Table of Content

25 January 2017 Volume 35 Issue 1

  

Microanatomy of the lateral wall of sphenoid sinus and the medial wall of the cavernous sinus via transnasal approach

XUE Liang，WANG Shou-sen, WEI Liang-feng, ZHENG He-ping, LU Song-song

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  1-4.  doi:10.13418/j.issn.1001-165x.2017.01.001

Abstract ( 800 )  

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Objective　 To study the features of the microanatomy of the lateral wall of sphenoid sinus and the medial wall of the cavernous sinus from the perspective of the transnasal approach and provide morphological basis for relevant operations. Methods　With the transnasal endoscopic approach, microdissections were performed on 10 cases of antiseptic cadaveric heads, and then the relationship among nerves, internal carotid artery and the lateral wall of sphenoid sinus were observed in the visual field of microscope； Finally, the length between the anterior nasal spine and orbital opening of canales opticus, internal carotid artery carina was measured, as well as the angle between anterior nasal spine and Abey’s plane.　Results　Internal carotid artery and optic nerve together formed a “＞”shape prominence, the distance between anterior nasal spine and the most salient point of internal carotid artery carina was (62.18±5.12) mm, and the angle between anterior nasal spine and Abey’s plane was (36.8±3.4)°. The length between anterior nasal spine and orbital opening of canales opticus was (69.24±3.95) mm，and their angle was (41.4±3.0) ° The intracavernous portion of internal carotid artery could be divided to parasellar and paraclival sections. Among them, the parasellar part was closely related to the lateral wall of the pituitary, and its distance with the mesal was (9.06±1.34) mm.　Conclusions　Familiarity with the anatomy of the lateral wall of sphenoid sinus would be  significant importance for intraoperative localization and safe treatment of cavernous sinus lesions.

Applied anatomy for transforaminal endoscopic lumbar surgery

WU Bo1, ZHAO Qing-hao2, ZHOU Xiao-qi1, SHI Ben-chao1, PENG Yan-kai1, CHEN Zhong1, DING Zi-hai2

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  5-8.  doi:10.13418/j.issn.1001-165x.2017.01.002

Abstract ( 1040 )  

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Objective　To provide data for transforaminal endoscopic lumbar surgery at different levels.　Methods　Anatomic structures, including the height of intervertebral foramens,the morphology of safety triangle of intervertebral foramen and safety triangle of spinal canal on 10 adult cadaver spine specimens (L1～S1) were observed and measured.　Results　①The vertical dimension between the intersection of a horizontal line drawn through the middle of disc space and the tip of the safety triangle of intervertebral foramen and the exiting nerve root at L1/2～L5/S1 were (4.75±0.80), (6.42±0.44), (7.30±0.82),(7.74±0.52) and (4.68±1.27) mm; ② The distance between the intersection of a horizontal line drawn through the middle of posterior margin of disc and the vertical line drawn through the medial one third of the pedicle and the exiting nerve root at L1/2～L5/S1 were (4.02±0.78), (4.67±0.65), (5.17±0.91), (6.16±0.74) and (5.48±0.61) mm; ③ The distance between the intersection of a horizontal line drawn through the middle of posterior margin of disc and the vertical line drawn through the medial one third of the pedicle and the thecal sac/traversing nerve root at L1/2~L5/S1 were (3.89±0.61), (4.39±0.71), (5.17±0.97), (6.58±0.70) and (6.22±1.20)mm.　Conclusions　Understanding detailed anatomic features of lumbar vertebrae is valuable for choosing a suitable working cannula during transforaminal endoscopic lumbar surgery.

Research on clavicle cadre fracture and the congruence between bone fracture plate and anatomical classification

ZHANG Xie-zhuo, Yilihamu Tuoheti, LIU Li-guo, HA Si-lu, GAN Zi-ming

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  9-14.  doi:10.13418/j.issn.1001-165x.2017.01.003

Abstract ( 936 )  

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Objective　To improve the existing clavicular plate, and to provide the anatomical basis for clinical treatment of clavicular fracture.　Methods　 The relevant data were collected and analyzed form 115 clavicular specimens and radiographic images of 115 cases of clavicular fractures; the compatibility of the two commercially available steel plates for clavicular fractures with the clavicular specimens were carried out, respectively.　Results　In 115 clavicles, type I, II, and III clavicle accounted, respectively, for 45.2%, 45.2% and 9.6%; in imaging data of 115 cases of clavicle fracture, fractures in the three types of the clavicle accounted for 14.8%, 57.4% and 27.8%, respectively. Fracture of the clavicular shaft is the most common one, accounting for 73.9%; the kappa values of compatibility of the modified steel plate and the conventional plates with the three types of the clavicle was 0.38 and 0.51, respectively.　Conclusion　The modified steel for clavicular fracture has obvious improvement in compatibility compared with the conventional ones. Our study has certain guiding significance for the clinical application.

Using the nerve entry points to localize the nerve block targets of the triceps surae muscle spasticity

HU Shuai-yu, ZHUO Li-fan YANG Sheng-bo

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  15-18.  doi:10.13418/j.issn.1001-165x.2017.01.004

Abstract ( 707 )  

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Objective　To investigate the location of nerve entry point (N point) of the triceps surae accurately in order to provide the anatomical basis for the clinical nerve block of this muscle spasticity.  Methods　Twenty sides of lower limbs of 10 adult cadavers were dissected and exposed in the prone position. The lines on the skin between the lateral epicondyle to the medial epicondyle of the femur and fro the lateral epicondyle of the femur to the lateral malleolus were designated as the horizontal reference line (H line) and the longitudinal reference line (L line) of the N point, respectively. Those cadavers were dissected to expose the point N of each nerve muscle branch of triceps surae for staining the N points by barium sulfate. CT scanning was performed. Syngo system was used to determine the body surface projection point (P point) of point N; P by N projecting to the contralateral limb skin was designated as P'; The intersections the vertical line through P and the H line,  the horizontal line through P and line L were designated as PH and PL, respectively. The percentage location of PH and PL points on H line and L line and depth of point N were measured, respectively.  Results  The point PH of the medial head of gastrocnemius, lateral head of gastrocnemius and soleus were located at（46.89±2.73）%, （40.90±3.05）% and（42.56±2.59）% of the H line, respectively, and at （7.58±2.88）%, （8.15±2.52）% and （17.42±3.31）% of the L line, respectively; The depth of N points after P points were located at（16.32±2.52）%, （13.83±1.77）% and（29.93±2.89）%, respectively. Conclusion　These parameters can improve the efficacy and efficiency of the neurolysis for the treatment of triceps muscle spasticity.

Evidence from medical images manifests drumstick spinal process originates from the bony fusion of normal L5 spinal process and isolated S1 spinal process

HOU Li-sheng, BAI Xue-dong, HE Qing, WANG Jing, CHENG Shi, LV You

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  19-24.  doi:10.13418/j.issn.1001-165x.2017.01.005

Abstract ( 1007 )  

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Objective　Chinese medical specialists asserted that the drumstick spinal process(DSP) originated from the bony union of the normal L5 spinal process and isolated S1 spinal process from sacral spina bifida occulta.  The imaging diagnosis is generally established based on the anteroposterior conventional radiograph image. This study was designed to verify the assertion by analysis of DSP images and direct visual inspection.　Methods　Cases met DSP imaging diagnosis criteria of plain radiographs from December, 2004 to July, 2016 were enrolled in the study, anteroposterior and lateral conventional radiographs of relative cases were observed to find DSP’s morphologic characteristics. If CT scanning or MR scanning was performed, sagittal reconstructed images at midline were observed to find the image evidence of DSP’s components. If open operation was performed, direct observation of DSP with naked eye was carried out.　Results　16 cases satisfied the DSP’s imaging diagnosis on plain radiographs which showed the distal end of the spinal process connected with L5 laminae reached the central defective area of sacral spina bifida occulta were enrolled. The contour of DSP at the lateral radiograph was clearly visible in 12 cases, which exhibited fin morphology, among whom, 7 had smooth rim while 4 had a dent at the inferoposterior edge.  CT scanning was done at three cases, two had sagittal CT images reconstructed which detected a narrowed region near the lower portion of DSP corresponding to the dent location found on plain radiographs and sclerotic bands could be detected adjacent to the narrow region distally and proximately. MR scanning was done on three cases. In two cases, sagittal MR images at the midline exhibited low T1WI and T2WI signals at the narrow area of DSP corresponding to the relative area at CT images and high T1WI and T2WI signals at bilateral margins adjacent to the narrow area distally and proximately, while in one case, the signals of the narrow area of DSP were similar to that of the normal L5S1 interspinal ligament, thus making it difficult to discern the existence of DSP. Open operation was performed on 2 cases, a dent could be found at inferoposterior edge of DSP in one case by naked eye. 　Conclusion　This study can support the assertion that DSP comes from the bony union of the normal L5 spinal process and the isolated S1 spinal process of sacral spina bifida occulta. The narrow area at lower portion of DSP detected by reconstructed sagittal CT images is the union location.

The impact on hemodynamics of proximally-based sural neurovascular flap by different management of sural nerve

XIE Yun，ZOU Wen-xuan， FANG Fang， ZHANG Qi，YE Jun-jian，ZHUANG Yue-hong

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  25-30.  doi:10.13418/j.issn.1001-165x.2017.01.006

Abstract ( 642 )  

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Objective　To investigate whether the sural nerve emanates sympathetic fibers to its accompanying artery, regulating its tone, and the hemodynamic change of the proximally-based sural neurovascular flap brought about by section of the sural nerve at its origin.　Methods　In 17 rabbits, two rabbits were used as the normal control group, from which the sural neurovascular bundles were harvested without flap creation, and the other 15 rabbits were randomly divided into two groups with 15 sides of hind limbs in each group: a nerve transection group, where the sural nerve was transected at its origin after creation of the proximally-based sural neurovascular flap, and a nerve preservation group, where the sural nerve was untouched after flap creation. The latter two groups were continued to be allocated respectively to three sub-groups according to the time points, i.e., 3d, 5d and 7d after flap creation. The rabbits were executed at the corresponding time points and the sural neurovascular bundles were harvested for glyoxylic acid staining. An infrared thermal imager was used for measurement of the average temperature of the flaps within 24h after flap harvest.　Results　The intensity of green fluorescent staining within the sural nerve and around the tunica externa of the sural artery showed a synchronized gradual decline in the nerve transection group at 3d, 5d and 7d after flap harvest. Significant difference of fluorescent intensity could be detected among the groups (F=13.563, P=0.004). The fluorescent intensity of the sural neurocutaneous bundle showed no decline in the nerve preservation group at the postoperative three time points. The average temperature of the flaps in the nerve transection group was higher than that in the nerve preservation group starting from 2h after flap harvest (P<0.05).　Conclusion　The sural nerve has issued sympathetic fibers to the accompanying arteries, regulating its vascular tone. The microvascular circulation within the proximally-based sural neurocutaneous flap could improve if the sural nerve is divided at its origin, leading to possible increased flap survival.

Abnormal multiple branch of left subclavian artery and axillary artery: a case report

FAN Hong-bo, GAN Sheng-Wei

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  30.  doi:10.13418/j.issn.1001-165x.2017.01.027

Abstract ( 467 )  

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A unilateral cervical spinal cord contusion injury model in rabbits and its MRI and histologic characterization

LIU Jun-hao, YAO Xin-qiang, HUANG Zu-cheng, HUANG Zhi-ping, WU Xiao-liang, WU Xiu-hua, JI Wei, KONG Gang-gang, LI Rong, ZHU Qing-an

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  31-36.  doi:10.13418/j.issn.1001-165x.2017.01.007

Abstract ( 659 )  

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Objective 　To establish a unilateral cervical spinal cord contusion injury model in rabbits, and characterize the MRI and histology of two-level spinal cord contusion at 24 hours after injury. Methods　Twenty-two male New Zealand rabbits were randomly assigned into the moderate lesion group (n=9), the severe lesion group (n=9) and the sham group (n=4), respectively. All animals in the moderate group were subjected to 2.0 mm contusion at 500 mm/s on the left of C5 spinal cord, while all animals in the severe group to 2.8 mm contusion. The flat head impactor was 3.0 mm in diameter and was  driven by an electromagnetic-servo material testing machine. The sham group exposed the spinal cord without contusion. Post-injury MRI was scanned and analyzed for 2 animals per group. Spinal cord samples of all animals were harvested 24 hours after injury, and analyzed the hemorrhagic area of the cord on cross section of the epicenter.　 Result　The peak force and actual contusion displacement were (2.47±0.39) N and (1.99±0.02) mm in the moderate group, and (5.16±0.82) N and (1.99±0.02) mm in the severe group, respectively. There was significant difference in the peak force between groups (P<0.05). There were high and low intensity T2-weighted signal in the C5 cord on post-operative MRI in the two injured groups. Histological analysis showed that there were hematoma and tissue damage on the left side of spinal cord in two injured groups, and hHematoma area was (0.012±0.006) mm2 in the moderate group and (0.039±0.006) mm2 in the severe group. There was significant difference in hematoma area between groups (P<0.05).　Conclusion　The study establishes a unilateral cervical spinal cord contusion model with displacement control and at high speed. Different unilateral cervical spinal cord contusions showed different degrees of lesions in peak force, MRI and histology.

The effect of anti-inflammatory treatment on the progress of diethylnitrosamine induced primary liver cancer

LI Xiang-zhi，NIU Hong-ling，LIU Xiao-long，LIU Li-xin

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  37-42.  doi:10.13418/j.issn.1001-165x.2017.01.008

Abstract ( 698 )  

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Objective　To investigate the influence of anti-inflammatory treatment on the progress of DEN induced primary liver cancer. 　Methods　42 rats which were fed with Diethylnitrosamine (DEN) solution to induce the rat model of liver cancer, and randomly divided into 3 groups. The nodule number and the structural change of liver tissue in each group were observed. CD68, CD206 and CD34 positive expression in liver tissue were detected by immunohistochemical staining in each group. Relative expression of TNF-α, IL10, TGF-β, HGF and NFκB in the liver tissue was detected by western blot in each group. Results　 Compared with the control group and glucurolactone group，hydrocortisone group's nodule number was fewer，the appearance time of liver cancer was postponed, the positive expression of CD68, CD206 and CD34 was fewer, the protein relative expression of TNF-α, IL10, TGF -β, HGF and NF kappa B was fewer at the 8th,10th, and 12th week.　Conclusion　Inhibiting the chronic nonspecific inflammation which is mediated by mononuclear - macrophage in liver microenvironment can delay the progress of the primary liver cancer in rats at an early stage which is induced by DEN.

Expression of EphA2 and EphrinAl in the breast carcinoma tissue and its relation to clinicopathological parameters

ZHANG Ben-si, BIAN Si-yuan, PAN Yun, LI Zheng-jun, LI Yue-kang

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  43-47.  doi:10.13418/j.issn.1001-165x.2017.01.009

Abstract ( 509 )  

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Objective　To investigatethe expression of EphA2 and EphrinAl in the breast carcinoma tissue fromYunnan Dali Bai, Han and other minority women and its relation to clinicopathological parameters. Methods　The expression of EphA2 and EphrinAl in the breast carcinoma tissue was detected by the immunohistochemistry (IHC) method and was compared with theclinicopathological parameters and with each other, respectively.　Results　EphA2 and EphrinA1 were mainly expressed in cytoplasm and membrane of tumor cells and of vascular endothelial cells, showing a tan or brown color. Out of 150 cases of breast cancer tissues, the positive expression of EphA2 and EphrinA1 appeared in 123 and129 cases, and the positive rates of them are 82% and 86%, respectively. The positive expression rates of EphA2 and EphrinAlhave no significant correlation with the patient age (P>0.05), but are correlated statistically with the pathological type, tumor size, lymph node metastasis, clinical stage and histological grade (P<0.05). The positive rates of EphA2 and EphrinAl in the invasive ductal carcinoma are higher than that in the intraductal carcinoma; and the positive rates of EphA2 and EphrinAl in the group with large size, lymph node metastasis, late clinical stage and high histological grade was higher than that in the group with a small size, negative lymph node metastasis, early clinical stage and a low histological grade, respectively. The positive staining of EphA2 and EphrinAliscolocalized in roughly the same tumor areas and vascular endothelial cells.Their distributions were fundamentally unanimous and their positive expression rates were positively correlated (P<0.05).　Conclusion　Over expression of EphA2 andEphrinA1 can be observed in breast carcinoma, which isconcerned with carcinogenesis, development, invasion, metastases and malignant transformation, suggesting that EphA2 and EphrinA1 may be associated with tumour prognosis and could be used as new markers for prognosis evaluation. Our research has laid a theoretical foundation for early diagnosis and targeted therapy of breast carcinoma.

Effects of Schwann-like cells on the expression of NGF and BDNF in spinal ganglia of rats with sciatic nerve injury

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  48-51.  doi:10.13418/j.issn.1001-165x.2017.01.010

Abstract ( 421 )  

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Objective　To investigate the effects of Schwann-like cells on the expression of NGF and BDNF in spinal ganglia of rats with sciatic nerve injury (SNI) and explore the protective effects of Schwann-like cells on spinal ganglion.　Methods　Firstly，the adipose derived stem cells (ADSCs) were differentiated into Schwann-like cells and the phenotype of the differentiated cells were identified, then the ADSCs and Schwann-like cells were implanted into the acellular nerve grafts (ANA), so the tissue engineering nerves were constructed. The rats were randomly divided into 3 groups: normal control group, ADSC group and Schwann-like cells group. The SNI model was established in rats of the latter two groups, and then the corresponding tissue engineering nerves were used to bridge the injured sciatic nerves. 4 Weeks after operation, Western Blot and Real-time PCR were used to detect the expression of NGF and BDNF protein and mRNA in spinal ganglia.　Results　ADSCs can be induced to differentiate into Schwann-like cells and expression of S100β and GFAP protein (markers of Schwann cells). In contrast with ADSC group, the expressions of NGF and BDNF protein and mRNA in Schwann-like cells group rats increased (P＜0.05). Conclusion　 Schwann-like cells can enhance the expression of NGF and BDNF in the spinal ganglia, so they can have protective effects on the spinal ganglia in rats with SNI.

Expression of monocyte chemoattractant protein-1 protein in cerebral cortex of rats after acute methanol poisoning

LI Fan，LI Hong-e，HAN Hong，CAO Xiao-qing，ZHAO Min，LI Juan-juan2，YUAN Yun，WU Chun-yun

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  52-56.  doi:10.13418/j.issn.1001-165x.2017.01.011

Abstract ( 502 )  

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Objective　This study was aimed to investigate the expression of monocyte chemoattractant protein-1 (MCP-1) proteinin rats after acute methanol poisoning.　Methods　Animal models of acute methanol poisoning in rats were duplicated using a plexiglas chamber exposed to a mixture of N2O/O2. Perfusion fixation, paraffin embedding, and sectioning were used, and positive cells expression was observed. Extract protein from brain tissue and Western blot were use to detected the expression level of MCP-1 protein.　Results　Results of Western blot: The expression level of MCP-1 were significantly enhanced with over time following acute poisoning, reaching the maximum at 24h; Expression in high-dose group was higher than low-dose group at 12h and 24h (P<0.01). There were no significant difference between the low-dose group and high-dose group at 3d (P>0.05). Results of immunohistochemistry experiment: MCP-1 positive cells reaction could be found in piriform cortex in the high-dose group, whereas the saline group showed no brown-yellow granules scattered. The expression level of MCP-1 were significantly increasedat 24 h (P<0.01), reached the maximum at 3d (P<0.01)，and then decreased at 1week, but still had significant difference compared with the saline control group (P<0.01).　Conclusion　The expression level of MCP-1 proteinare significantly enhanced and last a period of time following acute methanol poisoning; the degree of poisoning and the dose administered is apparently related, and MCP-1 might participate in brain pathological process.

Study of shear wave elastic modulus in a rat model of chronic myofascial trigger points

LV Heng-yong, LI Zhen, WANG Yue-xiang, LI Ying-xin, WU Jin-peng

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  57-61.  doi:10.13418/j.issn.1001-165x.2017.01.012

Abstract ( 555 )  

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Objective　To detect the shear wave elastic modulus of the myofascial trigger points of chronic myofascial trigger points in a rat model, and study the application value of elastic ultrasound in the identification of the rat model and clinical diagnosis, and provide the basis for the diagnosis of the disease such as myofascial pain syndrome.　Methods　A total of 24 male SD rats (7 weeks old) were randomly divided into a control group (group A) and a model group (group B). A blunt striking injury and eccentric exercise were applied to the rats in the model group for 8 weeks, and then all rats were fed normally for 4 weeks. At the end of 12 weeks, EMG of rats was detected, and the elastic modulus of myofascial trigger point was measured by shear wave elastography and the difference between groups was compared.　Results  Spontaneous electrical activity was detected in rats of group B, showing the existence of myofascial trigger points. The shear wave elastic modulus in focal region of the trigger point was significantly higher than that of the surrounding tissue (P<0.05), and the elastic modulus of the focal region and the surrounding tissue of the rats in the model group was higher than that of the control group.　Conclusion　Shear wave elasticity modulus measurement technique can quantify stiffness characteristics of myofascial trigger point, and prompt significant increase of the hardness of the trigger points, providing objective basis for clinical diagnosis. This technique can also be used to differentiate focal region and the surrounding tissue, providing a new way to identify the myofascial trigger point of the rat model. Therefore, this technique has an important study and application value for clinical diagnosis and treatment effect evaluation of myofascial pain syndrome.

The high flexion kinematic characteristics research of Human tibiofemoral joint

WANG Jian-ping, LIANG Jun, ZHANG Yan-ru, FU Long, WANG Meng, ZHANG Pan-pan

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  62-68.  doi:10.13418/j.issn.1001-165x.2017.01.013

Abstract ( 829 )  

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Objective 　Analyzing the femorotibial (FT) joint kinematics of natural and artificial knees under high flexion behaviors provides a reference for the study of kinematic characteristics of knees and the prosthesis design.　Method　On the basis of the CT and MRI scanning data of healthy volunteers， dynamic finite element models (FEMs) of the human knee joint and total knee arthroplasty (TKA) were established. Through the loaded three-dimensional quadriceps asynchronous variable forces to simulation of the squatting exercise, our study analyzed the relative kinematic characteristics of FT articulation. Data in the relevant literature were retrieved and compared with our study for analyses.    Result Three-dimensional kinematicsdata of the femur relative to the tibia of human’s natural and TKA knees were obtained during the squatting.The results showed that the overall trends of the relative kinematics of the femorotibial articulation before and after TKA were similar. However, the maximums of the kinetic aspects in the anterior or posterior translation,proximal or distal translation, medial or lateral translation, adduction or abduction rotation,and internal or external rotation were different. Our study found varying degrees of differences in the results through analyzing the relative kinematics of intact and TKA knees’ FT articulation and  the existing relevant literature data.　Conclusions 　The main differences for nature knee relative kinematics are the changes in the level of restraints on the directions and the shifted flexion degrees of the knees’ FT joints.The differences for the TKA knee derive mainly from the knee-surface and structural changes; andboth of these differences are related to the definition of the coordinate system, in vitro or in vivo, and the various loads. This study has performed finite element simulation analyses for the kinematics of intact and TKA knees’ FT articulations , offering certain valuable references on the study of the knee kinematics.

Three-dimensional reconstruction of subject-specific dynamic patella of femoral joint using static magnetic resonance based methodology

WANG Xing-liang, LIU Yun-peng, XU Zhi-qing,YAO Jie,YANG Bin

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  69-73.  doi:10.13418/j.issn.1001-165x.2017.01.014

Abstract ( 444 )  

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Objective　To reconstruct the dynamic 3D motion model of patellofemoral joint based on multi-angle static magnetic resonance imaging.　Methods　A healthy adultmale was enrolled, whose right knee was scanned with a MR machine at 0°, 30°, 60°,90°, and 120° of knee flexion, then the MR images were imported into the Mimics in Dicom format, the shape of patella and femoral were extracted to calculate the static 3D model of patellofemoral joint at the five flexion angles. Then import the models into Rapidform at the same coordinate system to match the dynamic model using spline interpolation algorithm, and the patella tracking was calculated and compared with the experiments in literatures.　Results　Using static MR scanning technology could reconstruct the quasi dynamic 3D motion model of patellofemoral joint accurately and without radiation in a short time. The patellar tracking was within the range of experimental measurements which was calculated based on the dynamic model.　Conclusion　The dynamic 3D model of patellofemoral joint is successfully reconstructed which includes the full process of knee bending from full extension to the maximum flexion; during the flexion of knee, the patella keeps rotating and mildly flexing and tilting at the same time.

Biomechanical comparison of postoperative stability in use of three kinds of endobutton technique for coracoclavicular ligament reconstruction

PAN Zhao-xun, DU De-kai, ZHANG Hong-xin, SUN Chao, ZHONG Bin, MIN Xiao-jun

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  74-77.  doi:10.13418/j.issn.1001-165x.2017.01.015

Abstract ( 523 )  

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Objective　To investigate the biomechanical differences of postoperative stability in use of single，double and triple Endobutton techniques for coracoclavicular ligament reconstruction.　Method　40 fresh frozen shoulder specimens were randomly divided into 4 groups,10 in each group. Tissues in the shoulder specimens were dissected away to only preserve the scapula-coracoclavicular ligament-clavicle structure. The first 3 groups were the experimental group (group 1, group 2 and group 3). The coracoclavicular ligaments were disruputed, and then we used three kinds of Endobutton techniques for the reconstruction of coracoclavicular ligament. The fourth group served as the control group (group 4). The original coracoclavicular ligament was reserved. And then,we continued the vertical biomechanical tensile test, and the maximum strength causing the reconstruction failure was recorded.　Result　When  thecoracoclavicular structure in each group was destroyed，the tensile strength were as follows： group 1（597.10±65.58）N，group 2（750.67±51.00）N，group 3（774.82±64.94） N and group 4（645.44±43.37）N. The maximum tensile strength of group 1 was slightly lower than that of group 4 (P>0.05); the maximum tensile strength of group 2 and group 3 was significantly higher than that of group 4 (P<0.05); the maximum tensile strength of group 3 was slightly higher than that of group 2 (P>0.05).　Conclusion　Three kinds of Endobutton technique all could be used for coracoclavicular ligament reconstruction. The vertical stability of the double Endobutton technique and thetriple Endobutton technique were superior to the single Endobutton technique. The vertical stability of the double Endobutton technique and the triple Endobutton technique was similar.

Comparative study on the application of two kinds of supports in anterior cervical subtotal corpectomy and fusion of cervical spondylotic myelopathy

PU Zhi-chao, MA Xiang-yang, YANG Jin-cheng，XIA Hong, WU Zeng-hui, YIN Qing-shui，Ai Fu-zhi, Wang Jian-hua

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  78-84.  doi:10.13418/j.issn.1001-165x.2017.01.016

Abstract ( 636 )  

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Objective　To compare the effects of titanium mesh and nano-hydroxyapatite / polyamide 66 (n-HA / PA66) cervical spine bone grafts on cervical spine subtotal resection, decompression fusion, anterior titanium screw fixation, Recovery and maintenance of cervical curvature, intervertebral height and fusion rate, the settlement rate differences.　Methods　Anterior cervical decompression and fusion were performed in 75 patients with cervical spondylotic myelopathy of two adjacent segments. Forty patients underwent titanium mesh support bone grafting and 35 patients received implantation of nano-hydroxyapatite / polyamide 66 (n-HA / PA66) into the cervical spine. The operative time, intraoperative blood loss, length of hospital stay, JOA score, curvature of cervical vertebrae, height of intervertebral fusion and bone fusion were compared between the two groups. Cobb angle, C2～7 Cobb angle, and D value of the cervical spine were measured before and after the operation, 3,6,9 months follow-up, (HAB) and posterior edge height (HPB) were measured to evaluate the fusion settlement of the support. The differences between the parameters were analyzed by the paired t test.　Results　All patients were followed up for 9-24 months (mean 16.7 months). The JOA score of the two groups was significantly higher than that of the preoperative group. There was no significant difference in the JOA scores between the two groups (P> 0.05). There was significant difference between the two groups (P <0.05). There was significant difference between the two groups (P<0.05), and there was significant difference (P <0.05) between the two groups at 3, 6, 9 months postoperatively, (P> 0.05), but there was significant difference in the settlement rate at 6 and 9 months after operation (P<0.05). There was obvious early subsidence in the titanium mesh group, which affected the fusion segment vertebrae Between the height.  Conclusion  Nano-hydroxyapatite / polyamide 66 (n-HA / PA66) cervical support has the advantages of improved fusion rate and less complication compared with titanium mesh support bone graft. It can effectively maintain cervical curvature and intervertebral heightand is an ideal support for bone graft material.

The analysis of spinal alignment for thoracolumbar dislocated fractures（type C）with posterior long-segment instrumentation

WANG Xiang, CAI Yi, ZHENG Ming-hui, QU Dong-bin

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  85-89.  doi:10.13418/j.issn.1001-165x.2017.01.017

Abstract ( 664 )  

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Objective　 The purpose of the retrospective study is to analyzethe imbalance of the spinal sagittal and coronalalignmentfor thoracolumbar fracture-dislocations with posterior long-segment pedicle screws instrumentation.　Methods　33 patients with thoracic or lumbar type C spinal injurieswere treated with long-segment fixation which contained four or more segments. The distance of the vertebrae moving forward or backward, Cobb angle and kyphotic angle were measured prior to and after surgery by radiography, and the spinal sagittal and coronal alignment was analyzed. 33 patients were divided into the group of balanced alignment (group A) and the group of imbalanced alignment (group B). Then we discussed influence of the number of pedicle screws placed on postoperative spinal alignment.　Results　Among all patients, there were 20 cases (60.6%) with balanced alignment, others (39.4%) with imbalanced alignment. The segments of instrumentation and the total number of pedicle screws showed no obvious difference between two groups (P>0.05). As far as the number of single vertebra screws was concerned, group A was 1.7±0.3 and group B was 1.3±0.4, which showed no significant difference (P＜0.05).　Conclusions　The imbalance of the spinal alignment often happened tothoracic or lumbar dislocated fractures with long-segment instrumentation. The segments of instrumentation, the number of screws, pedicular screw and so on play an important role in postoperative spinal alignment.

Clinical application of micro-debulking perforator flap based on descending branch of the lateral circumflex femoral artery

NIE Kai-yu, CHANG Shu-sen, WEIZai-rong, JIN Wen-hu, WANG Bo, SUN Guang-feng, TANGXiu-jun, ZENGXue-qin, HE Chun-nian

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  90-93.  doi:10.13418/j.issn.1001-165x.2017.01.018

Abstract ( 641 )  

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Objective　To investigate the effect of clinical application of the micro-debulking perforator flap based on the descending branch of the the lateral circumflex femoral artery.　Methods　Between May 2014 and January 2016, 26 cases of tissue defects of the hands and feet were repaired with the micro-debulking perforator flaps based on the descending branch of the lateral circumflex femoral artery. The soft tissue defect area ranged from 6 cm×4 cm to 15 cm×10 cm. The flaps ranged from 8 cm×5 cm to 21 cm×8 cm. According to the second-perforator course，the perforator and the deep fascia about 1 mm around it were preserved under a magnifying glass before cutting off the pedicle. The peripheral fat tissue was removed to the utmost extent. 2~3 mm thick circumferential fat tissues of the flaps were preserved. The flaps were transplanted to recipient site after excellent blood perfusion of the flaps was checked.15 cases are swelled obviously postoperatively, which was managed by re-open one edge of the flaps to remove the fatty tissue.　Results     Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis with a size of 2 cm ×1cm, which was healed after dressing change for two weeks. Fifteen cases with centrally-located bulk was thinned in a second phase. Patients were followed up for 6 to 20 months. The appearance of flaps was satisfactory and the texture was thin and soft, and the sensation was numb.only linear scars could be seen in the donor site.    Conclusions    The perforator flap based on the descending branch of lateral circumflex femoral artery can withstand the removal of most of the deep fascia and superficial fascia tissue. If necessary, the central fat tissue of the flaps was removed in asecond phase, reducing the number of plastic surgery and the difficulty of operation.

The application of three-dimensional visualization technique in preoperative planning of Chevron Osteotomy for treatment of hallux valgus

LV Zhi-yu1，ZHAO Yi-rong1，YU Chun-sheng1，LI Ji-chuan1，SHAO Zhi-ming2

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  94-97.  doi:10.13418/j.issn.1001-165x.2017.01.019

Abstract ( 671 )  

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Objective　To Discuss the benefit of the three-dimensional visualization technique in preoperative planning of Chevron Osteotomy for treatment of hallux valgus.　Methods 　From January 2014 to December 2015, the 3D visualization preoperative planning technique was applied to 20 admitted patients aged 48-72 years old with mild to moderate hallux valgus.  The image processing software M3d was performed to analyze the images obtained from 3D spiral CT with 0.625 mm thin slices, generate the hallux valgus model, simulate the osteotomy, measure hallux valgus angle (HVA) and 1st-2nd intermetatarsal angle (IMA), and compare measurements at different osteotomy angles.　Results　With the guidance of the preoperative planning made through digital reconstruction model of hallux valgus and osteotomy simulation, the imaging findings after osteotomy correction highly agreed with the one made from 3D virtual surgery.  AOFAS scores were significantly increased, as well as patient satisfaction.　Conclusions　The 3D foot weight-bearing reconstruction model for hallux valgus patient clearly shows the position change of the first metatarsal column in a 3D space.  It also provides a quantitative basis for Chevron osteotomy surface design and 3D post-treatment measurement of the first metatarsal head. Hallux valgus correction treatment should be designed to accommodate individual differences, so that the foot shape looks better and weight-bearing function works better to improve patient satisfaction after Chevron osteotomy.

Effect comparison of two methods for treatment of large free bone block associated with femoral shaft fractures

YIN Qu-dong, GU San-jun, XU Ke-lin, RUI Yong-jun, SUN Zhen-zhong, LIU Jun

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  98-101.  doi:10.13418/j.issn.1001-165x.2017.01.020

Abstract ( 869 )  

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Objective　To compare the difference in effect of two methods g for treatment of large free bone block associated with femoral shaft fractures.    Methods     66 cases of femoral shaft fractures with large free bone block treated by open reduction and internal fixation were selected.According to different methods for large free bone block,they were divided into control group(35 cases,treated without drilling and without bone grafting) and test group(35 cases,treated with drilling and cancellous bone grafting liking rice transplant in the holes and surrounding).The two groups were compared in terms of operation time,operative bleeding,healing time of fracture,morbidity of complications and functionary recovery of the adjacent joints(HSS’s criterion) at the last follow-up.    Results    The two groups were not significantly different in clinical data (P>0.05).The operation bleeding (847.58±147.53 ml) and operative time (138.43±12.10 min) in the control group were superior to those in the test group（752.18±143.78 ml and 115.27±11.31 min, respectively）, but the healing time of fracture（4.79±1.00 month）, the morbidity of delayed healing(1/35), nonunion (0) and broken of internal fixation (0)，as well as the functionary recovery in the test group were superior to those in the control group (9.49±2.59 month，11/35，8/35，4/35 and 15/13/7/0, respectively), the differences were statistically significant (P<0.05).　Conclusion　As for free bone block associated with femoral shaft fractures, simple reduction and fixation has unsatisfied result,but drilling and cancellous bone grafting can promote healing of creeping substitution and improve mechanical property in the fracture ends, the result is superior to that in the former.

Curative effect of recurrent patellar dislocation through arthroscopic lateral retinacular release combined with medial patellofemoral ligament reconstruction 

HUANG Yuan-xia, DUAN Yong-zhuang, WANG Li-min, XU Hai-bin

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  102-105.  doi:10.13418/j.issn.1001-165x.2017.01.021

Abstract ( 681 )  

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Objective 　To investigate clinical effect of arthroscopic lateral retinacular release combined with medial patellofemoral ligament reconstruction on recurrent patellar dislocation.　Methods　19 cases were admitted into our hospital for arthroscopic lateral retinacular release combined with reconstruction the medial patellofemoral ligament from January 2012 to January 2015. With Regular follow-up after surgery, we recorded preoperative and postoperative radiographic results, Lysholm knee function score and Kujala score changes of patellofemoral joint, ligament length reconstruction.　Results　19 cases were followed up for 12~48 (25.7±8.56) months after surgery, no patella redislocation and fear patellofemoral pain syndrome, no aggravation, X-ray Q angle in the normal range were found, and the knee joint CT (at 45 °) showed that patients with the lateral patellar articular surface opening angle had it increased to (11.2±5.1)°(5°~18°) postoperatively from an average (-1.2±6.8)°(-16°~8°)  preoperatively, with significant difference detected (P<0.01). Lysholm scores and Kujala patellofemoral joint score one year after surgery improved significantly compared with that prior to surgery. Average length of ligament after reconstruction immediately after operation was about (57.81±6.76) mm, and it increased to about (58.36±6.87) mm one year after surgery, with no significant relaxation found.　Conclusion　Arthroscopically assisted lateral retinacular release combined with medial patellofemoral ligament reconstruction can effectively restore the position and function of the patellofemoral joint and prevent recurrence, and the curative effect is satisfactory.

To explore a way and efficacy of curing epicanthoplasty by removing a modified triangle skin flap  

FU Fu-ren

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  106-108.  doi:10.13418/j.issn.1001-165x.2017.01.022

Abstract ( 719 )  

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Objective　To explore a way and effecacy of curing epicanthoplasty by removing a Modified  triangle skin flap.　Methods 　From May 2010 to 2015, epicanthoplasty was treated by a Modified  triangle skin flap in 168 cases. The △ABC skin flap was removed. Fibrous connective  tissue under skin was separated and  orbicularis oculi muscle was  dissected and  removed.∠BAD and ∠BCD were trimmed to a round shape. The  new point of canthus was formed by suturing A and C.　Results　After 3 months to 1 year follow-up, all 138 cases received satisfactory  results for suitably exposed lacrimal caruncle and and longer palpebral fissure and  so on. Two eyes were spaced naturally, with  recurrence and slight scars. Conclusion　Epicanthoplasty by removing a modified triangle skin flap has such  advances as easy performance, good effect with slight scars, and it is worth  popularization in clinic.

Research progress on lower limb function influenced by fracture or defect of fibula

WANG Yi-bei，XU Dao-rong, FU Mao-qing, QIAN Lei, JIANG Chun-yu, OUYANG Jun

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  109-111.  doi:10.13418/j.issn.1001-165x.2017.01.023

Abstract ( 812 )  

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Assessments and types of vaginal delivery injury based on the pelvic floor anatomy

ZHAO Yu-jiao, CUI Can, SHEN Wen, WU Yan-hong

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  112-113.  doi:10.13418/j.issn.1001-165x.2017.01.024

Abstract ( 455 )  

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The role of estrogen in osteoarthritis: a systematic review

XU Xiao, JIA Zhao-feng, DUAN Li, WANG Da-ping

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  114-116.  doi:10.13418/j.issn.1001-165x.2017.01.025

Abstract ( 495 )  

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Variation of median nerve and lateral antebrachial cutaneous nerve: one case report

ZHANG Heng, SI Dao-wen

Chinese Journal Of Clinical Anatomy. 2017, 35(1):  117.  doi:10.13418/j.issn.1001-165x.2017.01.026

Abstract ( 638 )  

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