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Chinese Journal of Clinical Anatomy
(Founded in July 1983 Bimonthly)
Responsible Institution: China Association for Science and Technology
Sponsor: Chinese Society of Anatomical Sciences
Editing and Publishing: Editorial Board of Chinese Journal of Clinical Anatomy
Advisor: ZHONG Shi-zhen
Editor-in-chief: OUYANG Jun
Former Editor-in-chief: XU Da-chuan
Overseas Distributor: China International Book Trading Corporation (P.O. Box 399, Beijing, China, Code No. BM5961)
Address: 1023 Shatainan Road, Guangzhou, 510515, China
Tel: (020)61648203
E-mail: journal@chjcana.com
CN: 44-1153/R
ISSN: 1001-165X

Table of Content

    25 September 2015 Volume 33 Issue 5
      
    Surgical exposure to posterolateral quadrant tibial plateau fractures: an anatomic comparison of posterolateral vs posteromedial approaches
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  497-501.  doi:10.13418/j.issn.1001-165x.2015.05.001
    Abstract ( 1274 )  
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    Objective To compare deep anatomical structures of posterolateral and posteromedial approaches, andanalyze the limitations and risk of injury to important structures during surgical dissection.Method Five lower limb specimens were dissected to measure the perforating level of the anterior tibial artery at the interosseous membrane fissure and the shielding percentage by fibular head to the posterolateral cortex. Clinically, 20 cases were treated via a posterolateralor posteromedial approach. The two approaches were compared with each other.  Result The posterolateral approach had three major disadvantages:(1) the width of the anterior vascular bundle was about 1 cm; the distance between the level ofthe anterior tibial artery perforating point and tibial plateau/superior tip of fibular head was 4.93 cm and 3.77 cm, respectively. The distance for the superior concomitant vein was 4.41 cm and 3.25 cm in average, respectively, which limit the incision exposure. (2) The percentage of the posterolateral cortical area shielded by fibular head was 61.7% in average. (3) In order to expose the posterolateral articular surface, partial structure of posterolateral corner was destroyed, including the popliteus tendon complex, ligament and joint capsule, etc. Conclusion A posteromedial approach via the medial head of gastrocnemius-soleus maybe more suitable to expose isolated posterolateral quadrant tibial plateau fracture.

    The anatomical and histological study of the sheath structure of thoracic, lumbar and sacral nerve roots
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  502-506.  doi:10.13418/j.issn.1001-165x.2015.05.002
    Abstract ( 850 )  
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    Objective To investigate the anatomical and histological structure of the sheath of thoracic, lumbar and sacral nerve roots as well as their distribution, and to explore the clinical significance.  Methods Seven adult cadaveric spine specimens were dissected to observe the way out of the dural sac of the nerve root sheath of different segments, and to prepare sections to observe the structure of the nerve root sheath under the light microscope. Results There were one-hole and two-hole nerve root sheaths both in thoracic and lumbar segments, while there was only one-hole nerve root sheath in sacral segments; the one-hole nerve root sheath could be classified intoⅠtype and Ⅱ type because of the different structures inside. Compared with the other sites of the nerve root, there were only several layers of collagenous fibers being loosely connected with each other in the ganglion. The dural sleeve of ganglion at lumbar 4/5 and sacral 1~5 segments is the thinnest (F=37.31,P<0.01). And the space under the sleeve does not disappear until the ganglion. Conclusion The distribution ofⅠtype and Ⅱ type nerve root sheath accounts for the phenomenon of patients presenting early sensory and motor dysfunction at the same time when compressed. And the dural sleeve of ganglion at lower lumbar and sacral segments is the thinnest, which is related with the high incidence of the lumbocrural pain. The nerve root transforms into the peripheral nerve from the ganglion.

    The morphological features of diaphragmatic crura and their effect on the reduction of thoracolumbar burst fracture
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  507-510.  doi:10.13418/j.issn.1001-165x.2015.05.003
    Abstract ( 1202 )  
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    Objective To study the morphological features of diaphragmatic crura and their effect on the reduction of thoracolumbar burst fracture.   Methods   Adult thoracolumbar segments of 3 specimens were anatomized. Sections of adult thoracolumbar segments were made in 5 specimens,4 in horizontal plane and 1 in sagittal plane. The clinical data of 64 patients with thoracolumbar burst fracturewere analyzed. The involved vertebrae included T12 (12 cases), L1 (31 cases), L2(14 cases), and L3 (7 cases). All patients underwent transvertebral pedicle screws internal fixation. The correction of compression rate and the Cobb angle of different segments were compared.     Results    The diaphragmatic crura were sturdy structure in front of T12~L4 vertebrae, which converged with the anterior longitudinal ligament in the end. The correction of Cobb angle of T12, L1, L2, and L3 injured vertebrae were 23.9±10.5°,20.4±10.7°,14.5±11.4°, and 11.9±8.7°, respectively. There was statistical significant difference among T12, L2 and  L3(P<0.05). The correction of compression rate of T12, L1, L2, and L3 were 0.48±0.13, 0.45±0.17, 0.37±0.20, and 0.30±0.18, respectively. There was statistical significant difference among T12, L1 and L3(P<0.05).   Conclusions    After transvertebral pedicle screws internal fixation, the reduction of T12 and L1 vertebrae is better than L2 and L3 vertebrae. The diaphragmatic crura may have an important effect on the reduction of thoracolumbar burst fracture.

    The anatomic observation of the lumbar intertranverse ligaments and its signific
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  511-513.  doi:10.13418/j.issn.1001-165x.2015.05.004
    Abstract ( 2418 )  
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    Objective To provide the anatomic data for the surgical treatment of  the extreme lateral lumbar disc herniation through the anatomic observation of the lumbar intertranverse ligaments. Methods The lumbar intertranverse ligaments were exposed and observed in 15 cases of the adult cadavers. The related data were obtained with vernir caliper. Results The length、width and thickness of the lumbar intertranverse ligaments were (1.67±0.39)cm、(0.80±0.23)cm、(0.09±0.04)cm, (1.80±0.35)cm、(0.94±0.23)cm、(0.09±0.06)cm,(1.72±0.25)cm、(0.95±0.21)cm、(0.09±0.03)cm,(1.50±0.20)cm、(1.04±0.23)cm、(0.09±0.04)cm in L1~2、L2~3、L3~4、L4~5 respectively. Conclusions The lumbar intertranverse ligaments were the important anatomic landmarks in the surgical treatment of the extreme lateral lumbar disc herniation with lumbar intertransverse approach ( including microendoscopic surgery ). It's important to master the applied anatomy of the lumbar intertranverse ligaments for this kind of surgical treatment.

    Applied anatomy of transcatheter implantation of clamp device to treat tricuspid incomplete
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  514-516.  doi:10.13418/j.issn.1001-165x.2015.05.005
    Abstract ( 749 )  
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    Objective To understand the anatomical characteristics of tricuspid valves and provide anatomical basis for transcatheter implantation of clamp device to treat tricuspid incomplete.   Methods   28 adult heart specimens (18 male and 10 female) were dissected and measured.   Results The long diameter, short diameter and the perimeter of tricuspid valves of adult were (43.5±6.5) cm, (29.3±5.4) cm, and (109.4±14.2) mm, respectively. The maximum distance of the anterior leaflet from the free margin to the attachment margin was (22.3±4.1)mm, The distance of the posterior leaflet from the free margin to the attachment margin was (20.5±3.8) mm.    Conclusions   The size and shape of the clamp device should be designed according to the anatomical characteristics of the tricuspid area and the relationship with surrounding structures. It is feasible for clamping the anterior leaflet and the posterior leaflet of tricuspid.

    Microsurgical anatomic features and intraoperative preservation of the olfactory nerve
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  517-519.  doi:10.13418/j.issn.1001-165x.2015.05.006
    Abstract ( 754 )  
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    Objective To review microsurgical anatomic features of the olfactory nerve and suggest operative nuances that may contribute to reducing the rate of postoperative olfactory dysfunction. Methods Region of ethmoidal plate of 15 dry skulls (30 sides) were observed and measurements among the ethmoidal plate and those related structures were carried out. Microsurgical dissection was carried out in 15 cadaveric heads filled with colored latex to obtain the anatomic features of the olfactory bulb, olfactory tract and olfactory trigone. Results Cribroethmoid foramen with butterfly-like shape were distributed in an area with a length (19.77±1.23) mm, and the transverse diameter in the midpoint was (3.15±0.45) mm. The number of cribroethmoid foramen in nasal concha were denser than in septum(t=8.179,P<0.01).The olfactory tract enveloped by olfactory cistern was situated in the shallow part of the olfactory sulcus,  being interposed between the gyrus rectus and the medial orbital gyri. The olfactory trigone is divided into medial and lateral olfactory strains in front of the anterior perforated substance. The arterial supply in most cases of the olfactory nerve was relatively independent. And the blood supply was segmental in a few cases.   Conclusions   The olfactory never is located in the anterior skull base in the shape of triangle cone. The arterial supply in most cases of the olfactory nerve was relatively independent. Knowledge of the microsurgical features would help to preserve the olfactary nerve and avoid postoperative complications.

    Recognition of the anatomy of carotid sheath
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  520-522.  doi:10.13418/j.issn.1001-165x.2015.05.007
    Abstract ( 1303 )  
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    Objective To acquire the correct and accurate knowledge of carotid sheath by investiating the relationships between carotid sheath and cervical fascia. Methods 20 adult cadavers (40 sides) were dissected. The posterior part of envelope fascia(superficial layer of cervical fascia)was dissected to observe whether it connected with carotid sheath, and to observe the characteristics of the connection. The relationships of carotid sheath to middle cervical fascia and superficial and deep layers of deep cervical fascia were observed. Meanwhile, the characteristics of connection were observed. Results Envelope fascia connected with carotid sheath loosely could be  separated easily by blunt dissection. Middle layer of the cervical fascia was composed of the junction of facial sheath of infrahyoid muscles, joining the anterior carotid sheath. Prevertebral fascia was composed of two parts, the superficial layer and deep layer, the former enveloping the carotid artery, jugular veinand vagus nerve, the latter not forming the carotid sheath. The junction fascia between middle layer of the cervical fascia and superficial layer of prevertebral fascia and carotid sheath was thick and tight. Conclusion Carotid sheath was closely associated with every layer of cervical fascia. Middle layer of the cervical fascia and superficial layer of prevertebral fascia forms the main body of carotid sheath.

    The accuracy of evaluation in the foundation and clinical application of the self-manufactured guider of the calcaneous sustentaculum tali screw for the fixation of the calcaneous sustentaculum tali
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  523-526.  doi:10.13418/j.issn.1001-165x.2015.05.008
    Abstract ( 761 )  
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    Objective To discuss the accuracy of the self-manufactured guider of the calcaneous sustentaculum tali screw for the fixation of the calcaneous sustentaculum tali in the calcaneous specimens and the clinical. Methods (1) 15 pairs of calcaneous specimens were collected for this study. A 2.5 mm Kirschner-wire was drilled into each of the cadaveric feet according to the guider and the position of the Kirschner-wire. (2) 25 cases (28 feet) of calcaneal fracture were enrolled in this study. According to Sanders classification, there were 9 cases falling into type-II,11 cases type-III and 8 cases type-IV. The guider of the calcaneous sustentaculum tali screw was used in each case and the sustentaculum tali screw position was evaluated by X-ray postoperatively. Results (1) In the specimens, all of the 30 Kirschner-wires were implanted into the calcaneous sustentaculum tali and 29 Kirschner-wires were passed though the middle of the sustentaculum tali; However, 1 Kirschner-wire was passed through the anteroinferior part of the sustentaculum tali. The accurate rate by this guider was 96.7%. (2) A total of 28 sustentaculum tali screws were implanted in 25 patients, and 27 screws were passed thoughthe middle of the sustentaculum tali. However, 1 screw was passed through the anterior part of the sustentaculum tali. The accuracy rate was 96.4%. Conclusion The self-manufactured guider of the calcaneous sustentaculum tali screw can significantly improve the accuracy of the screw or Kirschner-wire being implanted into the sustentaculum tali, which can avoid the artificial iatrogenic complications caused by the position deviation of the sustentaculum tali screw. Therefore, it is appropriate to be promoted widely in clinical practice.

    The research of the sectional anatomy and three dimensional reconstruction of the cerebral midline structure
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  527-530.  doi:10.13418/j.issn.1001-165x.2015.05.009
    Abstract ( 758 )  
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    Objective To provide anatomical basis for surgical resection of the tumor in the anterior and middle of the third ventricle through the three-dimensional reconstruction of the brain midline structure and measurement of the volume of third ventricle.   Methods    10 cases of formalin-fixed specimens of the adult brain were embedded by celloidin (5 males and 5 females) , successive horizontal and coronal sections with the thickness of 500 μm were performed for observation and pictures collecting. The horizontal sections of a female were used for 3D reconstruction and the third ventricle volume in the samples were measured by Amirasoft.   Results   The results of the three-dimensional reconstruction clearly showed the shape and structure of the midline of the brain and adjacent relationship. The average volume of the third ventricle of male was (1170.03±148.04) mm3 and (854.64±43.59) mm3 for women (P>0.05 ), and no significant difference between men and women was detected.    Conclusion    The 3D reconstruction of the cerebral midline structure clearly shows the morphological structure and the interrelationship,which provides morphological basis for removal of the third ventricle tumor through  tanscallosal-interfornical approach. Precise volume measurement of the third ventricle and comparison of differences between men and women provide an important reference data for endoscopic surgery of ventricle.

    Compatible study of anterior occiput to axis transarticular locking plate system
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  531-534.  doi:10.13418/j.issn.1001-165x.2015.05.010
    Abstract ( 507 )  
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    Objective  To investigate the feasibility of anterior occiput to axis transarticular locking plate system through analyzing its compatibility with the occipital cervical complex. Methods Thirty health cases were selected from the date of head-neck CT examination randomly. 3D models of occipital cervical complex were reconstructed on the date. The anatomical compatibility was assessed between the systems and the 30 cases through surgical simulation by computer via digital technology. The  morphological compatibility between the titanium plate and the surface of the axis as well as the screw trajectory were observed. The ideal screw trajectory parameters of trans-articular screws were measured so that the compatibility could be assessed. Results  There was a morphological match between the titanium plate and the surface of the axis. All the trans-articular screws passed through the atlanto-occipital articulation and the atlanto-axial articulation, without piercing the bones or going into the hypoglossal canal. The fixed screws were in the axial vertebral body without going into the intervertebral space and the spinal canal. There was no significant difference between the ideal screw trajectory and the actual screw trajectory. Conclusions Anterior occiput to axis transarticular locking plate system has a better anatomic compatibility with the Chinese occipital cervical complex. And it is feasible in clinical application.

    Verification of the limitations about two-dimensional image navigation for femoral neck fracture’s reduction by three-dimensional measurement
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  535-540.  doi:10.13418/j.issn.1001-165x.2015.05.011
    Abstract ( 438 )  
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    Objective  A three-dimensional measuring method was proposed for evaluation of the reduction quality of displaced or undisplaced femoral neck fractures with closed reduction and internal fixation surgery. Then, summarizing up the displacement tendency of the femoral head provides a theoretical basis for better fracture treatment using an appropriate manual reduction. Methods 91 patients with femoral neck fractures were categorized into two groups: an undisplaced fracture group and a displaced fracture group. Three-dimensional models were constructed.  Some parameters were measured: spatial distance displacement of the femoral head center(d), deflection angle of the femoral head (α); Self-rotation angle of the femoral head (β), shortened values of the femoral neck(L). Results There was no significant difference between the undisplaced and displaced groups concerning the displacement distance of femoral head’s center, flection angle (P=0.62; P=0.70). There was significant difference between the undisplaced and displaced groups concerning the self-rotation angle of the femoral head, shortened values of the femoral neck (P=0.047; P=0.019). Conclusion It is not adequate to evaluate the reduction quality of femoral neck fractures merely using the two-dimensional method. X-ray radiographs have some limitations in accurate descriptions when it comes to spatial displacement, especially rotation displacement of femoral head, while the three-dimensional method, such as spiral CT seems a better choice.

    A case of double coracobrachialis
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  540.  doi:10.13418/j.issn.1001-165x.2015.05.031
    Abstract ( 478 )  
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    The application of digital design combined with 3D printing technology in thumb reconstruction
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  541-544.  doi:10.13418/j.issn.1001-165x.2015.05.012
    Abstract ( 606 )  
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    Objective An accurate, personal and optimal realization for the choice of donor site area in thumb reconstruction via digital design combined with 3D printing.   Methods    CT scanning data of both hands and both feet of 7 patients with wounded thumbs were collected. The virtual models of both hands were reconstructed using Mimics.  According to the principle that both hands are mirror projection to each other, we can rebuild the mirror image of the uninjured hand in Mimics with one of its features-the mirror option. Thus we could complete the virtual morphological restoration of the defect of the wounded thumb by referring to the mirror projection. Thereafter, using digital virtual comparison and virtual incision, we could get the three-dimensional configuration model of the defect of the thumb. The physical model of the virtual model was produced by using 3D printing technology whereby we could tape the adhesive plaster. Finally, the chosen area of the donor site could be obtained by fixing the taped plaster under the precise direction.  Results   Totally, the 7 thumb-wounded patients were subject to the digital design combined with 3D printing technology when referring to the choice of their donor site. The physical appearance of the rebuild thumbs were highly resembled to the unwounded state. A rapid restoration of the functions, a favorable effect and a nice feedback from the patients were obtained.   Conclusions   Digital design combined with 3D printing can make an accurate, personal and optimal decision in the choice of donor site in thumb reconstruction.

    Role of iNOS during wound healing of skeletal muscle
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  545-548.  doi:10.13418/j.issn.1001-165x.2015.05.013
    Abstract ( 509 )  
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    Objective To observe the morphological changes and iNOS expression at cellular damaged zone during the wound healing of denervated muscle; To determine the affection of the expression of iNOS induced by supernatant of macrophages. Methods The damaged denervated muscle, three days after the damaged muscle model of rat was established, was harvested for H.E and immunohistochemical staining of iNOS. The cultured C2C12 cells were treated with supernatant of macrophages. The treated C2C12 cells were analyzed using RT-PCR method. Results New capillaries near the damaged muscle and high expression of iNOS could be observed. The expression of iNOS was different between the damaged and undamaged zones in muscle cells. The supernatant of macrophages could induce the expression of iNOS and MyoD genes.  Conclusion The high expression of iNOS can accelerate the regeneration of denervated muscle during wound healing.

    Effect of prenatal stress on the expression of Parvalbuminand Calretinin in adult female rat offspring
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  549-552.  doi:10.13418/j.issn.1001-165x.2015.05.014
    Abstract ( 518 )  
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    Objective  To observe the effect of prenatal stress on the expression of Parvalbumin(PV)and Calretinin(CR)in adult female rat offspring.    Methods    Six pregnant SD rats were randomly divided into a prenatal stress (PS) group and a control group (CON).  Rats in PS  group were subjected to restraint stress during the late gestational periods, while rats in the control group were not given prenatal stress. The adult female offspring were randomly divided into PS plus stress group (PS-S) and PS without stress group(PS-NS), CON plus stress group (CON-S) and CON plus no stress group (CON-NS). The rats in PS-S and CON-S were subjected to restraint and ice-water stress. All rats were offered free choice between water and ethanol solution. After model establishment, brain tissues were harvested, the levels of PVand CR proteins in the hippocampus were detected by Western blot. Furthermore, PV and CR expression in hippocampus CA1, CA3 and dentate gyrus were determined with confocal immunofluorescence.   Results    Compared to CON-NS group, the protein of PV and CR in the hippocampus was meaningfully decreased in CON-S, PS-NS and PS-S groups,  with the lowest being in the PS-S group. The immunofluorescent results of PV and CR in hippocampus CA1, CA3 and dentate gyrus were in agreements with the PV protein expression, which showed obviously decreased positive staining cells. Statistic analysis showed PV and CR expression had a significant difference between CON-NS and other groups, with most significant decrease of expression being in the PS-S group (P<0.05).    Coclusion    Prenatal stress may directly affect the calcium binding proteins PV and CR in the hippocampus of adult female rat offspring.

    Biomechanical evaluation of decellularized porcine bile duct for the construction of bile duct by tissue engineering
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  553-557.  doi:10.13418/j.issn.1001-165x.2015.05.015
    Abstract ( 447 )  
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    Objective  The porcine common bile ducts were treated with different acellular matrix, the biomechanical change of porcine common bile ducts before and after acellular matrix treatment were evaluated, and an appropriate acellular matrix was explored to provide theoretical basis for the application of bile duct scaffold materials for tissue engineering. Methods Thirty porcine common bile ducts were divided into 5 groups randomly, group A: control group, group B: 0.05% trypsin + nuclease, group C:0.1% SDS + nuclease, group D: 1.0% triton X-100 + nuclease, group E: 1.0% triton X-100 + 0.1% SDS + nuclease. The loading - unloading experiment and ultimate tensile strength experiment were performed using TestResources biomechanical tester. Indexes such as biomechanical material constant (α1, β1, α2, β2), elastic modulus, ultimate tensile strength (UTS) and breaking elongation rate were calculated. Results There were no statistical differences in the biomechanical material constants (α1, β1,α2, β2) of the common bile ducts between group A and two acellular matrix treatment groups D and E (F = 12.21, P = 0.06). The biomechanical material constants of group B and group D were lower than that of group A, group C and group E (P < 0.01). The elastic module of common bile ducts of the two acellular matrix treatment groups D and E were a little larger than that of group A, but without significant difference (P>0.05),the levels of group B and group C were lower than that of group A (P < 0.05). There were no significant differences in UTS value and SOF value between the acellular matrix treatment groups D, E, and group A (P > 0.05). The UTS value of acellular matrix treatment groups B and C was significantly lower than that of group A (P<0.05), and the SOF value was significantly higher than that of group A (P<0.05). Conclusion The acellular matrix treatment effect of 1.0% Triton X - 100 + nuclease and 1.0% Triton X - 100 + 0.1% SDS + nuclease was quite satisfactory, and the biomechanical characteristics of porcine common bile duct were not affected, therefore, it is an ideal acellular method for porcine common bile ducts.

    The distribution and significance of PGC-1α neurons in the centre of energy homeostasis in hypothalamus
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  558-562.  doi:10.13418/j.issn.1001-165x.2015.05.016
    Abstract ( 490 )  
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    Objective To investigate the role of high fat diet in the distribution of PGC-1α in SD rat hypothalamus.    Methods   12 SD rats were randomly divided two groups, a normal diet group and a high fat diet group. HE staining was used to detect the fatty degeneration of the liver tissue; Immunofluorescence staining was used to observe the change of PGC-1α in the hypothalamusventromedial nucleus, and arcuate nucleus after 8 weeks. Results 8 weeks later, the live tissue of normal diet rats showed that hepatic cord was well organized; the boundary among hepatic cord, liver blood sinus and liver cells was clear; the nucleus were clear and cytoplasmhomogeneous; there was no liver cell lipid and necrosis. But the high fat diet rat live tissues expressed the characteristic of serious fatty degeneration, such as hepatic corddisorganized, liver blood sinus cavity became smaller, the boundary was not clear, live cells swelling with fat vacuoles in the cytoplasm which was not uniform in size.  The PGC-1α cell number in the normal diet rat hypothalamusventromedial nucleus determination area was (199.96±42.95), but it was (256.08±39.25) in the high fat diet rat, and there was statistical significance(P<0.05). In the arcuate nucleus the cell number of PGC-1α was (173.25±47.19) in the normal diet rat, but high fat diet made the cell number increased to 200.48±51.44, and there was statistical significance between them( P<0.05). Conclusion High fat diet made the cell number of PGC-1α increased in ventromedial nucleus andarcuate nucleus, PGC-1α may play a role in regulating the energy metabolism balance.

    Traumatic ectopic testis: a report of 3 cases
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  562.  doi:10.13418/j.issn.1001-165x.2015.05.032
    Abstract ( 556 )  
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    Effects of electroacupuncture on expression of APP mRNA and BACE-1m RNA in SAMP8 mice
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  563-567.  doi:10.13418/j.issn.1001-165x.2015.05.017
    Abstract ( 369 )  
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    Objective To explore the effects of electroacupuncture on behavior and APP mRNA and BACE-1 mRNA in senescence accelerated mouse (SAMP8). This provides a further evidence for  therapy of  Alzheimer's disease. Methods Sixty senescence accelerated mice prone 8 (SAMP8) were randomized into a model group,an electroacupuncture group and a medicine group. Twenty mice of senescence accelerated mouse / resistance 1(SAMP1) were in a normal group.In the electroacpuncture group,electroacupuncture was applied to "Baihui","Shenyu","Neiguan" and "Dazhui".In the medicine group,the gastric infusion with Huperzine A was applied 0.02 mg/kg.The normal group and model group were not treated. After treatment for 20 days,Morris water maze test was used to determine the learning and memory ability of mice. The expression of  APP and BACE-1 was determined with immunohistochemistry. The real-time fluorescent quantitative PCR was applied to determine the expression of APP mRNA and BACE-1 mRNA.Results Compared with the model group,the escaping latent period was reduced significantly in the medicine group and the electroacupuncture group,frequencies of leaping and the target quadrant swimming time was increased significantly(P<0.05); the expressions of APP mRNA and BACE-1 mRNA were reduced significantly in the electroacupuncture group(P<0.05). Conclusion Electroacupuncture has improvements in learning and memory disturbance probably through inhibiting APP mRNA and BACE-1 mRNA expression and reduced cerebral Aβ level in SAMP8 mice.

    The finite element analysis and clinical significance of through the mouth atlanto-axial vertebral anterior plate fixation
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  568-572.  doi:10.13418/j.issn.1001-165x.2015.05.018
    Abstract ( 389 )  
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    Objective To analyze through the mouth atlanto-axial vertebral anterior plate fixation in finite element for the development of the segmental anterior fixation surgery and to provide the reference of inner plant improvement. Methods One case, male, 36 years old, 64 kg weight was randomly selected in January 2014 in our hospital, whom was excluded of the skull-atlanto-axial vertebral disease. The patient received scanning with a thickness of 0.625 mm; Image data were rebuilt in the Mimics16.01 software and Pro/ENGINEER4.0 software was used to rebuild the atlanto-axial vertebral anterior plate. After reconstruction of steel screw 3D model according to the classic through the mouth,the model was imported into Mimics16.01 and the model surface was meshed and material assigned. The model was then imported into Ansys14.0, and was forced 80 N vertical loading. The surface was applied 15 Nm torque to simulate three-motion state example, forward bends, stretch, side-bending. The stress and deformation of screw and rod were measured. Results Atlanto-axial vertebral three-dimensional reconstruction model were divided into 39842 individual grid and the model was loaded. The stress of upper screw root in bend was biggest (62.34 ±5.52) Mpa (F=73.23, P<0.05, the difference was statistically significant).A screw of the root and the top, lateral stress was the largest, respectively were (78.42±5.5.14) Mpa (F=112.32, P<0.05);(95.48±7.12)Mpa (F= 62.32, P<0.05), the difference had statistical significance; Under three different motion state and a screw root stress, Upper screw root stress in bending forward was greater than the lower (forward bends, stretch and lateral bending state , t value were 12.2, 9.23, 22.98, P<0.05, differences were statistically significant), and in the lateral current screw root stress was greater than the upper; In the same movement state, the top was greater than the root, the differences were statistically significant (forward bends, stretch and lateral bending state after t value were 23.14, 22.01, 8.13, P<0.05). Conclusion Through the mouth atlanto-axial vertebra fixed system stress distribution was more reasonable, could withstand normal atlanto-axial after vertebral motion bearing stress, but the postoperative patients should reduce the proneness and lateral movement to lower the risk of fatigue fracture fixation system.

    Effects of different surgical mananement of the three-column injury of ankle on the peak contact pressure in the tibiotalar joint
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  573-576.  doi:10.13418/j.issn.1001-165x.2015.05.019
    Abstract ( 708 )  
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    Objective To study the effects of different surgical procedures of clinical treatment of the three-column injury of ankle on the peak contact pressure in the tibiotalarjoint.    Methods    Six fresh cadaveric adult ankles were used for creation of 3 models of different surgical proceduresof treatment for the three-column injury of ankle. In model A, the medial and lateral ligaments of ankle joint were intact(repaired), the broken inferior tibiofibular ligament were not fixed. In model B, the medial and lateral ligaments of ankle joint were intact(repaired),the broken inferior tibiofibular ligament was fixed by a screw. In model C, lateral ligaments of ankle joint were intact(repaired), the broken inferior tibiofibular ligament was fixed by a screw, but the broken medial ligaments were not repaired. The three groups were tested in order A、B、C. The 3 models were tested with an electronic pressure sensor in  a BOSE material testing machine, respectively, in 5 positions. The peak values of the compressive stresses of the 3 models in 5 positions were recorded. All  data were collected and analyzed using SPSS22.0.    Results    Model B exhibited the smallest average stress in all 5 positions, followed by model C and model A, with significant differences between B and A groups (P<0.05).There were significant differences between B  and C groups (P<0.05)at 10° dorsal extension and 10°valgus position.  Conclusion  The surgical management of the three-column injury of ankle where the medial and lateral ligaments are intact or repaired, and the tibiofibular syndesmosisis effectively fixed can reduce the peak contact pressure in the tibiotalar joint.

    Sural nerve retrograde island flap to repair distal leg soft tissue defect
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  577-580.  doi:10.13418/j.issn.1001-165x.2015.05.020
    Abstract ( 523 )  
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    Objective To explore the clinical rapeutic effects of the retrograde island flap based on the sural nerve nutrient vessels in repairing skin and soft tissue defects in the distant lower limbs. Methods 52 patients were treated with the sural nerve nutrient vessels skin flap Between November 2009 and Jun 2014. The involved cases included 41 males and 11 females, with an average of 37.3 years old (range, 5 to 64 years old).   The size of soft tissue defects varied from 4.0 cm×4.5 cm to 6.0 cm×12.0 cm. The size of flap varied from 4.5 cm×5.0 cm to 7.0 cm×15.0 cm. The interval between injury and operating time was 9~45 days. In 52 case, the small saphenous vein was ligated in the flap pedicle. Result No postoperative venous congestion such as edema, congestion, and blisters occurred. All flaps survived. The flaps completely survived in 39 cases and healing by first intention was achieved. 3 cases with flap under mild infection, after treatment of control. The appearance and functional results were satisfactory with following up for 8 to 24 months. The color and texture of the flaps were good. The appearance and the function were satisfactory. Conclusion Sural nerve nutrient vessels of the retrograde island flap is an ideal choice for repair distal leg soft tissue defect. Not the small saphenous vein ligation of flap pedicle division of flap survival had no effect.

    Distally based tarsal tunnel arterial perforator flap for skin defects in foot
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  581-583.  doi:10.13418/j.issn.1001-165x.2015.05.021
    Abstract ( 509 )  
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    Objective To summarize the clinical effects of repairing skin defects in foot by distally based tarsal tunnel arterial perforator flap. Methods Between June 2005 and June 2013, based on the anatomic study of arterial perforators of tarsal tunnel, thirty-six patients with soft-tissue defects in the foot underwent reconstruction with the distally based tarsal tunnel arterial perforator flap. The etiology of injury: twenty-four cases were caused by traffic accident, two by crashing objects. The defect locations were as follows: fourteen at the dorsal foot, twenty-two at the medial margin of foot. The defect size ranged from 5.0 cm×3.0 cm to 16.5 cm×10.0 cm. The smallest dimension of the flap was 6.0 cm×4.0 cm and the largest ranged from 7.0 cm×5.0 cm to 18.0 cm×12.0 cm. The rotation point of the distal pedicle was at the medial malleolus.  Results    33 of total 36 cases obtained primary healing, and the other 3 obtained secondary healing. Postoperative follow-ups of the patients ranged from 5 to 15 months. All flaps survived completely with good color, and the appearance and function were satisfying. The donor site healed without morbidity after reconstruction with skin-grafting. Conclusion The distally based tarsal tunnel arterial perforator s flap is an ideal option for repairing soft tissue defects of distal segment of foots.

    The clinical significance of residual preservation in the operation of anterior cruciate ligament reconstruction and its postoperative recovery
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  584-587.  doi:10.13418/j.issn.1001-165x.2015.05.022
    Abstract ( 544 )  
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    Objective According to the analysis of the knee function and the stability, the postoperative efficacy of the anterior cruciate ligament(ACL) reconstruction with residual preservation was evaluated and the clinic role of residual preservation was explored. Methods From January 2011 to January 2013,78 cases of patients diagnosed with the anterior cruciate ligament rupture underwent ACL reconstruction with allogeneic hamstring tendons, and all patients were followed up for at least 12 months. Of  the 78 cases , there were 51 males and 27 females with an average age of 29.2 years old. The average interval from injury tosurgery was 3 months; All 78 cases of patients had complete rupture of the anterior cruciate ligament, including 30 cases of body rupture, 44 cases of femoral attachment point rupture and 4 cases of tibial attachment point rupture. Surgery was performed in a way that could retain the remaining stump as much as possible. The postoperative knee function and stability were followed up for a period of 12~35 months with an average of 25 months. The clinic effects were evaluated according to the physical examination.    Results    Lachmantest, anterior drawer test and pivot shift test were negative in 76 patients. Compared to preoperative data, postoperative Lysholmscores, Tegnerscores and IKDC scores were significantly improved(P<0.05).  Conclusion Reserved stump had important significance in ACL reconstruction operation. ACL reconstruction operation with it could achieve a good clinical efficacy.

    The preliminary application of freehand placing thoracic pedicle screw technique with uniform anatomical marks
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  588-592.  doi:10.13418/j.issn.1001-165x.2015.05.023
    Abstract ( 661 )  
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    Objective   To evaluate the accuracy and safety of freehand placing thoracic pedicle screw technique with uniform anatomical marks, as compared with the conventional freehand technique. Methods From December 2014 to February 2015, a contrast study was performed on 25 patients needed posterior surgery with pedicle screw in our department. The right side thoracic pedicle screws were implanted with uniform anatomical marks put forwarded by Fennell, while the left side ones were done with traditional method described by Kim. The accuracy and safety of the pedicle screw placements was evaluated according to Heary classification after operation. And the time of implanting screws on each side was compared.  Results   A total of 133 thoracic pedicle screws were assessed. There were 67 screws implanted by the new method. The accuracy of this technology was 89.55% (Heary classⅠ) and the security was 97.01% (Heary classⅡabove). 7 (10.45%) screws were considered in a negative location (below Heary classⅠ).The average time of placing pedicle each screw was 5.75 min. while, there were 66 pedicle screws implanted by traditional method. The accuracy of this technology was 75.76% and the security was 89.39%. A total of 16 screws (24.24%) developed bad location. The average time of placing each pedicle screw was 8.95 min. A significant difference in the accuracy of pedicle screw placement was observed between the 2 methods(P<0.05),But on the security of implanting screws has no statistically significant (P > 0.1). In addition, there was significant difference in the implanting time between the 2 methods (P< 0.05). Conclusion Free hand placing thoracic pedicle screw technique with uniform anatomical marks is more accurate for screw location, more simple for operation, more easy for acceptance, learning and communication.

    Comparison of short-term effects of adopting transforaminal lumbar interbodyfusion and posterior lumbar interbodyfusion for treatment of single segment degenerative lumbar diseases
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  593-596.  doi:10.13418/j.issn.1001-165x.2015.05.024
    Abstract ( 770 )  
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    Objective To compare the effects of adopting LUXOR system-assisted minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) and  posterior lumbar interbody fusion (PLIF) for treatment of degenerative lumbar diseases. Methods Clinical data about 34 patients with single segment degenerative lumbar disease who underwent MIS-TLIF in our hospital were retrospectively analyzed. The operative time, intraoperative blood loss, postoperative drainage volume, postoperative bedtime were recorded and compared with those of 30 patients with the same disease undergoing conventional open PLIF during the corresponding period. The back pain visual analogue score (VAS), Oswestry disability index (ODI) score and imaging examination were performed before operation and during follow-up period for each patient. Results There was no significant difference in the gender, age, clinical diagnosis, lesion location, VAS and ODI scores before operation between the two groups (P>0.05).  The operative time was longer in MIS-TLIF group than in PLIF group(P<0.05), and the intraoperative blood loss, postoperative drainage volume, postoperative bedtime were lower in MIS-TLIF group than in PLIF group (P<0.01). The back pain VAS scores and ODI scores on 3rd and 6th month after surgery in MIS-TLIF group were lower in PLIF group (P<0.01) . Radiological follow-up imaging revealed good fusion 6 months after operation in all the patients.  Conclusion MIS-TLIF has several advantages over conventional open PLIF, such as less intraoperative blood loss, milder muscle damage, and lighter back pain.

    Anatomic tilt x-ray evaluating the position of the distal radial screws
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  597-600.  doi:10.13418/j.issn.1001-165x.2015.05.025
    Abstract ( 666 )  
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    Objective To investigate the reliability and clinical value of anatomic tilt x-ray of wrist joint evaluating the position of the distal radius screws. Methods 31 patients, in whom the distal radius screws were suspected penetrating into the joint in standard X-ray films, received further evaluation in CT scans and  anatomic tilt x-ray of wrist joint (abbreviated ATX). Two observers were selected to judge independently the screw position from ATX, the sensitivity, specificity and predictive value, as well as the consistency of ATX were calculated compared with CT scans. 67 patients, in whom the screws were suspected penetrating into the joint in standard X-ray images, judged by ATX were: no penetration in 39 cases and penetration in 28 cases. Removal of penetrating screws: replacing screws during the operation or early removal postoperatively after healing of fractures. Results The sensitivity of ATX was 88.24%~94.12%,the specificity was 87.50%~106.25%,and the predictive value was 87.50%~100.00%;the intra-observer Kappa coefficient was 0.81~0.94, with a high reliability, the inter-observer Kappa coefficient was 0.87 each, with a high  reproducibility. The patients were followed up for 16 to 30 months. At the last follow-up, the wrist joint function (Sarmiento’s criterion): excellent in 14 cases, good 19 in cases, fair in 5 cases and poor in 1 case in the no penetrating group, whereas the efficacy was excellent in 10 cases, good in 13 cases, fair in 4 cases and poor in 1 case in the penetrating group. There was no significant difference (P>0.05). Conclusions Evaluation of the position of the distal radius screws with ATX is simple, practical and reliable.

    The effects of positive end expiratory pressureon the cross-sectional areas, and puncture and catheterization of right internal jugular vein during general anesthesia
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  601-603.  doi:10.13418/j.issn.1001-165x.2015.05.026
    Abstract ( 690 )  
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    Objectivve To investigate the effects of different degrees of positive end expiratory pressure (PEEP) on the cross-sectional areas (CSAs) and puncture and catheterization of right internal jugular vein (RIJV) in anesthetized patients. Methods  A total of 304 patients with selective cardiac operation were divided into four groups by random number table method: group A (PEEP=0 cmH2O), group B (PEEP=5 cmH2O), group C (PEEP=10 cmH2O), group D(PEEP=15 cm H2O). The CSAs of RIJV were measured by ultrasonography. Total puncture times, inadvertent carotid puncture times, easiness of withdrawing blood, cases of hematoma formation, cases of RIJV puncture failure were recorded. Bradycadia and hypotension were recorded.Results CSAs of RIJV after PEEP in group C and group D were both significantly increased compared to that before PEEP (P<0.05); The CSAs of RIJV in group C and group D after PEEP were significantly larger than that of both group A and group B (P<0.05). The success rates of RIJV puncture at first attempt in group C and group D were significantly higher than that of both group A and group B (P<0.05). The incidence of inadvertent carotid puncture, local hematoma formation and puncture failure in group C and group D after PEEP were significantly lower than that of both group A and group B (P<0.05). The incidence of bradycardia and hypotension in group D were significantly higher than that of the other three groups (P<0.05). Conclusions Appropriate PEEP significantly increases the CSA of RIJV, increases the success rate of puncture, and decreases the incidence ofcomplications.

    Researching microvascular casting model of oral and maxillofacial regions of Wistar rats
    Chinese Journal Of Clinical Anatomy. 2015, 33(5):  604-607.  doi:10.13418/j.issn.1001-165x.2015.05.027
    Abstract ( 392 )  
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    Objectives To build the capillaries casting method of Wistar rats maxillofacial microvascular specimens by perfusion combined with scanning electron microscopy (SEM), so that the three-dimensional digital models of capillaries were established. Methods Maxillofacial microvascular specimens of 8 weeks of Wistar rats were resected from the abdominal cavity. The catheter was inserted from ventricle to the aorta. The resin material was filled, and specimen was placed in constant temperature water bath for 24 hours. The sample was divided into some parts, such as skin, tongue, jaw bones. The samples were corroded, washed, dried, and plated gold. The anatomical morphology of vascular casting was observed under scanning electron microscopy, course and adjacent structures. Results Capillary casting specimens of skin, tongue, mandible and maxilla of Wistar rats were successfully prepared. They clearly showed the morphology and course of the capillaries in the specimens. Under the scanning electron microscopy, the micro capillary structures of the capillaries were showed in three dimensions. Conclusion The facial capillaries casting methods in Wistar rats can serve as the basis for 3D digital model of the microvascular morphology and 3D printing of the capillaries.