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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 January 2016 Volume 34 Issue 1
      
    Perforator flap research: a candid view
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  1-3.  doi:10.13418/j.issn.1001-165x.2016.01.001
    Abstract ( 608 )  
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    Study of hemodynamics on three different patterns of flaps on dorsum of rats
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  6-11.  doi:10.13418/j.issn.1001-165x.2016.01.003
    Abstract ( 471 )  
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    Objective To study hemodynamic characteristics of three different patterns of flaps on the dorsum of rats.    Methods 30 Sprague Dawley rat were equally divided into three groups: the perforator group, the perforator-based fasicocutaneous flap group and the random flap group. Laser Doppler flowmeter was adopted for measurement of blood perfusion on zoneⅠ、Ⅱand Ⅲ of the flaps on the three groups at the multiple time points. 7 d after surgery, photographs were taken for the flaps and the fasciocutaneous vascular network between the iliolumbar perforator and the sacrococcygeal perforator. Comparison of necrotic rates among the three groups, and comparison of perfusion values of zoneⅠ、Ⅱand Ⅲ on the perforator flap and the perforator-based fasciocutaneous flap immediately and 1d after surgery were carried out. Results The necrotic rates of the perforator flap, the perforator-based fasciocutaneous flap and the random flap was 0.087±0.07, 0.071±0.05 and 0.267±0.11, respectively. Immediately after surgery, the perfusion value of zoneⅠandⅡin the perforator flap group was larger than that in the perforator-based fasciocutaneous flap group with statistical significance. Perfusion value of the three zones in the random flap group was lower than their counterparts of the perforator flap group and the perforator-based fasciocutaneous flap. 7 d after surgery, the vascular network between the iliolumbar perforator and the sacrococcygeal perforator underwent tremendous enlargement in diameter. Conclusion There is no significant difference on the survival capacity between the perforator flap and the perforator-based fasciocutaneous flap. The survival of the random flap depends on the dilation of the vascular network between the pedicle and the nearest potential perforator.

    Digital anatomical study of perforator flap based on the perforating arteries of profunda femoris artery in vivo
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  12-15.  doi:10.13418/j.issn.1001-165x.2016.01.004
    Abstract ( 513 )  
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    Objective To explore the feasibility of three-dimensional visualization of the profunda femoris artery perforator flap and provide the anatomical data for clinical application of profunda femoris artery perforator flap. Methods A series of DICOM images were obtained from eight patients by DSA and dual source CTA. Then  Mimics 16.0 was used for three-dimensional reconstruction of perforating artery and perforators of profunda femoris arteryies.     Results The 3D visualization models of perforating arteries of the profunda femoris artery and their perforators could be successfully achieved by using Mimics. The 3D reconstruction models showed variable origin, location, presence, volume and course of the profundafemoris artery, perforating arteries as well as their perforators clearly. Three perforating arteries which derived from the profunda femoris artery were found in six patients and four perforating arteries displayed in two patients. 66 cutaneous perforators (>0.5 mm) have been found in the eight patients. The average internal diameter of perforator was (0.9±0.2) mm. Cutaneous perforators can be found on a line extending from the ischium to the lateral femoral condyle. Conclusion The 3D reconstruction models can provide perfect dynamic visualization of perforating arteries of profunda femoris artery and their perforators. It can provide the anatomical basis for clinical application of perforator flap base on perforating arteries of profunda femoris artery, and may be used for its individualized design.

    Applied anatomy of deep inferior epigastric artery posterior rectus sheath peritoneum flap
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  16-20.  doi:10.13418/j.issn.1001-165x.2016.01.005
    Abstract ( 651 )  
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    Objective To 3D reconstruct the angiosomes of the deep inferior epigastric artery (DIEA)using Mimics and CT supporting workstations, in order to provide morphological evidence for clinical application of different types of tissue flaps with the DIEA as the vascular pedicle. Methods The systemic arteriography using the mixture of lead oxide-gelatin or oxide-latex was performed on five fresh adult cadavers. ① Data serially scanned by 64 slice spiral CT were 3D modeled and analyzed in Mimics and CT supporting workstations respectively. ② The anterior abdominal walls of the five cadavers were sectioned, observed by layers dissection combined with X-ray examination. Results The DIEA distributed into musculoperitoneal branches, muscular branches, lateral branches and musculocutaneous perforators. 3 musculoperitoneal branches with the diameter≥0.5 mm, which had the same vascular pedicle with muscular branches and musculocutaneous perforators, respectively. Conclusions  Different types of tissue flaps with the DIEA as the vascular pedicle, such as the musculoperitoneal flap, muscle flap, cutaneous flap and composite flap, can be harvested to reconstruct complicated defects of different parts and of various types, especially for the through and through defects reconstruction in oromaxillo-facial region.

    The applied anatomy of the design of the free tripaddle flap on the pedicle of the posterior interosseous artery
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  21-23.  doi:10.13418/j.issn.1001-165x.2016.01.006
    Abstract ( 529 )  
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    Objective To provide the anatomical basis for the design of the tripaddle flap on the posterior interosseous artery (PIA). Methods Eight cadaveric forearms were used for this study. A line was drawn representing the axial line from the lateral epicondyle of the humerus to the radial side of the ulnar styloid on the dorsal forearm. The dissection was applied in distal three segments for the peforators of the PIA. The following contents were investigated: the position and the number of the perforators; the course of the perforator; the length of the pedicle of perforators dissected from the underneath layer of the deep fascia and the superficial layer of the deep fascia. One cadaveric was used to imitate the harvest tripaddle PIA flap. Results The PIA gave off 4 to 7 perforators, and the range number of perforators in segment Ⅰ,Ⅱ and Ⅲ was from 2 to 4, 2 to 3, and 1 to 3, respectively. The range of the pedicle length of perforators dissected from the underneath layer of the deep fascia was from 0 to 0.6 cm, 0.2 to 1.2 cm, 0.5 to 1.8 cm, respectively. The range of the pedicle length of perforators dissected from the superficial layer of the deep fascia was from 1.2 to 2.7 cm, 1.2 to 4.5 cm and 1.8 to 4.5 cm, respectively. Conclusion The perforators at the different segments of the PIA can be used to design the tripaddle flaps.

    Flow-through anterolateral thigh perforator flap for the treatment of skin and soft tissue defects of palm with circulatory disorder
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  24-27.  doi:10.13418/j.issn.1001-165x.2016.01.007
    Abstract ( 925 )  
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    Objective To investigate the application and clinical effects of flow-through anterolateral thigh perforator flap for the treatment of skin and soft tissue defects of palm with circulatory disorder.  Methods Anterolateral thigh perforator flap was used to repair skin and soft tissue defects of palm with arterial circulatory disorder in 9 cases. The injured artery was bridged by descending branch of lateral circumflex femoral artery for blood supply reestablishment. The flap was designed based on the perforating artery of lateral circumflex femoral artery (intermuscular branch or cutaneous branch). The length of descending branch of lateral circumflex femoral artery was from 4cm to 8cm, and the area of the flap was from 7 cm×9 cm to 11 cm×16 cm. Results All flaps and skin grafts of donor sites survived, and the repaired hands had good blood supply.  All patients were followed up for 6 to 9 months.The flap and hand tip both had good blood supply.  Protective sensation of the flap as well as sweating function was recovered. Scar formation occurred in some donor sites. Conclusion It may be an ideal method to use flow-through anterolateral thigh perforator flap for the treatment of skin and soft tissue defects of palm with arterial circulatory disorder.  It can bridge the vessel and cover the wound.

    The clinical curative effect of repairing of the wounds surface of foot and ankle with three different kinds of posterior tibial artery perforator flaps
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  28-32.  doi:10.13418/j.issn.1001-165x.2016.01.008
    Abstract ( 641 )  
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    Objective To summarize and analyze the clinical curative effectof three different kinds of posterior tibial artery perforator flaps to repair the wounds of foot and ankle.Methods From January 2008 to June 2014,26 patients with skin necrosis and defects of foot and ankle caused by trauma were treated with three different kinds of posterior tibial artery perforator flaps,including anterograde perforator flaps in 5 cases,perforator propeller flaps in 5 cases,and reversed perforator flaps in 16 cases.Above the flaps,the maximum was 15 cm×8 cm,and the smallest was 6 cm×4 cm.   Results Flaps in 22 cases survived completely, flap in one case that had necrosis which washealed by debridement and skin graft after 2 weeks,and flaps in 3 cases that had marginal necrosis at the distal part of the flaps which scar healing by debridement after one to two months.All patients were followed for 3 to 36 months (mean 10 months), the texture and appearance of flaps in 25 cases were excellent. In the case with flap necrosis and subsequent skin graft, obvious scar hyperplasia developed. In 5 cases, the flaps  were slightly bulky,but the function of the foot and ankle was not obviously influenced.Conclusion According to the characteristics of wound surface of foot and ankle,using three different kinds of posterior tibial artery perforator flapscan obtain satisfactory clinical effect in treating the wounds,which is a simple and practical method.

    Application of DIEP to repair the wound after radical vulvectomy
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  33-35.  doi:10.13418/j.issn.1001-165x.2016.01.009
    Abstract ( 541 )  
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    Objective To study the method and effect of using the deep inferior epigastric perforator flap (DIEP) to repair the wound after radical vulvectomy.    Method From May 2010 to March 2011, 5 cases of patients with carcinoma of vulva were treated by radical vulvectomy. Then DIEP was harvested from the abdominal wall and transplanted to repair the wound through subcutaneous tunnel under skin of mons pubis, using the deep inferior epigastric artery and vein on one side as vascular pedicle. The urethral orifice and vaginal orifice were also reconstructed in the same stage of operation.   Results    All DIEP (6~10 cm×12~17 cm)survived well after operation with satisfactory appearance of the urethral orifice and vaginal orifice.  Conclusion    Application of DIEP is one of the best methods to repair the wounds after radical vulvectomy for the advantages like: safety, convenience, minor injury of donor site and satisfactory appearance.

    Anatomic study on the proximal femoral lateral wall and its clinical implications for geriatric intertrochanteric fractures
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  39-42.  doi:10.13418/j.issn.1001-165x.2016.01.011
    Abstract ( 971 )  
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    Objective Proximal femoral lateral wall is defined as the lateral cortex distal to the vastus insertion, which is the entry point to put lag screw/helical blade into femoral head for fixation of intertrochanteric fractures. This study was focused on the bony and soft-tissue of lateral wall anatomy, and aimed to provide reference data for clinical implications. Method Sixteen femurs, 10 lower limbs and 20 CT slices in geriatric pertrochanteric fractures were used to measure the bony area (height and width), soft-tissue attachment and intersection (height, width and thickness), and femur lateral cortical thickness at the mid lesser trochanteric level. Result The bony lateral wall has a mean height of (24.4±2.4) mm,width of (23.3±2.0) mm,and area of (567.0±82.8) mm2. The attachments of gluteus medius and minus terminal and the vastus origin were mixed and intersected with each other to form a tedious aponeurotic structure together. The soft-tissue lateral wall has a height of (33.2±2.3) mm,width of (28.2±1.9) mm,and thickness of (1.6±0.1) mm. The femoral  lareral wall in geriatric patients was very thin, with a cortical thickness of (2.3±0.5) mm. Conclusion The lateral wall in geriatrics is very weak and vulnerable to fracture perioperatively. Cephalomedullary nail is superior to DHS for geriatric intertrochanteric fractures.

    Clinical anatomic study of the lag screw guide device for the acetabulum posterior column
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  43-45.  doi:10.13418/j.issn.1001-165x.2016.01.012
    Abstract ( 471 )  
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    Objective To measure anatomical parameters of the guide device for antegrade lag screw fixation of the fractures in the posterior column of acetabulum. Methods 17 females and 14 males semi pelvic bony specimens were collected for this clinical anatomic study. After successful implantation of the antegrade lag screw into the posterior column of acetabulum, the screw entry point and entry angle of inclination were separately measured and statistically analyzed. Results The average distance between the entry point and the arcuate margin was (0.96±0.32) cm in female and (0.92±0.16) cm in male (P>0.05), while the distance between the entry point and the sacroiliac joint front was (2.43±0.66) cm in female and (1.87±0.26) cm in male (P<0.05). The average retroversion angulation of screw was (59.68±6.28)°in female and (56.75±3.22)°in male (P>0.05), while the extraversion angulation was (41.27±2.76)°in female and (34.31±2.78)°in male (P<0.05). Conclusions The results of our measurement can contribute to design of guide device for antegrade lag screw, which could improve the success rate and accuracy of the screw implantation in the posterior column of acetabulum, reduce the surgery risk, and minimize operative trauma.

    The morphologic features and meaning of the tendons in pesanserinus
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  46-49.  doi:10.13418/j.issn.1001-165x.2016.01.013
    Abstract ( 1438 )  
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    Objective The aim of this study was to delineate the consistent anatomical structures in the pesanserinus and to provide an applied anatomic data for location the tendons on pesanserinus in autograft surgery. Methods Sixty-nine lower extremities from fixed cadavers were dissected to expose the pesanserinus. The locations of end point of sartorius, semitendinosus, and gracilis were measured. Results Three types of array pattern of the tendons in pesanserinus were found. The lower bound of tendons in pesanserinus was located (1.765±0.759) cm below the transverse plane of tibial tubercle. And the horizontal range between ending point of semitendinosus, gracilis, sartorius, to tibial crest was (1.550±0.557), (1.376±0.551), and (1.294±0.629) cm, the horizontal range between Saphenous nerve,Infrapatellar branch to tibial crest was (7.071±0.696),(4.033±0.991) cm. Conclusion Knowledge of the microsurgical features  of the tendons in pesanserinus would help to better the approach in autograft surgery, which can improve the quality of in autograft surgery.

    Anatomical study of the surface projection of the dorsal scapular artery to the medial border of the scapula
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  50-52.  doi:10.13418/j.issn.1001-165x.2016.01.014
    Abstract ( 1005 )  
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    Objective To identify the surface landmarks for location of the course of the dorsal scapular artery by cadaveric dissection. Methods 26 adult complete cadavers were dissected to reveal the dorsal scapular artery, the diameters and the distances to the medial border of the scapula of the dorsal scapular artery were measured, and the data was analyzed by SPSS statistical software. Results The distance from the dorsal scapular artery to the superior angle of the scapula was (0.34±0.25) cm, to the medial border of the scapular spine was (1.58±0.41) cm, and to inferior angle of the scapula was (3.45±0.28) cm. The dorsal scapular artery coursed medially along the medial border of the scapula. The link line of the following three points was the course of the dorsal scapular artery: The point 0.34 cm to the superior angle of the scapula, the point 1.58 cm to the medial border of the scapular spine, and the point 3.45 cm to inferior angle of the scapula. Conclusions The surface projection of the dorsal scapular artery should be remembered by medical worker to avoid artery injury and the course can provide the anatomic basis which determines the central axis of the dorsal scapular artery flap.

    Radiographic measurement and the screw placement strategies of axis quadricortical pedicle screw
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  53-58.  doi:10.13418/j.issn.1001-165x.2016.01.015
    Abstract ( 694 )  
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    Objective To study the feasibility of screw placement strategies and the technique of axis quadricortical pedicle screw.  Methods 49 males and 43 females with normal cervical spine were included. At the C2 pedicle level of MRI images, we marked the tangent of pedicle medial wall which was parallel with central axis of C2 pedicle, and measured the distance between the tangent and spinal cord and the distance between the tangent and dura mater. At the same time, the tangent of C2 spinal canal medial wall which was parallel with sagittal axis of C2 was marked too, also we checked the distance between the tangent and spinal cord and the distance between the tangent and dura mater. Spinal cord diameter, spinal canal diameter and other associated parameters were recorded too. Result No statistical difference occurred between same sex.The mean distance between C2 pedicle medial wall and spinal cord was (male 9.05 mm, female 8.57 mm); The mean distance between C2 pedicle medial wall and dura mater was (male 5.04 mm, female 4.76 mm); The mean distance between the C2 spinal canal medial wall and spinal cord was (male 7.14 mm, female 6.70 mm); The mean distance between the C2 spinal canal medial wall and dura mater was (male 3.28 mm, female 3.28 mm).     Conclusion    At the C2 level, the space between the C2 spinal canal medial wall and dura mater was safe for C2 quadricortical pedicle screw;However, there were individual differences among patients.Therefore, different screw placement strategies should be applied based on different situations.

    Digital display of lumbar ligamentum flavum hypertrophy and ossification
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  59-62.  doi:10.13418/j.issn.1001-165x.2016.01.016
    Abstract ( 785 )  
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    Objective Through the digital reconstruction of the degenerative of lumbar ligamentum flavum,a stereoscopical and intuitive morphologic basis for the degenerative lumbar ligamentum flavum for diagnosis and surgical planning was provided. Methods CT imaging data of lumbar pain patients were collected, and cross-sectional images of lumbar ligamentum flavum in post-processing workstation were observed, a total of 63 patients aged 32 to 80 years old whose lumbar ligamentum flavum either hypertrophied greater than 4 mm and / or ossified were selected, male 31 male  and 32 female. Then, CT scan raw data were imported into mimics 16.0 software for image reconstruction, its morphology and distribution were observed. Results In the 63 cases of 315 lumbar vertebrae, a total of 205 segments’ ligamentum flavum were hypertrophied and /or ossified. The ligamentum flavum hypertrophied alone was 79.51%, and ossification alone ossification was 6.34%. Hypertrophy with ossification was 14.15%. All 205 segments’ ligamentum flavum were successfully modelled and ligamentum flavum hypertrophy modeling morphology included hinge-like, irregular flake and irregular column, ossification of ligamentum flavum contained with short columnar shape, short cone-shape, irregular flake, ligamentum flavum hypertrophied with ossification had their different forms after reconstruction. Conclusion The computer digital technology reconstruction of lumbar degenerative ligamentum flavum could clearly demonstrate the distribution, morphology and adjacent structure of the relationship. Moreover, lumbar spinal models and computer constructed ligamentum flavum models could be randomly assembled and sectioned, which could comprehensively and intuitively display all details of the lesion.

    Comparison of the reliability of computed tomography and magnetic resonance imaging in the evaluation of facet tropism in degenerative cervical spondylolisthesis
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  63-67.  doi:10.13418/j.issn.1001-165x.2016.01.017
    Abstract ( 638 )  
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    Objectives  To determine the reliability of MRI and CT in the assessment of facet tropism of spondylolisthesis levels in degenerative cervical spondylolisthesis. Methods Using a 4-point scale, 3 reviewers blindly and independently graded the severity of facet tropism of 76 cervical facet joints on axial T2-weighted and sagittal T1- and T2-weighted turbo spin echo images and separately on the corresponding axial MRI and CT scans. All results were subjected to the kappa coefficient statistic for strength of agreement. Results When assessing the severity of facet tropism, the weighted kappa coefficients for agreement between MRI and CT grading were 0.76 (P<0.001), MRI grading of facet tropism was identical to the CT grading in 62 of 76 joints (82%), with substantial intermethod concordance. The inter-rater reliability of three reviewer in MRI and CT were 0.61~0.74 and 0.65~0.81 (range k), respectively. CT performed better, with substantial to very good inter-rater reliability than MRI, which had substantial inter-rater reliability. Intra-rater reliability was higher than inter-rater reliability for both CT and MRI. Conclusion When using MRI and CT to assess facet tropism, they all performed excellent, with substantial to very good agreement for both intermethod agreement and inter-rater reliability or intra-rater reliability. This indicates that MRI can reliably determine the presence or degree of facet tropism. Therefore, for comprehensive assessment of facet tropism, an MR scan should not be performed in addition to a CT.

    Expression of TAp73 and Beclin1 in human osteosarcoma and their clinical significance
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  68-72.  doi:10.13418/j.issn.1001-165x.2016.01.018
    Abstract ( 550 )  
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    Objective To investigate the expression of TAp73 and Beclin1 in human osteosarcoma and their relationship. Methods The immunohistochemical SP method was used to detect the expressions of the TAp73 and Beclin1 proteins in 48 osteosarcoma patients’ tumor tissues, and the correlations of TAp73 and Beclin1 were analyzed with their clinical data. Results The positive rate of TAp73 was 54.17%, and the positive rate of Beclin1 was 60.42%. TAp73 positive expression, and the expression of Beclin1 were higher (Z=-2.146, P=0.032). The expression level of TAp73 was positively correlated with the expression of Beclin1 (P=0.001). The overall survival rate of patients with TAp73 and Beclin1 positive expression was better than that of negative expression (80.8% vs 50.0%, P=0.000, 80.0% vs 44.4%, P=0.001). The expression level of TAp73 and Beclin1 was positively correlated with the survival time of patients(r=0.696,P=0.00;r=0.372,P=0.009). Conclusion In human osteosarcoma, TAp73 may be related to the upregulation of Beclin1 dependent tumor autophagy activity.  And to detect the expression of TAp73 and Beclin1 is helpful for the assessment of patients’ prognosis.

    Changes of the periosteal reaction of diabetic rat and the protection of genistein
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  73-77.  doi:10.13418/j.issn.1001-165x.2016.01.019
    Abstract ( 552 )  
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    Objective To study the changes of the periosteal reaction of the diabetic rat and the protection of genistein.  Methods The diabetic model (STZ) of rat was established and randomly divided into a normal group and adiabetic group, with 10 rats in each group; GenLow group; GenHigh group. 20 rats each group. The change of collagen fiber depositing was observed by Van Gieson collagen fiber staining method and the microvascular density was measured by ink infusion method.    Results The thickness of periosteum wasreduced in the 10-week diabetic group than those in the control group(P<0.01), the microvascular density and permeability were enlarged. Thickness of periosteum was reduced by GenLow and by GenHigh after 10 weeks of treatment (P<0.01). Conclusions With periosteal reaction include periosteal edema, proliferation and regression in the diabetic. Gen could protect the periosteum in the diabetes rats.

    Influence of neural cadherin protein expression on myocardial fibrosis in rats
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  78-82.  doi:10.13418/j.issn.1001-165x.2016.01.020
    Abstract ( 606 )  
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    Objective To investigate the expression of neural cadherin (N-cadherin) on isoproterenol induced myocardial fibrosis in rat, and provide morphological data for the investigation of the cardiac hypertrophy signal transduction mechanism and reversal of cardiac hypertrophy.Methods    The rat models of myocardial hypertrophy were prepared by subcutaneous injection with isoprenaline (ISO) to healthy adult SD rats. The pathological changes of the myocardial collagen fiber were observed conventional paraffin section and Masson staining. The expression and distribution of N-cadherin was detected by immunohistoehemistry and immunofluorescence staining.Reverse transcription polymerase chain reaction was used to determine mRNA expression levels of N-cadherin in the myocardial tissues. Image analysis software was used to conduct quantitative analysis.    Results    Compared with the control group, the positive expression of N-cadherin protein in the experimental group had no significant difference. Furthermore, mRNA expression of N-cadherin in the myocardial tissues of rats was consistent with the immunohistoehemistry results.    Conclusion    The N-cadherin protein may be necessary for maintaining the structure and physiological function of myocardium.

    Analysis of the relationship between the changes of 5-HT2A receptor in spinal cord and the mouse tail spasm after spinal cord injury
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  83-86.  doi:10.13418/j.issn.1001-165x.2016.01.021
    Abstract ( 546 )  
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    Objective To study the relationship between the immunoreactive changes of 5-HT2A receptor and tail Spasticity, within spinal L1 segment after SCI, and to provide a theoretical basis for The treatment of spinal cord injury. Methods Sixty adult males Wistar rats were randomly separated into three groups: control group, attacked group and transversed group. To study 5-HT2AR immunoreactivity and hyperexcitability of tail of rats.    Results    (1) Compared the attacked and transversed groups with the control group, 5-HT2AR-IR density significantly increased in both attacked and transversed groups compared with that in the control group. (2) Spasticity and reflective hyperfunction symptom after SCI were positively correlated with 5-HT2AR-IR density and extent of SCI.    Conclusion    Spasticity and reflective hyperfunction symptom after SCI are positively correlated wtih 5-HT2AR-IR density  and the extent of SCI, which provides the theoretical basis for  using 5-HT2A receptor blockers in patients with limb spasm.

    The study on biomechanical effect of different torsion torque on the adjacent segment after lumbar fusion
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  87-90.  doi:10.13418/j.issn.1001-165x.2016.01.022
    Abstract ( 748 )  
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    Objective To evaluate the effects of small different torsion torques on intradiscal pressure(IDP)and pressure in the facet joints (PFJ )on the upper adjacent segment before and after lumbar spinal fusion. Methods Twelve lumbar porcine cadaveric motion segments were divided into two groups and loaded in the neutral position with 300 N of axial compression. IDP and PFJ at L3/4 measurements were obtained at 0, 1.0, and 2.0 Nm of torsion before and after lumbar spinal fusion (L4/5).   Results   The IDP increased with the increase of torsion torques. The changes of IDP in different torsion torques had statistically significant difference. Both non fusion group and fusion group, the PFJ become more and higher, the larger torsion torque, the higher PFJ. The changes of PFJ in the fusion group and non-fusion group both had statistically significant difference. Conclusions The IDP in the fusion group increases with the torsion torque increasing. The PFJ increases with the torsion torque increasing in non-fusion group and fusion group.

    A case report of 8 pulmonary lobes variation
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  90.  doi:10.13418/j.issn.1001-165x.2016.01.030
    Abstract ( 464 )  
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    Finite element study on two kinds of bone grafting methods for the treatment of first lumbar vertebral burst fracture
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  91-95.  doi:10.13418/j.issn.1001-165x.2016.01.023
    Abstract ( 463 )  
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    Objective To construct a finite element model(FEM) of first lumbar vertebral burst fracture, and compare the stress distributions between transpedicular grafting and transcanal grafting.    Method    The FEM of normal thoracolumbar segment T12~L2 with first lumbar vertebral burst fracture was established through thin layer CT scan, three-dimensional reconstruction by using Mimics and ANSYS software, respectively. The model was fixed by the posterior pedicle screws. On the basis of the models, we subsequently generated another 2 models simulating 2 types of surgical techniques, transpedicular grafting (TPG) and transcanal  grafting(TCG). The stress distribution of model was observed in the respective 4 models when spine was exposed to a stress of 350N/8Nm in the position of flexion, extension,lateral bending and rotation.    Results Through the static analysis of Ansys software, it was concluded 4 model under various conditions of equivalent stress nephogram, and display the equivalent stress peak, flexion: 6.89, 54.10, 8.03, 5.92 MPa; extension: 56.70, 109.00, 12.50, 8.61 MPa; lateral bending: 6.83, 47.50, 11.30, 3.60 MPa; rotation: 23.80, 112.00, 13.10, 7.65 MPa. Not concentrated stress at the time of bone graft screw of the tail and connecting rods, stress significantly decreased after bone graft, assuming a scattered distribution to the central screw.    Conclusion    Both of the 2 types of grafting procedure/technique can reconstruct the strength of injured vertebrae and enhance the instant stability. Nevertheless, the technique of transcanal grafting may offer a better mechanical performance through decreasing the stress on the internal fixation in a more adequate and efficient way. Therefore this study concludes that it is a better surgical technique worth of being popularized in clinic.

    A comparative study of 3D laparoscopic versus 2D laparoscopic hepatectomy
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  96-99.  doi:10.13418/j.issn.1001-165x.2016.01.024
    Abstract ( 702 )  
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    Objective To explore the application value of three-dimensional(3D)laparoscopic visualization during liver resection.    Methods    From October 2013 to August2015, 46 patients with liver tumors underwent laparoscopic hepatectomy in our department. Among these cases, 22 patients underwent laparoscopic hepatectomy (LH) by 3D laparoscope,and 24 patients underwent LH by two-dimensional (2D) laparoscope. The surgical methods of LH, the operation time and the intraoperative blood loss, postoperative hospital stay and operative complications were collected and analytic comparation was performed.   Results    The number of patients who underwent major hepatectomy was 6 (27.3%) in the 3D group and 6 (25%)in the 2D group,and minor hepatectomy was 15(68.2%) in 3D group and 17(70.8%) in 2D group. There was no significant difference between them,respectively. The operative time was significantly shorter in the 3D group when compared to 2D group(150±62 min vs 205±94 min,P=0.024). No differences were found in intraoperative blood loss (267±233 ml in 3D group vs 289±265 ml in 2D, P=0.774),postoperative hospital stay(7.8±2.7 d vs 8.2±3.2 d,P=0.936),and operative complications(18.2% vs 25%,P=0.575)respectively.Conclusion  When compared to 2D laparoscope,3D laparoscope that provides 3D stereoscopic visualizationcan facilitate to identify anatomical structures clearly,and be helpful to complex operations,and then may reduce the operating time.

    The surgical skills based on anatomic experience for treating the pediatric hernia by the single-port technique
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  100-103.  doi:10.13418/j.issn.1001-165x.2016.01.025
    Abstract ( 726 )  
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    Objective To summarize our anatomic experience and surgical skills to treating the pediatric hernia by the single-port technique. Method A total of 1735 boys with the inguinal hernia who underwent single-port laparoscopic hernia repair were retrospectively included. The mean age was 26.7 months (range from 23.5 to 36.8 month). A right-sided hernia was observed in 892 boys, a left-sided hernia in 595 boys and a bilateral hernia in 248 boys. Result All procedures were performed successfully without any serious complications resulting from anatomical factors, except for one case of iliac vessel hematoma.  Conclusion  Better anatomic understanding of surgical region is crucial for successful laparoscopic hernia repair operation, and practiced technique is the key for improving the surgical safety and preventing complications and recurrence.

    Clinical efficacy analysis of artificial humeral head replacement for treating elderly patients’proximal humeral Neer three-part and four-part fractures
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  104-107.  doi:10.13418/j.issn.1001-165x.2016.01.026
    Abstract ( 573 )  
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    Objective To discuss the indications, surgical methods andclinical efficacy of treating elderly patients’proximal humeral Neer three-part and four-part fractures. Methods 39 elderly patients with proximal  humeral complex fractures received artificial humeral head replacement were analyzed, retrospectively;Postoperative function of the shoulder joint and degree of pain in 15 cases with three-part fractures and 24 cases with four-part fractures, were assessed using neer score of shoulder joint function and VAS score of pain, respectively. Results All patients were followed up with follow-up time ranging from 12 to 32 months, with an average of 24 months; Neer score: 15 cases were optimal, 18 cases were good, 5 cases were moderate, 1 case was bad, the excellent rate being 84.6%. Conclusion Artificial humeral head replacement for treating elderly patients’ proximal humeral Neer three-part and four-part fractures can get satisfactory curative effect; the key for guaranteeing  postoperative clinical efficacy includes correct prosthesis implantation, effective rotator cuff repair, corrective reconstruction of greater and lesser humeral tubercles in operation and  individualized early joint functional exercise.

    Single incision ORIF for the treatment of distal tibial and fibular fractures
    Chinese Journal Of Clinical Anatomy. 2016, 34(1):  108-110.  doi:10.13418/j.issn.1001-165x.2016.01.027
    Abstract ( 612 )  
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    Objective  To investigate therapeutic effect of single incision and surgical methods for treatment of open reduction with internal fixation (ORIF) fractures of the distal tibia and fibula. Methods  August 2012 - August 2014 for treatment of single incision method by ORIF fractures of the distal tibia and fibula in 40 patients, including 34 cases of closed fractures, 6 cases of open fracture.  Results After a mean follow-up of 18 months, 40 patients were found to have fracture healed as expected and have primary closure of incision. Skin incision in 3 cases had developed superficial dry necrosis in the margin. The necrosis turned to scar after dressing change and fall off naturally without infection. Four patients developed manifestations of injury ofthe superficial peroneal nerve probably due to intraoperative traction, but natural recovery followed after 2~3 months. According to the standard Merchant function evaluation: the efficacy was excellent in 28 cases, good in 8 cases, poor in 4 cases.  The excellent and good rate was 90%. Conclusion Single incision ORIF of distal tibia fracture damage does not affect fracture healing. The soft tissue coverage and blood supply are better than the traditional two incisions, thus reducing the risk of infections and necrosis of the calf skin and soft tissue.  It is an alternative surgical approach.