Table of Content

25 November 2024 Volume 42 Issue 6

  

Clinical application of penile fascia anatomy in the surgery of congenital concealed penis

Zhang Hongyi, Feng Gaifeng, Zhou Haibin, Sun Menghang, Wang Chenyue, Li Huafeng, Cui Jie, Jin Lei

Chinese Journal of Clinical Anatomy. 2024, 42(6):  617-621.  doi:10.13418/j.issn.1001-165x.2024.6.01

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Objective    To explore the etiology of congenital concealed penis and provide theoretical basis for preventing postoperative penile retraction, long-term lymphedema of prepuce by the anatomical observation of penile fasciae in cadavers.    Methods    Ten adult male cadaver penises were dissected to observe the structures of penile fasciae. The anatomical findings were applied to the surgery for correcting congenital concealed penis. The intraoperative and postoperative data of 60 patients were investigated and recorded.    Results    The dartos fascia has sub-layers. Many blood vessels, nerves, and lymphatic tissues were found in the superficial layer. The reserve of an intact superficial layer of dartos fascia during surgery will help prevent long-term lymphedema of prepuce. The deep layer of dartos fascia was a membranous tissue with fewer venules, and there were many fused fibers with the superficial layer of dartos fascia or Buck's fascia. The deep layer of dartos fascia was fixed to Buck's fascia by the fused fibers. After removing the deep layer of dartos fascia, the penis was extended obviously. None of the patients underwent postoperative penile retraction. The Buck's fascia fixed the dorsal artery, deep dorsal vein and dorsal nerves to tunica albuginea. The injury may lead to severe complications. The skin borderline between penile shaft and mons pubis or scrotum, as well as the fat plane of subpubic or scrotal septum, is an anatomical landmark for reconstructing the penoscrotal angle.    Conclusions    The anatomical structures and functions of penile fascia are different. It is important to have a good understanding of the anatomical structure to prevent the penis retraction after operation, long-term lymphedema of prepuce and restore the normal appearance of the penis. 

Anatomical study of superficial inguinal lymph nodes and its nutrient vessels

He Xizhu, Liang Haibing, Li Zeyu, Zeng Deqing, Ke Wumei, Ouyang Jun, Wang Haiwen

Chinese Journal of Clinical Anatomy. 2024, 42(6):  622-626.  doi:10.13418/j.issn.1001-165x.2024.6.02

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Objective   To determine the number, size and distribution of superficial inguinal lymph nodes, as well as the source and external diameter of nutrient arteries, so as to provide anatomic basis for clinical flap transplantation with lymphatic vessel pedicle and lymph node transplantation in the treatment of limb edema.   Methods    The inguinal region of 4 adult cadavers (8 sides) was dissected, and the quadrants were divided with the great saphenous vein as the origin. The superficial lymph nodes and their nutrient vessels were measured and counted by Photoshop.    Results    A total of 38 lymph nodes were detected on 8 sides, including (2.3±0.7) nodes in Quadrant 1, (0.8±0.7) nodes in quadrant 2, (1.3±0.7) nodes in Quadrant 3, and (0.5±0.5) nodes in quadrant 4. Quadrant 1 was compared with Quadrant 2, Quadrant 3 and Quadrant 4, respectively, and the differences were statistically significant (P<0.01). The sources and external diameters of the main arteries in the lymph nodes were as follows: Quadrant one was the superficial circumflex iliac artery, superficial abdominal artery, deep femoral artery, (0.53±0.23) mm; Quadrant two was the superficial circumflex iliac artery, superficial abdominal artery, (0.56±0.09) mm; Quadrant 3 was the femoral deep artery, (0.81±0.17) mm; Quadrant 4 was the femoral deep artery, (0.58±0.11) mm.    Conclusions    The number of lymph nodes in Quadrant 1 is more than that in the other three quadrants, and the area is relatively small. The external diameter of the nutrient artery meets the requirements of microsurgical vascular suture, and can be used as a candidate area for clinical flap transplantation with lymphatic vessel pedicle and lymph node transplantation.

Clinical anatomic study of end-to-end anastomosis repair of tension-free recurrent laryngeal nerve

Hu Xuyi, Yang Yang, Huang Wenhua

Chinese Journal of Clinical Anatomy. 2024, 42(6):  627-633.  doi:10.13418/j.issn.1001-165x.2024.6.03

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Objective   To further understand the blood supply source of recurrent laryngeal nerve, determine the growth range, origin point and free end point of left and right recurrent laryngeal nerve, and provide anatomical basis for end-to-end anastomosis of recurrent laryngeal nerve.   Methods   The blood supply of recurrent laryngeal nerve was dissected in 20 female and 10 male cadavers by modified perfusion technique. In the simulated operation, the shape of recurrent laryngeal nerve was changed and the length of recurrent laryngeal nerve growth was measured after continuous free "vagal branch" operation under X2.5 times anatomical microscope. Tissue sections were taken at the stop of the free "vagolaryngeal branch" operation, the originating point of the recurrent laryngeal nerve and the middle of the two, and no nerve fibers were damaged during the separation operation, and the free end point of the "vagolaryngeal branch" was defined.    Results   The blood supply to the left side of the recurrent laryngeal nerve was mainly from the aortic arch and the left common carotid artery, and the blood supply to the right side was mainly from the brachiocephalic trunk, the right common carotid artery and the right subclavian artery. The total growth of recurrent laryngeal nerve in male was (11.93±1.23) mm (left) and (3.89±0.37) mm (right), respectively. The total amount of recurrent laryngeal nerve growth in female was (10.13±0.98) mm (left) and (3.17±0.33) mm (right), respectively. At the same time, the free "vagolaryngeal branch" operation was histologically tested without nerve damage.   Conclusions   The blood supply of recurrent laryngeal nerve, the growth length of recurrent laryngeal nerve after changing nerve course and free "vagal laryngeal branch", and the data of point surface projection can provide the basis for clinical surgical repair of recurrent laryngeal nerve.

Anatomic study on blocking point of erector spinae plane block

Chen Yonghe, Ma Yangyang, Zheng Minghui

Chinese Journal of Clinical Anatomy. 2024, 42(6):  634-638. 

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Objective    To investigate the positional relationship between the dorsolateral branch (DLB) of the thoracic nerve in the deep surface of the erector spinae muscle (ESM) and the paravertebral space by using cadaveric specimens, so as to provide anatomical evidence for improving ultrasound-guided erector spinae plane (ESP) block.    Methods   Eighteen embalmed and fixed adult cadaveric specimens were used. Loose tissue between the ESM-transverse process plane and the thoracic paravertebral space was removed to measure the distances between the DLB and the intertransverse ligament (ITL) and lateral costotransverse ligament (LCTL).    Results    The DLB of the thoracic nerve at the ESM-transverse process plane communicated with the spinal nerve in the paravertebral space through a bony-fibrous canal, surrounded by loose connective tissue. The distances between the DLB and ITL, and between the DLB and LCTL at the ESM-transverse process plane generally increased from T1 to T11. The smallest distances were observed at the T1 segment, which were (4.86±1.81) mm and (5.02±1.60) mm, respectively, while the largest distances were observed at the T11 segment, which were (7.94±2.43) mm and (8.43±2.57) mm, respectively.    Conclusions The DLB at the ESM-transverse process plane may be an ideal block site for ESP block. Under ultrasound guidance, using the ITL and LCTL as localization landmarks is feasible for performing ESP block.

Comparison of microanatomy and digital subtraction angiography of the superficial veins in the central brain region

Xian Junmin, Yang Weimin, Wu Qingjie, Miao Lei, Feng Yugong

Chinese Journal of Clinical Anatomy. 2024, 42(6):  639-643.  doi:10.13418/j.issn.1001-165x.2024.6.05

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Objective    To investigate the observation and clinical significance of microanatomy and digital subtraction angiography (DSA) of the central cerebral superficial veins.   Methods    The imaging data of 50 patients (100 sides) who were examined by digital subtraction angiography (DSA) in Heze Municipal Hospital from September 2020 to March 2023 were retrospectively analyzed, and the morphological structure and reflux position of the superficial cerebral veins in the brain central region were observed, and the diameter of the tubes were measured. Red and blue latex were used to infuse the arteries and veins of 20 (40 sides) cadaveric head specimens, and the composition, morphology, and course of the central superficial veins were observed under the microscope, and the diameter of the tubes were measured. The two results were then compared.    Results   Six types of central superficial veins were observed in DSA images: (1) anterior central vein type, (2) Trolard vein type, (3) central sulci vein type, (4) posterior central vein type, (5) mixed type, (6) absent central superficial vein type. The diameter of the anterior central vein was (3.84±1.24) mm on the left and (3.68±1.43) mm on the right. The diameter of the central sulcus vein was (4.12±1.11) mm on the left and (4.03±1.16) mm on the right. The venous tube diameter of Trolard was (1.12±0.41) mm on the left and (1.21±0.48) mm on the right. The diameter of the posterior central vein was (1.07±0.78) mm on the left and (1.14±0.67) mm on the right. The microanatomical observation of 20 cases (40 sides) showed that the central superficial veins were divided into five types: (1) anterior central vein type, (2) central sulcus vein type, (3) mixed type, (4) Trolard vein type and (5) posterior central vein type. Anterior central vein diameter: left (3.79±1.04) mm; Right was (3.51±0.97) mm. The left diameter of central sulci vein was (4.02±1.07) mm; the right was (3.93±1.03) mm. The left diameter of Trolard venous tube was (1.06±0.61) mm. The right was (1.13±0.59) mm. The left diameter of the posterior central vein was (1.45±0.44) mm, the right was (1.72±0.75) mm. There was no significant difference in pipe diameter between the two methods (all P>0.05).  Conclusions The microanatomy and imaging showed that the morphological structure and reflux position of the superficial veins in the central region of the brain were varied. Both microanatomy and clinical imaging data can provide more detailed morphological information of the central superficial vein for neurosurgeons, which is conducive to the preoperative planning of surgeons.

Digital anatomical research on the maximum screw channel of the percutaneous retrograde suprapubic  branch

Yang Demeng, He Jinjian, Zhang Mingkun, Song Jinhang, Li Shaojuan, Ren Tianning, Yan Hanxiao, Hu Zhenhua, Peng Dandan, Zhu Shuliang, Hou Likang, Han Muyu, Chen Zhiguo

Chinese Journal of Clinical Anatomy. 2024, 42(6):  644-648.  doi:10.13418/j.issn.1001-165x.2024.6.06

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Objective   To construct a 3D model of the pelvis, simulate the process of suprapubic screw placement, and determine the parameters of the largest channel for retrograde suprapubic screw placement.    Methods    Pelvic CT scan data of 50 adults were collected from the Imaging Center of Pingxiang People's Hospital from December 2020 to December 2022. This data was imported into Mimics 20.0 software to reconstruct the 3D pelvic model and simulate screw placement. The placement process was as follows: (1) The axis of the suprapubic screw channel was determined, a small-diameter virtual cylinder was inserted; (2) The diameter of the virtual cylinder was increased until it didn't break through the pubic body, suprapubic ramus and acetabulum, considering it as the largest screw channel; (3) The length and diameter of the largest screw channel, the angle of the screw axis with the sagittal and transverse planes were measured. Results   The ranges of the largest channel length were: male right (107.26±7.58) mm, male left (106.96±11.01) mm, female right (102.34±8.30) mm, female left (103.30±10.05) mm; the range of largest channel diameter were: male right (8.10±0.61) mm, male left (8.05±0.66) mm, female right (6.57±0.77) mm, female left (6.48±0.61) mm. There was no significant difference in the maximum length of the screw channel and the included angle with the cross section between male and female and between the left and right sides (P>0.05). There was no significant difference in the maximum diameter between the left and right sides (P>0.05), but the difference between male and female was statistically significant (P<0.001).   Conclusions   The average diameter and length of male in maximum screw channel are 8.07 mm and 107.11 mm, respectively. The average diameter and length of female are 6.50 mm 102.82 mm, respectively. This study can provide anatomical reference for percutaneous retrograde suprapubic branch screw fixation and help clinicians choose suitable surgical screws.

Anatomical morphologic classification of the peroneal trochlea on the calcaneus and its clinical significance

Zhang Lei, Chen Xu, Chen Xueyi, Wu Wangyu, Xiong Bin, Shi Houyin, Wang Guoyou

Chinese Journal of Clinical Anatomy. 2024, 42(6):  649-654.  doi:10.13418/j.issn.1001-165x.2024.6.07

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Objective    To investigate the morphological classification of the peroneal trochlea, and to explore its clinical significance.   Methods    From July 2014 to February 2023, 215 people were included in this retrospective study, which was provided by Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University. The peroneal trochlea was classified according to its morphology and the height, length, relative position to the surrounding structures and the excision angle were measured, respectively.   Results   The calcaneus of 166 (77.2%) cases showed peroneal trochlea. The morphology of the peroneal trochlea could be divided into 4 types: flat type in 12 cases (7.2%), conicalness type in 73 cases (44.0 %), straight ridge type in 74 cases (44.6%), and olecranon-type in 7 cases (4.2%). There was no statistical significancein height and distance from the midpoint of peroneal trochlea to posterior surface of calcaneus between genders (P>0.05). The height of straight ridge type and olecranon-type were significantly higher than that of the conicalness type (P<0.05). Meanwhile, the height of conicalness type was significantly higher than that of the flat type (P<0.05). The length of conicalness type was significantly shorter than that of other types (P<0.05). The distance between the midpoint of peroneal trochlea and the fifth metatarsal tuberosity and the lateral midpoint of calcaneocuboid articular surface of conicalness type was significantly longer than that of straight ridge type (P<0.05). The distance between the midpoint of peroneal trochlea and the posterior surface of calcaneus of conicalness type was significantly shorter than that of straight ridge type (P<0.05).   Conclusions    This study provides further information on the classification, size and location of the peroneal trochlea, which may present anatomical basis for clinical diagnosis and treatment of hyperplastic peroneal trochlea, to avoid blind resection of the peroneus tendon injury.

Bony structure measurement and bilateral 3D registration of radial head  

Yang Guang, Chen Renjie, Li Shangzhe, Zhang Hailong, Lu Yi

Chinese Journal of Clinical Anatomy. 2024, 42(6):  655-659.  doi:10.13418/j.issn.1001-165x.2024.6.08

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Objective    To measure bony structure of adult radial head, register three-dimensionally the bilateral radial heads and analyze the correlation of factors including age, gender and BMI.    Methods Three-dimensional CT data of both elbows were collected from 53 normal volunteers, consisting of 22 females and 31 males, with an average age of (34.2±8.1) years, excluding those with abnormal bony structures. The radiological data were transferred to the MIMICS 21.0 software in DICOM format. The measurements included the maximum diameter (D1max) and the minimum diameter (D1min) of the lateral edge of the bilateral radial heads, the maximum diameter (D2max) and the minimum diameter (D2min) of the medial edge, the height of the radial head (H), the radius of curvature (r), and the neck-shaft angle (a). Further, three-dimensional registration of bilateral radial heads was conducted to evaluate the differences in the stereo structure of both sides. The effects of age, sex and BMI on the structural differences of bilateral radial heads were analyzed. Results   For all patients, the left D1max, D1min, D2max, D2min, H, r, and a were (23.13±2.20) mm, (21.76±2.15) mm, (17.68±2.03) mm, (16.62±1.80) mm, (11.13±0.9) mm, (11.61±1.09) mm, and (167.78±2.25)° respectively. For the right side, the values were (23.28±2.12) mm, (21.87±2.15) mm, (18.28±1.83) mm, (16.93±1.77) mm, (11.32±1.33) mm, (11.53±0.89) mm, and (167.81±2.31)° respectively. There was significant difference in D2max between the bilateral radial heads (P=0.027), but the average difference was less than 2 mm and not clinically significant.  There were no significant differences in other anatomical parameters between both sides. Correlation analysis showed that age, gender and BMI were not the influencing factors of structural differences.    Conclusions    In the normal population, there are no significant differences in the osseous structure of the bilateral radial heads, and no significant correlation among age, gender or BMI. Therefore, the osseous structure of one radial head can be used to construct an anatomical template for the opposite radial head.

Roles of glycogen synthase kinase 3α and glycogen synthase kinase 3β in neural differentiation of mouse embryonic stem cell

Deng Weiling, Zhang Xuhui, Chen Zirui, Huang Yihua, Hu Yafang, Wu Yongming

Chinese Journal of Clinical Anatomy. 2024, 42(6):  660-665.  doi:10.13418/j.issn.1001-165x.2024.6.09

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 Objective    To investigate the roles of glycogen synthase kinase 3α (GSK3α) and glycogen synthase kinase 3β (GSK3β) in neural differentiation of embryonic stem cells (ESCs) in vitro.    Methods Gsk3a or Gsk3b knockout ESCs lines were generated using CRISPR/Cas9 technology. These ESCs lines were then subjected to neural induction in vitro, and the differential gene expression of ESCs was analyzed using RNA sequencing (RNA-seq).   Results    Gsk3a-/- ESCs or Gsk3b-/- ESCs cells still maintained pluripotency and were capable of differentiating into neural stem cells (NSCs). However, Gsk3b-/- ESCs failed to form neural rosettes, and their NSCs were unable to further differentiate into neurons and glial cells. Analysis of mRNA expression of germ layer markers revealed slightly higher expression of neural ectoderm markers in Gsk3a-/- ESCs compared to the wildtype (WT) group, while the expression of endoderm markers in Gsk3b-/- ESCs was significantly higher than both the WT group and Gsk3a-/- ESCs（P<0.001）, with lower expression of neural ectoderm markers. RNA-seq results indicated changes in genes involved in the JAK-STAT, PI3K-Akt signaling pathway, as well as genes like Neurog1 and Hes1.  Conclusions  GSK3α inhibits neuronal differentiation while GSK3β promotes neuronal differentiation, and their mechanisms are associated with the JAK-STAT, PI3K-Akt signaling pathways, as well as Neurog1 and Hes1.

Hepatocyte growth factor promotes neuroinflammation mediated by BV2 cells through activating NF-κB signaling pathway

Shen Ruoqi, Lu Yubao, Wang Ziming, Liu Bin, Zhang Liangming, Yang Yang

Chinese Journal of Clinical Anatomy. 2024, 42(6):  666-672.  doi:10.13418/j.issn.1001-165x.2024.6.10

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Objective    To explore the effect of hepatocyte growth factor (HGF) on microglia-mediated neuroinflammation and its regulatory mechanism, and to provide experimental basis and theoretical reference for the determination of possible treatment targets.   Methods    The mouse immortalized cell line-BV2 cells, which retain multiple morphological and functional characteristics of microglia, were divided into a control group and a HGF group. The effects of HGF on the activity of NF-κB signaling pathway and subsequent expression of neuroinflammatory factors were determined by tyrosine phosphorylated proteomic analysis, cell survival assay, quantitative real time polymerase chain reaction (qRT-PCR) and western blot (WB).   Results Tyrosine phosphorylated proteomic analysis showed that after addition of HGF, NF-κB signaling was one of the most enriched pathways in BV2 cells. At 1 hour after the addition of HGF with different concentrations, the proliferation activity of BV2 cells was decreased. At both 6 hours and 12 hours after the supplementation of HGF with various concentrations, the proliferation activity of BV2 cells increased at early stage, while decreased at late stage. qRT-PCR found that HGF could upregulate the transcription level of inflammatory factors derived from BV2 cells (iNOS, TNF-α, IL-1β). WB also showed that HGF could promote protein translation of associated inflammatory factors (TNF-α, NF-κB p65).    Conclusions    This study confirms the role of HGF in promoting neuroinflammation by activating the NF-κB signaling pathway in BV2 cells and its mechanism. It provides important clues to further explore the regulatory strategies on neuroinflammation to develop more effective treatment in the clinic.

Augmentation of flap survival and sensory recovery in rats with GSK429286A

Lin Jiafu, Wang jianhong, Fang Fang, Liu Donghong

Chinese Journal of Clinical Anatomy. 2024, 42(6):  673-679.  doi:10.13418/j.issn.1001-165x.2024.6.11

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Objective    o explore the efficacy of the strong ROCK inhibitor GSK429286A in promoting the survival and sensory recovery of extended flaps in rats.    Methods   32 male SD rats were adopted and extended flaps measuring 10 cm×3 cm based on the iliolumbar perforator were harvested. The rats were then equally divided into a control group and a GSK429286A group (administered intraperitoneally at a dose of 10 mg/kg), and into 7 and 30 days after surgery. At day 7, the flaps were photographed for calculation of necrosis rates. Subsequently, laser Doppler contrast imaging was used to assess blood perfusion in the second choke zone. At day 30, the sensory recovery of the flaps in both groups was evaluated using the cutaneous trunci muscle reflex (CTMR). Tissue samples from the second choke zone were collected at day 7 and 30, and immunohistochemical staining with α-SMA and NF-200 antibodies was performed to visualize the vessels and nerves. For in vitro study, dorsal root ganglia (DRG) were obtained from 15-day pregnant rats and divided into the control and GSK429286A groups. After treatment with GSK429286A (10 mmol/L) for 3 days, Tuj1 antibody was used to stain the DRG axons, and the length of DRG axons was measured. The Independent sample t-test was used to compare the data between the two groups.   Results    The necrosis rates in the control and GSK429286A groups were (19±7) % and (11±5) %, respectively, showing a significant difference (P=0.032). The vascular diameter in the second choke zone of the control and GSK429286A groups were 81±8 um and 106±7 um, respectively, also demonstrating a significant difference (P<0.001). In accordance, blood perfusion in the second choke zone was (67±5) PU in the GSK429286A group, significantly higher than 45±11 PU in the control group (P=0.002). At day 30, abundant NF-200-positive nerve fibers could be observed within the flaps of the GSK429286A group, resulting in positive CTMR. In contrast, no NF-200-positive nerve fibers could be observed in the control group, resulting in negative CTMR.    Conclusions    The strong ROCK inhibitor GSK429286A can simultaneously promote the survival and sensory recovery of flaps in rats.

Endoscopic-assisted hematoma evacuation and medial meningeal artery angiotomy for compartmentalized chronic subdural hematoma: surgical procedures and clinical outcomes

Xu Feifei, Shao Lin, Ma Xiaoyue, Li Zhihong, Wang Qingyi

Chinese Journal of Clinical Anatomy. 2024, 42(6):  680-685.  doi:10.13418/j.issn.1001-165x.2024.6.12

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Objective    Chronic subdural hematoma (CSDH) is a prevalent and severe clinical condition that poses significant treatment challenges. The current surgical procedures are inadequate in addressing the removal and prevention of the hematoma, often resulting in high recurrence rates. This study developed a novel surgical procedure and validated its therapeutic effect.   Methods    Considering the anatomical features of CSDH and the middle dura mater artery, the author proposed a procedure known as Endoscopic Assisted Hematoma Evacuation and Mediated Meningeal Artery Angiogomy (EHEMMA). This retrospective study detailed the EHEMMA procedure and evaluated the conditions of patients and clinical outcomes, comparing them in the EHEMMA cohort with those of the cohort control undergoing Endoscopic Assisted Hematoma Evacuation (EHE).   Results  Thirty-two patients with CSDH were included in the EHEMMA group and 41 patients in the EHE group. Compared with the EHE group, the recurrence rate of hematoma was markedly reduced in the EHEMMA group (P=0.048), at 180 days following the surgeries. No patients in the EHEMMA group required additional surgery, while 6 patients in the EHE group received secondary surgeries. There were no significant differences between the two cohorts in terms of favorable outcomes, mortality, postoperative acute intracranial hemorrhage, and surgical site infection.    Conclusions The EHEMMA procedure is deemed to be as safe as EHE and can significantly lower the risk of postoperative hematoma recurrence in CSDH patients. It also reduces the need for secondary surgeries, thus achieving comparable outcomes to EHE surgery in a cost-effective way.

Treatment of scaphoid bone fracture nonunion with autogenous bone graft fixed with multiple Kirschner Wires through small radial incision of carpal 

Liu Jiayin, Liu Huiren, Yu Zhanyong, Wang Yan, Sun Rutao

Chinese Journal of Clinical Anatomy. 2024, 42(6):  686-689.  doi:10.13418/j.issn.1001-165x.2024.6.13

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 Objective    To investigate the clinical efficacy of scaphoid nonunion with autogenous bone graft fixed by multiple Kirschner Wires through small radial incision of carpal.    Methods    From January 2008 to January 2018, 19 cases of scaphoid nonunion were treated with multiple Kirschner wires fixation and autologous bone grafting through small radial incision centered on the radial styloid process, including 15 males and 4 females. The age ranged from 25 to 54 years, with an average of 37.6 years. The treatment time of patients after injury ranged from 3 to 32 months, with an average of 15.1 months. After the operation, the thumb and forearm were immobilized with a tube cast for 12-16 weeks.   Results   All the incisions were healed in one stage. Fracture union occurred in 17 cases and non-union in 2 cases,  union rate was 89.5%. Clinical healing time ranged from 12 to 16 weeks, with an average of 14.5 weeks. Postoperative modified Mayo wrist score (76.3±8.7) was significantly improved compared with preoperative score (54.1±9.6), χ2= -6.780, P=0.000, with significant difference.    Conclusions   Multiple Kirschner wires fixation and autologous bone grafting through small radial incision of carpal is an effective method with less injury, full exposure and high fracture healing rate. 

Clinical observation of vertebral height after percutaneous bone grafting and pedicle screw fixation for thoracolumbar vertebral fracture

Ren Tao, Qu Dongbin, Zheng Minghui, Ma Yangyang, Chen Yonghe, Li Jianlong

Chinese Journal of Clinical Anatomy. 2024, 42(6):  690-694.  doi:10.13418/j.issn.1001-165x.2024.6.14

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Objective    To investigate the effect of bone grafting and pedicle screw internal fixation on the recovery of central vertebral height after thoracolumbar fracture and its clinical observation.   Methods From January 2012 to December 2019, 89 patients with single-segment thoracolumbar fracture were admitted to our hospital, all of whom had single vertebral fracture T11~L2 (AO type A). Patients were divided into 3 groups according to different treatment methods: a trans-injured vertebra fixation and bone grafting group (n=15), a trans-injured vertebra fixation group (n=58), and a cross injury vertebral fixation group (n=16). The anterior vertebral body height (Ha), central vertebral body height (Hm), posterior vertebral body height (Hp) and kyphosis Cobb Angle of the injured vertebra were measured. The Ha loss rate, Hm loss rate and kyphosis Cobb Angle loss rate were statistically compared and analyzed in the last follow-up, and the recovery of vertebral height and kyphosis Angle after treatment was observed.   Results   The Ha compression rate, Hm compression rate and Cobb Angle of 89 patients after operation and at the last follow-up were significantly improved compared with those before operation, with significant differences (P<0.05). However, in the last follow-up, Hm loss rate (7.73±5.26) % in the trans-injured vertebra fixation and bone grafting group and Hm loss rate (11.71±11.15) % in the trans-injured vertebra fixation group were both lower than that in the cross injury vertebral fixation group (19.81±8.50) %, with significant significance (P<0.05). Hm loss rate in the trans-injured vertebra fixation and bone grafting group was lower than that in the simple injured vertebra fixation group, and there was similar statistical difference between them (P=0.052).   Conclusions Percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures can promote the recovery of the anterior and central height of the fractured vertebra, and the injured vertebral bone graft pedicle screw internal fixation in combination with vertebral body bone graft is more effective to prevent the loss of the central height of the injured vertebra 

Clinical effect of supramalleolar osteotomy in the treatment of varus ankle osteoarthritis and postoperative changes of the knee 

Zhang Kaiting, Mo Fangdong, Jie Ke, Xu Jingcheng, Zou Baoli, Li Zhuo, Zou Yunxuan, Zhu Yongzhan

Chinese Journal of Clinical Anatomy. 2024, 42(6):  695-699.  doi:10.13418/j.issn.1001-165x.2024.6.15

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Objective   To evaluate the clinical outcome of supramalleolar osteotomy (SMO) in the treatment of varus ankle osteoarthritis and the changes of ipsilateral knee joint after operation.   Methods   The clinical data of 36 patients (37 feet) treated with SMO in our hospital from January 2016 to December 2022 were analyzed retrospectively. The clinical efficacy of ankle joint was evaluated by pain visual analogue scale (VAS) and American Association of foot and ankle surgery score (AOFAS), and the clinical changes of knee joint were evaluated by VAS and Hospital for Special Sugery (HSS), ankle and knee joint changes were evaluated by relevant grading system and imaging indexes, and postoperative complications and operation failure were calculated.   Results   All patients were followed up for an average of 30.05 months. At the last follow-up, the clinical and imaging indexes of ankle were significantly improved compared with those before operation, but there was no significant difference between knee clinical and imaging indexes (P>0.05), and there was no significant correlation between correction angle and other knee clinical and imaging changes except with the changes of HKA.   Conclusions   SMO is effective in the treatment of varus ankle arthritis and will not cause changes in the ipsilateral knee joint in the short term after operation.

Therapeutic effect of whole body vibration training combined with ultrasound injection on patients with shoulder pain after stroke

Li Weikun, Jiang Taiwen, Xiang Jing, Liang Shuiqi, Bai Wenfang

Chinese Journal of Clinical Anatomy. 2024, 42(6):  700-704.  doi:10.13418/j.issn.1001-165x.2024.6.16

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Objective    To investigate the therapeutic effect of whole body vibration training combined with ultrasound injection in the treatment of shoulder pain after stroke.    Methods    A total of 60 patients with post-stroke shoulder pain admitted to the department of Rehabilitation Medicine, the Fourth Affiliated Hospital of Guangzhou Medical University from January 2022 to December 2023 were randomly divided into control group and observation group, with 30 patients in each group. The control group received routine rehabilitation training and ultrasound-guided injection of compound betamethasone, and the observation group received whole body vibration training on the basis of the control group. The two groups were compared before treatment (t0) and 7 days after treatment (t1). At 30 days after treatment (t2), pain Visual Analogue Scale (VAS) score, Fugy-Meyer Rating Scale Upper limb partial score (FMA-UE), painless passive shoulder abduction + external rotation total score (PROM) and modified Barthel Index scale (MBI) were used to evaluate the situation.    Results    There were no significant differences in gender, age, course of disease and type of stroke between the two groups before treatment (P>0.05). Compared with t0, VAS score, FMA-UE score, PROM total score and MBI score of the two groups were improved at each time point after treatment (P<0.01). The FMA-UE score and MBI score of observation group at t1 were significantly higher than those of control group (P<0.01). The FMA-UE score and MBI score at t2 in the observation group were significantly higher than those in the control group (P<0.01), while the VAS score and PROM score in the observation group were significantly lower than those in the control group (P<0.01).    Conclusions    Whole body vibration training combined with ultrasound injection in the treatment of post-stroke shoulder pain can relieve the pain of the affected shoulder, improve the range of motion of the shoulder joint, and improve the mobility of the shoulder joint.

Effect of thoracoscopic direct vision intercostal nerve micropuncture injection and T8-9 epidural block combined with oxycodone（T-E-O) triple process on analgesia and respiratory recovery after radical resection of thoracic laparoscopic esophageal cancer

Wang Hailang1, Wang Lingchuan2, Zhao Qing3, Cao Liangliang1, Xiong Miaomiao1, Zhang Zhongjun1, Wang Jun4

Chinese Journal of Clinical Anatomy. 2024, 42(6):  705-709.  doi:10.13418/j.issn.1001-165x.2024.6.17

Abstract ( 14 )   PDF (936KB) ( 0 )  

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Objective    To study the effects of thoracoscopic direct vision intercostal nerve micropuncture injection and T8-9 epidural block  combined with oxycodone（T-E-O) triple process on analgesia and respiratory recovery after radical resection of esophageal cancer by thoracic laparoscopy. Methods   One hundred and forty patients of both sexes, of American Society of Anesthesiologists (ASA) physical status I or II, were scheduled for elective radical resection of esophageal cancer undergoing thoracoscope and laparoscopic radical surgery of esophageal cancer, and then were randomly divided into 2 groups (n=70 each): a control group (group C) and a T-E-O triple process group (group T). Sufentanil 0.1 μg/kg in group C or oxycodone 0.1 mg/kg in group T were intravenously injected at 10 min before the end of operation. T8-9 epidural block was applied before anesthesia induction, and thoracoscopic direct vision intercostal nerve micropuncture injection in the chest before closing chest was performed. All patients sent to Postanesthesia Care Unit (PACU) after surgery were extubated and sent to ward after resuscitation. Analgesic pump was connected at the end of operation in two groups. Sufentanil 0.05 μg/kg in group C or oxycodone 0.05 mg/kg in group T were intravenously injected when visual analogue scale score(VAS) ≤３. At 1min before one-lung ventilation(OLV) (t0), before re-expansion of the collapsed lung (t1), at 30 min after re-expansion of the collapsed lung (t2), into PACU (t3), before extubation (t4), pain after extubation (t5), after the analgesic injection (t6), when leaving PACU (t7), blood gas analysis was performed, oxygenation index (OI), alveolar-arterial oxygen gradient(A-aDO2) and respiratory index (RI) were calculated, the number of rescue analgesia when in PACU, the recovery time, tracheal extubation time and PACU residence time were collected,  the occurrence of abnormal lung function and agitation were recorded.    Results    Compared with group C, OI was significantly increased, A-aDO2  and RI was reduced at t5-7(P<0.05), and the number of requirements for rescue analgesia, the recovery time, tracheal extubation time and PACU residence time, the occurrence of abnormal lung function and agitation were decreased in group T (P<0.05).    Conclusions    T-E-O triple process can significantly relieve pain and improve respiratory function during the recovery period after radical laparoscopic surgery for esophageal cancer.

Etiology, diagnosis, and treatment of far out syndrome (FOS): A review and case report

Huang Yongxiong, Cheng Xing, Yu Tao, Chang Yun bing, Xiao Dan

Chinese Journal of Clinical Anatomy. 2024, 42(6):  710-715.  doi:10.13418/j.issn.1001-165x.2024.6.18

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Far-out syndrome (FOS) is a rare spinal disorder primarily caused by the compression of the L5 nerve root between the L5 transverse process and the sacral ala, leading to severe lower back pain, leg pain, and functional impairment. The underlying causes include osteophyte formation, pseudarthrosis, thickened lumbosacral ligaments, ligamentum flavum hypertrophy, intervertebral disc degeneration, and anatomical variations such as transitional vertebrae. Diagnosing FOS is challenging and requires a combination of imaging techniques (such as MRI and CT) and neurophysiological testing. For patients with mild to moderate symptoms, non-surgical treatments, including medications and physical therapy, may be effective. However, for those with severe symptoms or cases unresponsive to conservative treatment, minimally invasive surgery, such as unilateral biportal endoscopic decompression (UBE), is the preferred option. This article reviews the etiology, pathogenesis, diagnosis, and treatment of FOS and presents a case report of a 67-year-old female patient who successfully underwent UBE surgery, demonstrating the efficacy and potential of this technique.

Application of polyurethane foam adhesive for vascular leak prevention in the construction of human brain tissue bank

Pu Yonghua, Wang Miao, Sun Biqiang, Luo Yutao, Zhang Qionghua, Yan Xiaoxin, Pan Aihua

Chinese Journal of Clinical Anatomy. 2024, 42(6):  716-719.  doi:10.13418/j.issn.1001-165x.2024.6.19

Abstract ( 11 )   PDF (1383KB) ( 2 )  

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Objective　 To observe the vascular leak prevention and cranial bone fixation effects of polyurethane foam adhesive during the preservation and perfusion of fresh gross specimens after craniotomy. Method    Reset the skull cap, suture the scalp continuously, fix it with a zip tie along the mandible through the ear to the top of the skull, and fill it with intracranial polyurethane foam adhesive; Bilateral catheterization of the femoral artery was performed, and gravity and micro pumps were used for perfusion. The leakage rate of the skull section was measured to evaluate the effectiveness of polyurethane foam adhesive in preventing vascular leakage and fixing the skull cap on fresh gross specimens after removal.   Result   The proportion of skull section leakage to the total perfusion fluid is relatively low, and the effect of vascular leak prevention is significant; After drying, the foam adhesive tightly adheres to the cranial bone and evenly covers all holes and fissures in the skull base.   Conclusion    Polyurethane foam adhesive has an ideal effect on the preservation, perfusion, leak prevention, and fixation of fresh gross specimens after craniotomy, which is beneficial for the recovery of the donor's residual appearance and contributes to the construction and development of the human brain tissue bank.

A multi-dimensional comprehensive detection method for scalp and hair follicle health

Liang Fengting, Wang Xueer, Ye Li, Lin Meifen, Zhang Min, Zhang Lin

Chinese Journal of Clinical Anatomy. 2024, 42(6):  720-725.  doi:10.13418/j.issn.1001-165x.2024.6.20

Abstract ( 18 )   PDF (3165KB) ( 3 )  

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Research progress of autonomic nervous system associated with colorectal cancer

Zhang Haoyang, Wang Lili, Da Mingxu

Chinese Journal of Clinical Anatomy. 2024, 42(6):  726-729.  doi:10.13418/j.issn.1001-165x.2024.6.21

Abstract ( 11 )   PDF (1247KB) ( 0 )  

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Research progress of C₅ nerve root palsy after cervical spine surgery

Chen Runsen, Wang Qing, LI Guangzhou, Zhang Jian, Zhang Pengxin, Lei Shuao

Chinese Journal of Clinical Anatomy. 2024, 42(6):  730-733.  doi:10.13418/j.issn.1001-165x.2024.6.22

Abstract ( 13 )   PDF (523KB) ( 0 )  

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Progress on the clinical anatomy of the third part of vertebral artery

An Leilei, Kong Xiangyu, Du Xinru

Chinese Journal of Clinical Anatomy. 2024, 42(6):  734-740.  doi:10.13418/j.issn.1001-165x.2024.6.23

Abstract ( 12 )   PDF (2953KB) ( 0 )  

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Middle temporal vein variation: a case report

Han Kexin, Sun Shihong, Zhao Caiyun, Xu Nuo, Chen Wendan, Chen Hongli, Xu Yun

Chinese Journal of Clinical Anatomy. 2024, 42(6):  638.  doi:10.13418/j.issn.1001-165x.2024.6.24

Abstract ( 14 )   PDF (1109KB) ( 2 )  

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Family congenital bilateral patellar absence: report of 3 cases

Li Huibin, Sha Yu

Chinese Journal of Clinical Anatomy. 2024, 42(6):  729.  doi:10.13418/j.issn.1001-165x.2024.6.25

Abstract ( 16 )   PDF (961KB) ( 0 )  

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