of ferroptosis, the relationship between ferroptosis and IVDD, and its clinical application potential, aiming to provide new ideas for the prevention and treatment of IVDD.

Research progress of screw-rod internal fixation technique optimization with posterior atlantoaxial fixation fusion

Chen Zexing, Zou Xiaobao, Zhu Changrong, Yang Haozhi , Lian Peirong, Ma Rencai, Chen Junlin, Ma Xiangyang

Chinese Journal of Clinical Anatomy. 2025, 43(1):  107-111.  doi:10.13418/j.issn.1001-165x.2025.1.17

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Atlantoaxial dislocation is one of the most common diseases of upper cervical vertebrae, and screw rod internal fixation has become the most widely used technique for posterior approach of atlantoaxial vertebrae. In recent years, a large number of studies have optimized the posterior atlantoaxial screw rod system, which has increased the safety of screw placement, the stability of internal fixation system and the ability of reduction. Through a comprehensive review of the pertinent literature on the optimization of posterior atlantoaxial screw-rod internal fixation technique both domestically and internationally over recent years, this paper reviews the evolution, characteristics, and optimization strategies of various commonly employed atlantoaxial screw placement technique, with the aim of assisting clinical decision-making in the management of atlantoaxial dislocation.

Research progress on vertebral cartilage development-related molecules in the pathogenesis of congenital scoliosis

Zhao Xingchen, Ye Yongyu, Dai Jingxing, Yu Tao, Cheng Xing, Yin Dong, Ouyang Jun, Chang Yunbing, Chen Chong

Chinese Journal of Clinical Anatomy. 2025, 43(1):  112-115.  doi:10.13418/j.issn.1001-165x.2025.1.18

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The vertebral body originates from the body segments and is an important part of spine. Its developmental abnormalities are related to various diseases such as congenital scoliosis (CS). During human embryonic development, mesenchymal cells derived from somites differentiate into vertebral cartilage cells and then ossify to form vertebral bodies. During this process, vertebral cartilage development is coordinated and regulated by a variety of molecular signals. However, there is no comprehensive review on the relationship between the development process of vertebral cartilage and the pathogenic factors of CS. Therefore, we summarized the molecular mechanisms related to the development of vertebral cartilage and CS, and elucidated the molecular regulation behind the pathogenic factors of CS, in order to find clinical better methods to treat CS provide theoretical basis and research direction.

Fetal pulmonary artery sling complicated with multiple cardiovascular malformations: a case report

Lv Yang, Wang Yu, Zhang Ping-feng, Zhang Zeyu, Yang Wencheng, Fu Heng

Chinese Journal of Clinical Anatomy. 2025, 43(1):  116-117.  doi:10.13418/j.issn.1001-165x.2025.1.19

Abstract ( 12 )   PDF (1464KB) ( 3 )  

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