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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 2016 Volume 34 Issue 5
      
    Applied anatomy of percutaneous "valve-above-valve" stent implantation to treat the acute aortic insufficiency
    LIU Jie, XU Bai-da, LING Qiu-yang, WANG Xiao, AN Dong-mei, CAO Li, BAI Yuan, ZONG Gang-jun
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  481-485.  doi:10.13418/j.issn.1001-165x.2016.05.001
    Abstract ( 907 )  
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    Objective To provide the anatomical basis for percutaneous "valve-above-valve" stent implantation in the treatment of the acute aortic insufficiency. Methods The normal adult hearts and the ascending aorta in 5 specimens with the same shape and size were dissected, the aortic CTA data of 178 cases were retrospectively analyzed, among which 131 cases were male, 47 cases female; and the aortic angiography data of 85 cases were retrospectively analyzed, among which 45 cases were male, 40 cases were female. The inner diameter and length of the ascending aorta in different location were measured. Results The inner diameter at the opening of the brachiocephalic trunk measuredby aorta CTA was (30.5±2.3)mm, the inner diameter at the opening of the coronary artery was (25.5±1.8)mm, and the distance from the midpoint to the two openings was (36.5±36.5) mm and (31.2±4.1) mm, respectively. After standardization of the body surface area, the values were respectively (17.1±1.2),(14.2±0.9),(21.4±1.1)and(17.8±1.3)mm; the above mentioned values measured in the same way by DSA were (28.7±2.8),(24.4±2.1),(34.3±2.9) and (29.4±3.6)mm, respectively. After standardization of the body surface area, the values were (16.0±1.4),(13.5±1.2),(19.7±1.6) and(16.7±2.0)mm, respectively. Conclusion There has been a successful animal experiment research background in the percutaneous "valve-above-valve" stent, which can be used for clinical purposes as a new technology. The size and shape of the "valve-above-valve" stent should be designed by the inner diameter and the length of the ascending aorta.

    The microscopic anatomical and clinical study of little free flap harvested from toes
    HOU Shu-Jian, SUN Le-tian, LIU Hong-zhang, LIU Ya-ping, WANG Zheng-jun, FENG Peng
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  486-489.  doi:10.13418/j.issn.1001-165x.2016.05.002
    Abstract ( 676 )  
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    Objective    To provide guides for transplantation of six kinds of little free flap harvested from toes by further exploring the course and diameter of four plantar metatarsal arteries and plantar digital arteries of the 1st, 2nd, 3rd and 4th toe at different plane, and apply these kinds of small-sized free flaps to repair subtotal defect of thumb and fingers.    Method    Twelve fresh foot specimens were dissected, observed and measured about four plantar metatarsal arteries and plantar digital arteries of the 1st, 2nd, 3rd and 4th toe. The transplantation of six kinds of small-sized free flaps harvested from toes was applied to repair subtotal defect of thumbs and fingers in 51 cases.    Result    The 1st, 2nd, 3rd and 4th plantar metatarsal artery originated from the deep plantar arterial arc,whose diameter was (1.24±0.36),(1.16±0.32),(1.10±0.27) and (1.09±0.29) mm,respectively,at the origin. The diameter of the fibular plantar digital artery of 1st toe was (1.09±0.21) mm at the initial site. The diameter of the tibial planter digital artery of the 2nd, 3rd and 4th toe was (0.98±0.24) mm, (0.85±0.18) mm, (0.82±0.17) mm at the initial site. All transplants survived. The period of following-up was from two to fifteen months postoperatively. All cases were graded as excellent as assessed using Criterion of Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery.    Conclusion    The four plantar metatarsal arteries were constant in their location and course without remarkable variation. The main blood supply of the small-sized free flap harvested from toes is from plantar digital artery. The main blood supply of the small-sized free flap harvested from 1st toe is from the fibular plantar digital artery, and that of the small free flap harvested from the 2nd, 3rd or 4th toe is from fibular planter digital artery. Transplantation of six kinds of small-sized free flaps harvested from toes is an optimal method for repairing subtotal defect of the thumb and fingers.

    Applied research about modified method of vertebral plate stress line and articular facet as a reference mark of pedicle screw insertion
    JIANG Chuan-jie, YANG Yong-jun, ZHOU Ji-ping, YANG kai, WU Rui, TAN Yuan-chao
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  490-494.  doi:10.13418/j.issn.1001-165x.2016.05.003
    Abstract ( 543 )  
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    Objective  To study the modified method of pedicle screw insertion. Methods 205 cases of spinal disorders, including thoracic, cervical and lumbar disorders, were randomly divided into two groups and underwent surgery to insert pedicle screw. Pedicle screw insertion method of group A was determined by the traditional method and group B was by the modified method, using the vertebral plate stress line and articular facet as a reference mark. Intraoperative and postoperative X-ray, CT and intraoperative nerve dissector touch inspection were adopted to determine the insertion accuracy. One-time success rate of pedicle screw insertion was calculated to compare which determination method was more successful.  Results Success rates of traditional method and the modified method were respectively 80.7% and 96.5% (P<0.001), among which 78.1% and 95.5% (P=0.002) were in cervical spine surgery, 82.4% and 95.9% in thoracic surgery (P<0.001), 80.3% and 97.0% in lumbar spine surgery (P<0.001). Conclusion The modified method using vertebral plate stress line and articular facet as a reference mark of pedicle screw insertion has a higher success rate of insertion. As stress line and articular facet respectively representing the stress conduction of the vertebral body, the modified pedicle insertion method showed a great application value and could realize individualized pedicle screw insertion.

    The precision of the 2D/3D registration techniques in measuring the cervical intervertebral foramen morphology
    ZHANG Xin-tao,YE Qiang,LI Jian-yi,PENG Peng,LI Shao-Lin
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  495-498.  doi:10.13418/j.issn.1001-165x.2016.05.004
    Abstract ( 670 )  
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    Objective To investigate the 2D/3D registration techniques in measurement accuracy of cervical intervertebral foramen morphology in specimens. Method Spiral CT images from 16 cervical specimens were collected to obtain a three-dimensional model through three-dimensional reconstruction. CT scan and lateral radiography with each isolated specimens after changed the position of the specimen were performed. 2D/3D image registration techniques were used to restore the cervical spine’s three-dimensional position where we had taken the X-rays. The bilateral foramen area, anteroposterior diameter and vertical diameter from C2/3 to C6/7 before and after registration were measured using Rapidform XOR3. Results The number of the foramen area, anteroposterior diameter and vertical diameter were measured were 158. Compared with the pre-registration, the registration area of the intervertebral foramen, anteroposterior diameter, and vertical diameter showed no significant difference (P>0.05) by paired samples t-test. The accuracy of the intervertebral foramen area was 96.77%, with a precision of (1.27±1.16) mm2, the accuracy of the anteroposterior diameter was 94.35% with a precision of (0.30±0.27) mm, the diameter of the upper and lower accurate degree was 96.14% with a precision of (0.32±0.28) mm. Conclusion Application of 2D/3D registration techniques to measure cervical intervertebral morphological parameters was high in accuracy and precision.

    Characteristics of CTA images of anterolateral thigh flap perforators and its source artery: CT-angiography study
    XIANG Yang, GAO Jian-ming, XIA Yun-bao, CHENG Wei-nan, XIA Xiao-liang, WANG Ya-dong, ZHANG Liang
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  499-503.  doi:10.13418/j.issn.1001-165x.2016.05.005
    Abstract ( 660 )  
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     Objective To study the characteristics of CT-angiographic images of the anterolateral thigh perforators and its source arteries ,in order to guide individual design of the anterolateral thigh perforator flap.   Methods    CTA data of 28 adult lower limbs were collected and three-dimensional images were reconstructed by ADW 4.6 workstation for observation, including the number, course, and location of the perforators at the deep fascia level and the course, length, and caliber of the source arteries were also investigated. Results    Descending branch of lateral circumflex femoral artery(DB) can be classified  as common trunk type (TypeⅠ, 64.2%) and non-common trunk type ( TypeⅡ, 35.8%). The total number of perforators of DB was 37. No obvious perforator were found in 3 case (10.7%), one perforator was found in 15 case (53.6%), one perforator was found in 10 case (35.7%). The average number of TypeⅠand type Ⅱperforator count for (1.5±0.78) and(1.0±0.66), respectively; septocutaneous perforators accounted for 37%  and 40%, respectively. The caliber of the typeⅠand typeⅡDB as the primary source arteries was(1.3±0.31)mm  and (1.0±0.54)mm.    Conclusions    CTA images have very high application value in the observation of anatomic parameter of perforators and its source artery. It can provide guidance for individual design of anterolateral thigh perforator flap.   

    Radiological anatomy of the structural weak region in the femoral neck in the osteoporosis and its clinical significance
    CUI Zhi-gang, DU Xin-ru, KONG Xiang-yu
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  504-508.  doi:10.13418/j.issn.1001-165x.2016.05.006
    Abstract ( 912 )  
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    Objective The purpose of the study was to observe a structural weak region in the femoral neck in the osteoporosis. Methods 159 dry femur specimen were collected for this study for identification of the "V"-shaped weak region of trabeculae in the femoral neck. The degree of osteoporosis of the femoral neck specimens were classified according to the Singh index grading. The relationship between the Singh index grading and the "V"-shaped weak region of the neck was assessed. 10 femur neck samples were sectioned in transversal, coronal and sagittal plane for identifying the position of the trabeculae and the "V"-shaped weak region. Femoral neck three-dimensional CT reconstruction was used for identifying bone trabecular contorts.    Results Singh index 1 (7/159), no of them have the "V"-shaped weak region; as Singh index 2 (23/159), 34.78% of them have the "V"-shaped weak region; as Singh index 3 (42/159), 85.71% of them have the "V"-shaped weak region; as Singh index 4 (48/159), 75% of them have the "V"-shaped weak region; as Singh index 5 (27/159), 29.63% of them have the "V"-shaped weak region. There was not the "V"-shaped weak region of the neck in the Singh index 6. The main pressure trabeculae, the main tension trabeculae, and the minor pressure trabecular bone consisted of WARD triangle in the coronal view, when the main tension trabecular disrupting or missing in osteoporosis, the "V" –shaped weak region is obvious.  Conclusions Singh index 1-2 is prone to subcapital femoral neck fracture; In Singh index 3-4 tends to produce typical type of femoral neck fracture; In Singh index 5-6, femoral neck fracture is not easy to take place.

    The application of CTA in TARP: studying in the relationship of ICA and atlas lateral mass
    XIAO Yao-sheng,MA Xiang-yang,XIAO Jian-hua, YANG Jin-cheng,QIU Feng,ZHOU Xing,HU Hai-sheng
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  509-513.  doi:10.13418/j.issn.1001-165x.2016.05.007
    Abstract ( 609 )  
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    Objective To avoid ICA injury in TARP surgery by studying anatomic  structural relationships between atlas and carotid artery from three-dimensional CTA reconstruction. Methods A series of 145 cases underwent TARP surgery were retrospectively selected from January 2012 to June 2015, in whom had performed CTA in neck before surgery. The images were reconstructed by multi-planar reconstruction techniques. The cases with the medial border of the ICA located outside the medial edge of transverse foramen in the atlas transverse center line level were divided into lateral group and the medial group. The parameters were measured including distance from the medial edge of the ICA to perpendicular lines drawn in the axial plane, distance from the medial border of the foramen transversarium to perpendicular lines, deviation distance of the medial edge of the ICA postoperatively. Statistical analysis was carried out to determine if there was a significant difference between lateral and medial by comparing both sides of each segment. The location of the ICA was categorized into 4 areas of C1 lateral mass.    Results    In the medial group,the differences of bilateral d, ipsilateral d and l, D and d were significant(P<0.05). The offset distance of ICA postoperative was 3.12 mm (F), 3.83 mm (M). The difference was statistically significant compared with the preoperative value.    Conclusions    It is necessary that every patient performs the three-dimensional CTA preoperative to determine the anatomical structures between ICA and C1 lateral mass, then avoid ICA injury and improve the safety of the surgery. Strict periosteal stripping should be taken in surgical exposure process, and the left side in particular should to be more careful.

    CT manifestations of normal transverse mesocolon and anatomic basis
    WANG Qian-qian, WANG Ya-qin, YANG Chun-bo, DONG Peng
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  514-516.  doi:10.13418/j.issn.1001-165x.2016.05.008
    Abstract ( 922 )  
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    Objective    To measure the anteroposterior diameter of the portacaval space (PCS) using the computed tomography (CT).    Methods    Abdominal CT scan was performed in 41 patients. The patients who had no disease revealed on CT images were considered as the normal individuals group, the patients with small renal cyst were included. Emphasis was placed on the following findings: the minimum anteroposterior diameter of the PCS on the plane of initial part, final end and lower margin of the caudate lobe of the live;The thickness of the fat layer in the navel based on the axial CT images.   Results    The minimum anteroposterior diameter of the PCS on the initial part, final end and lower margin of the caudate lobe of the live was 0.427, 0.529 and 0.344 cm,respectively. The minimum anteroposterior diameter of the PCS on the plane of the lower margin of the caudate lobe of the live was correlative with the thickness of the fat layer in the navel (r=0.387, P<0.05). The minimum anteroposterior diameter of the PCS on the plane of the initial part and final end was not in correlation with the thickness of the fat layer in the navel (P>0.05). Conclusion    The CT can demonstrate the details of the PCS.

    Shexiang baoxin pill protects cardiomyocytes against high glucose-induced injury by inhibiting the p38 MAPK and NF-κB pathway
    YANG Yi-ying, CHEN Wei-yan, SUN Xiu-ting, WANG Xiang, LI Zheng-xun, LIANG Mei-ling, SHI Hui, YANG Zhi-sheng, ZENG Wu-tao
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  517-522.  doi:10.13418/j.issn.1001-165x.2016.05.009
    Abstract ( 731 )  
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    Objective To explore whether Shexiang Baoxin Pill(SXBXP/SBP)protects H9c2 cardiac cells against high glucose(HG)-induced injury by inhibition of p38 MAPK and NF-κB pathway.Methods H9c2 cardiac cells were treated with 35 mmol/L glucose(HG)for 24h to establish a model of HG-induced injury;Cell counter kit-8(CCK-8)was used to measure cell viability;Apoptotic cells were tested by Hoechst 33258 nuclear staining followed by fluorescence imaging;Intracellular levels of reactive oxygen species(ROS)were detected by 2’,7’-dichlorfluorescein-diacetate(DCFH-DA)staining,followed by fluorescence imaging; Mitochondrial membrane potential (MMP)was measured by a fluorescent dye,rhodamine 123(Rh123),followed by fluorescence imaging;The expression levels of p38 MAPK and NF-κB p65 protein were detected by Western blot assay. Result Treatment of H9c2 cardiac cells with HG for 24h signally induced injuries,proved by a decrease in cell viability,an increase in amount of apoptotic cells and intracellular ROS production,as well as a loss of MMP;HG strengthened the expression of phosphorylated(p)-p38 MAPK and p-NF-κB p65; Pretreatment with SBP notably inhibited the up-regulation of expression of p-p38 MAPK and p-NF-κB p65 induced by HG; Pretreatment with SBP or SB203580,an inhibitor of p38 pathway or PDTC, an inhibitor of NF-κB pathway,attenuated the above HG-induced injuries,including cytotoxicity,apoptosis,increase in ROS production and a loss of MMP,in H9c2 cardiac cells. Conclusion SXBXP(SBP) may protect H9c2 cardiac cells against the HG-induced injuries by inhibiting the p38 MAPK and NF-κB pathway.

    Effect of dexamethasone on the expression of TREM-1 in acute lung injury
    LUO Feng, ZHENG Hao-xiang, DONG Liang, LI Nian-wang, ZHOU Qin, JIA Zhe, HE Li-ping,SUN Guo-ying
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  523-527.  doi:10.13418/j.issn.1001-165x.2016.05.010
    Abstract ( 445 )  
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    Objective To investigate the effects of dexamethasone (Dex) on the TREM-1expression in acute lung injury(ALI) of mice induced by lipopolysaccharide (LPS). Methods  Kunming mice (KM mice) were used as the research object and LPS (10 mg/kg) was used to induce acute lung injury model. After half an hour given different concentrations of Dex (5, 10, 20, 40 mg/kg) and selection of different time points (6, 12, 24 and 36 h) were observed. The lung tissue was observed by HE staining, RT-PCR was used to detect TREM-1 expression, and ELISA was used to detect the expression of sTREM-1 in bronchoalveolar lavage fluid of mice.    Results    Dex could time-dependently down-regulate the expression of lung tissue in the acute lung injury and in 6h treatment peak; Dexcould dose-dependently down-regulate TREM-1 expression in acute lung injury of lung tissue, and reached the peak at 10 mg /kg. Dex could decrease the protein level of sTREM-1 in bronchoalveolar lavage fluid of ALI mice. Conclusion Dex can down-regulate TREM-1 of lung tissues of ALI mice in a dose and time-dependent manner, and reduce myeloid cell membrane of TREM-1 in lung. Our research indicates that Dex may inhibit inflammatory cascade and protect lung tissue by regulation of TREM-1 expression.

    BMSCs-BMP-2 composite with magnesium alloy rod in the repair of femoral head necrosis
    ZHANG Yan-ru,ZHANG Hui, Kaka, ZHANG Ge-chen, SHANG Yan, SUN Hao, HUANG Wen-hua
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  528-533.  doi:10.13418/j.issn.1001-165x.2016.05.011
    Abstract ( 791 )  
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    Objective  To investigate the effect of BMSCs transfected BMP-2 composite with magnesium alloy rod in the repair of the femoral head necrosis.   Methods  Rabbit BMSCs was isolated, cultured, and successfully transfected pcDNA3.1-BMP-2 plasmid by electroporation. 40 rabbit femoral head necrosis was established by liquid nitrogen freezing method, and then were randomly divided into 4 groups of 10 animals each: the magnesium rod /BMSCs group, the magnesium rod group, the BMSCs group, and the blank group. The bio-magnesium alloy rod imported the BMSCs-BMP-2 plasmid pcDNA3.1. Repair effect was assessed post-operatively at 6 weeks and 12 weeks. Results Six weeks and 12 weeks after operation, the concentration of magnesium ion in blood and urine was tested by first, two, four, eight and twelve weeks, respectively. X-ray and HE staining at the sixth and twelfth week showed that the femoral head of magnesium rod /BMSCs group had the best recovery, and at the twelfth week, the magnesium alloy rod was completely absorbed; the femoral head necrosis in the magnesium rod group and BMSCs group was slower, and some of the femoral head necrosis was improved. Conclusion Implantation of composite magnesium alloy-BMSCs-BMP-2 gene has effect on delaying femoral head necrosis and improving repair.

    Changes of motor neurons in spinal cord anterior horn after peripheral nerve graft repair in rat
    KAN Shi-lian,LI Gui-shi,ZHAN Hai-hua,ZHANG Jian-bing,MA Ning,LI Ming-xin,ZHAO Jia-guo
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  534-539.  doi:10.13418/j.issn.1001-165x.2016.05.012
    Abstract ( 498 )  
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    Objective To observe morphologic and functional changes of motor neurons of spinal cord horn in the rat transplanted nerve model, and to provide theoretical foundation for the distal anastomostic re-suture of theperipheral transplanted nerve.    Methods    120 SD rats were randomly divided into six groups respectively: a pure nerve transection (group 1); a suture after nerve transection (group 2); a nerve graft repair after nerve transaction (group 3); a distal anastomosis resection after free nerve graft repair (group 4); a re-suture of distal anastomosis resection after free nerve graft repair (group 5); a sham operation (group 6). The lumbar enlargement of the spinal cord were removed to detect histological changes at 1st week, 2nd week, 4th week, 8th week, 12th week, 16th week, respectively. Pathologic changes of white and gray matter in each group were observed using a light microscope at each postoperative time point. And the expression of various neurotrophic factor receptors in the anterior motor horn of the spinal cord was observed using immunohistochemistry.    Results    Experimental group showed cytoplasmic edema, mitochondrial swelling, and vacuolization at postoperative 1st week. And the changes of neuronal ultrastructure significantly increased at 2nd to 4th week. Electron microscope images suggested the damaged neurons had been into the recovery period at 4th to 8th week. Group 3 showed the increase of BDNF expression in motor neurons at 1st week, reaching a peak at 2nd week, and declining at 8th week. NGF expression increased at 2nd week, reaching a peak at 8td week, and declining at 8th week. BDNF expression gradually increased at 8th to 16th week in group 5. NGF Expression maintained a steady state after 8th week, without a downward trend. the control group did not showed significant changes at each time.    Conclusions Re-suture of distal anastomosis resection after long nerve graft repair can promote the recovery of neurological function at a proper time, because it removes the distal anastomotic scar and activates the endocrinic state of the neurons in the anterior horn of the spinal cord.

    The preliminary research on neurovascular unit injury of hyperacute infarction of rabbit middle cerebral artery by magnetic resonance diffusion-weighted imaging
    PENG Song, HE Wei, YE Bin, RONG Peng-fei, LIANG Qi, ZHANG Sheng-wang, LIAO Yun-jie, HU Peng-zhi
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  540-545.  doi:10.13418/j.issn.1001-165x.2016.05.013
    Abstract ( 390 )  
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    Objective To investigate the diagnostic efficacy of magnetic resonance diffusion-weighted imaging (DWI) on the injury characteristics of neurovascular unit (NVU) of hyperacute infarction of rabbit brain. Methods Fifteen New Zealand rabbits were randomly separated into two groups: the contrast group (n=5) and the experimental group (n=10). Micro-catheter was used to produce middle cerebral artery occlusion (MCAO) on the experimental group animals via internal carotid artery. According to different occlusion time, the experimental group was divided into 2 sub-groups (sub-group 0.5 h and 4 h) with 5 animals per group. All the animals underwent T2-flair and DWI scanning before and after MCAO. The imaging characteristics of DWI and the values of apparent diffusion coefficient (ADC) and relative apparent diffusion coefficient (rADC) were analyzed. After MRI, the animals were sacrificed for the Nissl′s staining, the glial fibrillary acidic protein (GFAP) and CD31 detection of brains. Results Compared with the contrast group, abnormal high intensity signal on DWI, low signal on ADC, unaltered T2-flair signal, high expression of GFAP were observed at sub-group 0.5 h in the right basal ganglia region. At sub-group 4 h, abnormal high intensity signal on DWI and low signal on ADC which appeared more intense than sub-group 0.5 h. T2-flair scanning showed high signal. The Nissl’s results showed that the number of Nissl’s body at the control group and sub-group 0.5 h appeared intact, while the number of Nissl’s body decreased and neurons were damaged at sub-group 4 h. The high expression of GFAP were observed. The values of ADC and rADC in sub-group 0.5 h were significantly different with those in sub-group 4 h. The value of rADC and the intensity of GFAP showed linear correlation (r=-0.672, P<0.01). Conclusions The DWI can diagnose accurately on hyperacute infarction of rabbit brain, and the DWI changes of relative time were consistent with the injury of NVU.

    Study on biological effect of nanoparticles from Ershiwuwei Shanhu’ Pill
    LIAO Yi-nuo, LIU Ya-li, QIU Ren-jie, WU Peng, HUANG Fu-kai, XIAO Wei
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  546-550.  doi:10.13418/j.issn.1001-165x.2016.05.014
    Abstract ( 497 )  
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    Objective To explore the biological effect of drug-loaded nanoparticles from Ershiwuwei Shanhu’Pill. Methods The ESP drug-loaded nanoparticles were incubated with SH-SY5Y cells for 8hrs. Cellular uptake and intracellular distribution was observed by immunofluorescent staining assays. Intracellular translocation was tracked by transmission electron microscopy (TEM). Rats were randomly divided into a model group and an ESP-treated group, being injected with normal water or drug-loaded nanoparticles through tail vein, respectively. HE staining was used to observe liver pathological change. Changes of excitatory was assessed by open field test. SH-SY5Y development on the ESP insoluble components were measured by scanning electron microscope (SEM).    Results    The drug-loaded nanoparticles could fill the whole cells and the cellular nucleus was fragmentized. In vivo experiments, the liver cells in the treatment group had liquefactive necrosis. Compared with the model group, total distance was significantly improved in ESP-treated group (P<0.05). Cells regularly growing on the insoluble component exsited in ESP. Conclusion Drug-loaded nanoparticles from ESP may lead to anxiety and strongliver toxicity of rats.

    The biomechanical effect of transforaminal lumbar interbody fusion with different types of posterior instruments for stabilization
    YU Wei-bo,LIANG De, YE Lin-qiang,HUANG Xue-cheng,YAO Zhen-song, JIANG Xiao-bing
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  551-556.  doi:10.13418/j.issn.1001-165x.2016.05.015
    Abstract ( 606 )  
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    Objective To investigate the biomechanical effect of transforaminal lumbar interbody fusion (TLIF) with three different types of posterior instruments. Methods A validated L3~5 FE model was modified to simulate three different TLIF finite element modelsat L4~5: unilateral pediclescrew fixation;bilateral pedicle screw fixation; a unilateral pedicle screw fixation supplemented with contralateral facet screw construct. Various biomechanical parameters were evaluated for intact and implanted models in all loading planes. Results When compared with the intact model, all reconstructive models displayed decreased motion at L4~5, and Model B conferred greater stability in flexion-extension (18.2% of intact model). The maximum stress of instruments was found in Model C with 234.9 MPa under left lateral bending. In addition, Model B generated the lowest cage stress. Conclusion The reconstruction with bilateral pedicle screw fixation can gain the optimal stability and decrease posterior instrumentation stress. A unilateral pedicle screw fixation supplemented with contralateral facet screw construct could also gain a relatively good stability.

    Finite element analysis of the anatomic nano-hydroxyapatite /polyamide 66 cage in XLIF/OLIF surgery
    PENG Xiang, WANG Wen-jun, YAN Yi-guo, ZUO Jian-hong, ZHANG Jian, YAO Nv-zhao, WANG Cheng, XUE Jing-bo
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  557-562.  doi:10.13418/j.issn.1001-165x.2016.05.016
    Abstract ( 642 )  
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    Objective To establish an effective L3~5 three-dimensional finite element model, and study the biomechanical attributes of the anatomical nano-hydroxyapatite / polyamide 66 cage in XLIF/OLIF operation. Methods We established the model of normal lumbar spine( L3~5) in order to simulate the XLIF/OLIF operation process by assembling a new anatomic cage and a bullet- liked cage, and the assignment model was imported into software to obtain the final finite element model. Pre-load with axial compression of 400 N and 8 Nm torque was imposed on the model, which caused motion of flexion, extension, bending and rotation of the model. the maximum stress, stress distribution of the two kinds of cage and the ROM of the L4~L5 were analyzed. Results Under 6 different operating conditions, the maximum stress of the bullet-liked cage was 134.83, 79.17, 71.31, 114.96, 76.85, 78.77 MPa, and the maximum stress of the anatomic cage was 56.91, 61.78, 35.82, 52.28, 31.76, and 32.45 MPa, respectively. The stress distribution of anatomic cage was smaller and more dispersed than that of the bullet-liked cage. The ROM of L4~L5 in the two groups was significantly less than that of the normal persons,and the ROM of L4~L5 in anatomic cage group was less than that of the bullet-liked cage group. Conclusions  The application of the new anatomic nano-hydroxyapatite / polyamide 66 cage in minimally invasive XLIF/OLIF operation can reduce the maximum stress, circumvent the stress concentration and reduce the activity of vertebral body, proving that it has better mechanical properties.

    Categorization of intramedullary ependymoma in cervical spinal cord by imaging anatomy and surgical strategy
    CHEN Ke-en, WANG Xiang-yu, XU Dian-shuang, ZHOU Meng, ZHANG Liu, GUO Guo-qing
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  563-567.  doi:10.13418/j.issn.1001-165x.2016.05.017
    Abstract ( 681 )  
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    Objective To investigate the imaging anatomical characteristics of intramedullary ependymoma in cervical spinal cord and formulate appropriate surgical strategy. Methods Tumors in 26 patients with intramedullary ependymoma in the cervical spinal cord were categorized by analyzing the pre-operative magnetic resonance imaging (MRI) characteristics and the compressed alteration of the spinal cord,and removed with assistance from real time neuro-electrophysiological monitoring. Results The tumors were classified into three types based on their morphological changes and the anatomical relationship between the spinal cord and the tumor : Type I: Solid tumor with syringomyelia or cyst;Type II: Solid tumor;Type III: Tumor tubercle in the cyst. For type I, tumors were removedstarting from operating at the posteriormedian sulcus at the border of the poles of the tumor and the syringomyelia or cyst,or at the center of the tumors. For type II,tumors were resected starting from operating at the posterior median sulcus at the center of the tumors, and for type III, starting from operating at the posterior median sulcus at the point close to the tumor tubercles.When the introperative neuro-electrophysiological monitor indicated a 50% reduction of the amplitude or a 10% delay of the latency of somatosensory evoked potential (SEP), andor the amplitude of motor evoked potential (MEP) for the target muscles dropped to 20%, surgical procedures should be suspended for its recovery. The final pathological diagnosis of all the cases was intramedullary ependymoma. Post-operative MRI indicated of all the cases, 23 were total removed, 3 partially, without death during surgery. Post-operative symptoms were significantly improved in 23 patients, partially in 2 and deteriorated in 1. Conclusion Classification based on pre-operative MRI characteristics and formulation of appropriate surgical strategy may be helpful for total removal of intramedullary ependymomain the cervical spinal cord and reduction of injury of spinal cord.

    Clinical outcomes and anatomic evaluation of single-stage one side lamina retaining posterior approach for resection of upper cervical schwannoma
    HUANG Yang-liang, ZHONG Yi, LIU Shao-yu
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  568-571.  doi:10.13418/j.issn.1001-165x.2016.05.018
    Abstract ( 488 )  
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    Objective To evaluate clinical outcomes and anatomy of single-stage one-side lamina retaining posterior approach for resection of C1/2 schwannoma. Methods From Jan 2009 to Jan 2014, C1/2 schwannoma cases admitted in our department were selected according to following indication: (1) Epidural tumor; (2) lateral growth pattern which went through C1/2 lamina space; (3) the diagnosis of schwannoma was suggested by MRI. 9 cases were collected, among which 5 were male and 4 female, and whose average age was 47.2 y (25~74 y). JOA score, radiological images, operative time, bleeding amount, complications and atlanto-dental interval of lateral cervical X-ray picture at last follow-up were recorded and analyzed. Results All cases were successfully followed up for 6 to 48 month, with an average of 20 months. There was no recurrence, cervical instability and post-operative axial pain reported. At last follow-up, all of the atlanto-dental intervals were less than 2mm. Pre-operative JOA score was improved from 11.3±1.64 to 15.4±0.70 at the final follow-up of 8 neurologically impaired patients, and the difference was significant(P<0.05). Conclusion MRI should be used to recognize the tumor pre-operatively. After careful patient selection, the single-stage one-side lamina retaining posterior approach for resection of upper cervical schwannoma has a satisfied clinical outcome, few complications and good prognosis. 

    The study of the tibial tunnel enlargement andmedium-term clinical effects after anatomical single bundle anterior cruciate ligament reconstruction
    XU Cong1, CHEN Yong-liang, DAI Hai-feng, LI Jia, CAO Xiang-yu, WANG Yong-wei, LiuWen-tao, LU Yong-ming
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  572-576.  doi:10.13418/j.issn.1001-165x.2016.05.019
    Abstract ( 646 )  
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    Objective To explore the effect of tibial tunnel enlargement on the clinical outcome after anatomical single bundle anterior cruciate ligament (ACL) reconstruction. Method The clinical data of 40 patients who had received anatomical single-bundle ACL reconstruction from May 2011 to December 2012 in affiliated hospital of Cheng De medical college were reviewed. After measuring the tibial bone tunnel width through X-ray films, CT scanning and three-dimensional reconstruction, The bone tunnel enlargement is classified and defined. To evaluate the clinical outcome, range of motion (ROM), anterior drawer test (ADT), Lachman Test, pivot shift test (PST),the Lysholm Knee Scoring Scale and IKD C2000 Scoring Scale were adopted. Results During postoperative follow-up,there was no activity disabilities of joint flexion and extension. Between affected limb and the contralateral limb flexion angle there was no statistically significant difference (t=-1.844, P=0.069).There was no statistically significant difference between the two groups in ADT、Lachman test and PST (χ2=1.314,0.011,0.005, P=0.33、1.0、1.0). Comparing the preoperative Lysholm score with postoperative score in the 40 patients, There was statistically significant difference(t=-45.50, P<0.001). Comparing the preoperative IKDC score with postoperative score in the 40 patients, there was statistically significant difference (t=-25.18, P<0.001). According to tibial tunnel diameter of 3D-CT, there was no statistically significant difference among all Lysholm score in different levels (F=1.274, P=0.292), and there was no statistically significant difference between any two levels. Conclusion The tibial tunnel enlargement after anatomical single bundle ACL reconstruction has no significant effect on medium-term clinical outcomes.

    The clinical study of reamed intramedullary nail and cruciate ligament reconstruction used in the treatment of femoral shaft nonunion
    GAO Yi-jia, HUANG Feng, DONG Hang, ZENG Zhi-kui
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  577-580.  doi:10.13418/j.issn.1001-165x.2016.05.020
    Abstract ( 555 )  
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    Objective To observe effect of "reamed intramedullary nail and ligament reconstruction" to treat knee instability (combined with cruciate ligament injury) femoral shaft nonunion. Methods 10 cases with femur bone nonunion combined with cruciate ligament injury were treated. The effect of stability of the knee to the femoral shaft fracture healing was analyzed. The femoral shaft nonunion caused by knee instability was treated with "the original implant removal + reamed intramedullary nailing of femoral shaft reseat + cruciate ligament reconstruction ". Results Ten patients were followed up with the healing rate being 100%. Tohner-Wrnch standard assessment was excellent, and Lysholm knee function score excellent rate was 100%. Conclusion Knee instability is an important factor of femoral shaft fracture nonunion; the treatment of femoral shaft fractures must consider whether knee instability exists.” Removal of original implant, fixation with reamed intramedullary nail and cruciate ligament reconstruction “is a reliable method for treatment of the femoral shaft nonunion combined with a cruciate ligament injury.

    Minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation for thoracolumbar burst fractures with neurologic injury
    CHEN Zi-hua, LIU Dan, CHEN Xin-ying, CHEN Jian-wei, ZENG Hong-sheng, FANG Lei, YOU Jun
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  581-583.  doi:10.13418/j.issn.1001-165x.2016.05.021
    Abstract ( 785 )  
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    Objective To explore the efficacy of minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation for the treatment of thoracolumbar burst fractures with neurologic injury. Methods From January 2013 to February 2016, 33 cases of thoracolumbar burst fractures with neurologic injury were treated with minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation. Result 33 patients were followed up for 2-36 months,with an average of 17 months. Compared with the conventional surgical approach, shorter operative time,less intraoperative and postoperative bleeding,milder back pain were resulted using the surgical approach described in this paper.There were varying degree of recovery of vertebral height,,Cobb angle correction rate,spinal stenosis and neurological conditions. Conclusion Minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation for treatment of thoracolumbar burst fractures with neurologic injuryhas the advantages of enjoying a shorter operative time,less trauma,less bleeding,rapid postoperative recovery,as well as retaining the structure and stability of the spine, resulting in effective reduction of pressure within the spinal canal.

    Self-made sharp opening teeth entrapment plate for treatment of avulsion fractures
    LU Rao, LIU Jun, RUI Yong-jun, WU Yong-wei, MA Yun-hong
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  584-587.  doi:10.13418/j.issn.1001-165x.2016.05.022
    Abstract ( 630 )  
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    Objective To investigate the characteristics and therapeutic efficacy of self-made sharp opening teeth entrapment plate for treatment of avulsion fractures. Methods Sixteen cases with avulsion fractures were treated with self-made sharp opening teeth entrapment plate between January 2012 and February 2015. There were 10 males and 6 females, with an age ranging from 20 to 63 years old, averaging 43.6 years old. Among all the cases, there were posterior cruciate ligament tibial avulsion fractures in 8 cases, lateral malleolus avulsion fractures in 2 cases, medial humeral epicondyle avulsion fractures in 3 cases,greater tuberosity of humerus avulsio fractures in 1 cases and olecranon avulsion fractures in 2 cases. All were fresh fractures, and the fracture type(according to Meyer method): type I in 1 cases, type II in 6 cases and type III  in 9 cases. Early postoperative rehabilitation was taken. The limb functionary recovery was evaluated according to the Lysholm knee score, Kaikkonen ankle injury scores and DASH upper limb function evaluation questionnaire, respectively. Result The incision healed by first intention, without vascular and nerve injuries. All were followed up, the follow-up time was 12~24 months , with an average 18.1 months. All fractures healed, and the healing time was 2~3 months,with an average 2.5 months. No redisplacement of fracture and loosening of internal fixation occured. At the last follow-up, the limb functionary recovery was excellent in 12 cases, good in 4 cases (the excellent and good rate was 100%). no instability of joint and other complications was noted.  Conclusion Self-made sharp opening teeth entrapment plate for treatment of avulsion fractures is simple, widely indicated, and has reliable fixation and good effectiveness.

    Reconstruction of a digital three-dimensional model of fetal whole-body arterial system and its significance
    HUANG Hai-long, WANG Gang, GONG Da-cong
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  588-592.  doi:10.13418/j.issn.1001-165x.2016.05.023
    Abstract ( 494 )  
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    Objective To explore the method and significance of reconstructing digital three-dimensional models of the fetal whole-body arterial system.    Methods    One case of a fresh induced labor normal fetal specimen(33 weeks)was infused with epoxy resin-lead oxide and then casted, the 64-slice spiral CT thin layer scanning data of the casting specimens were used to reconstruct three-dimensional models of the fetal whole-body arterial system by Mimics software.  Results    Using the Mimics 15.0 software, the digital three-dimensional models of the fetal whole-body arterial system could be successfully reconstructed based on CT data. The three-dimensional models are realistic and stereoscopic, showing morphological structures of its fetal main artery and its branches clearly, which are highly consistent with the fetal whole-body arterial casting specimens. The three-dimensional models can not only be zoomed in or out, but also be revolved freely for better observation of fetal arterial vessels.    Conclusion    The digital three-dimensional models of thefetal whole-body arterial system can fully display the fetal arterial vessels. It is a good support platform to usedigital three-dimensional models to study fetal vessels, which serves as an anatomical support for intrauterine virtual surgery and intrauterine virtual surgery and intrauterine blood transfusion.

    Research progress of the fingers degloving injuries
    SHI Zhi-hua, JU Ji-hui, HOU Rui-xin
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  593-595.  doi:10.13418/j.issn.1001-165x.2016.05.024
    Abstract ( 527 )  
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    Research progress of perforator flap preoperative imaging navigation technology
    CHANG Shu-sen, WEI Zai-rong
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  596-598.  doi:10.13418/j.issn.1001-165x.2016.05.025
    Abstract ( 700 )  
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    CTA revealed the variation of unilateral peroneal artery and posterior tibial artery :a case report
    DUAN Jia-zhang, HE Xiao-qing, XU Yong-qing
    Chinese Journal Of Clinical Anatomy. 2016, 34(5):  599.  doi:10.13418/j.issn.1001-165x.2016.05.026
    Abstract ( 872 )  
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