Table of Content

25 March 2017 Volume 35 Issue 2

  

Fracture mapping of proximal femoral lateral wall

ZHANG Ying-qi，CHANG Shi-min， XIONG Wen-feng, MA Zhuo， DU Shou-chao， HU Sun-jun

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  121-125.  doi:10.13418/j.issn.1001-165x.2017.02.001

Abstract ( 672 )  

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Objective　Using fracture map technology to study characteristics of the proximal femoral wall fracture, providing reference data for clinical and biomechanical studies.　Method　CT data from 96 patients with trochanteric fracture were collected. In the cases with proximal femoral lateral wall fracture, the lateral wall and fracture area (width, height, area, fracture line direction) were measured and fracture mapping was created.　Result　In 96 patients, 56 had lateral wall fractures. 71.4% were A2 type(40 cases). The average width of fractures area was (10.1±6.0) mm, the height was (23.1±11.3) mm, and the area was (158.5±105.2) mm2, accounting for (12.1±8.1)%. The fracture line was (64.6±14.5) ° with the horizontal plane. 28.6% were A3 type (16 cases). The average width of fracture area was (26.0±7.0) mm, height was (38.8±11.7) mm, and area was (860.1±357.0) mm2, accounting for (64.5±25.9)%. The angle of fracture line was (30.2± 39.6) °.　Conclusion　Characteristics of different types of trochanteric fractures of the lateral wall are significantly different. The fracture map can directly display fracture information. The results of this study can provide a reference for the standard fracture model in clinical and experimental study.

The clinical anatomy of the anteromedial neurovascular interval approach of the elbow

YANG Xiao-hua，CHEN wei，LI Guo-ping，WANG Jian-ji，ZHAO Hai-tao， SHI Li-tao，CAO Xiang-yu，ZHANG Ying-ze

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  126-129.  doi:10.13418/j.issn.1001-165x.2017.02.002

Abstract ( 954 )  

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Objective　To study the anatomy of anterior neurovascular and relevant structures of the elbow to provide better surgical approach for the elbow.　Method　The upper extremities of 10 adult cadavers that were fixed by formaldehyde and perfused with latex from the artery, were dissected for observation of anatomic structures of the anteromedial approach of the elbow.  Dissection was performed first in the space between the brachioradialis and the pronator teres to access the neurovascular interval between the medial nerve, and the brachial artery and ulnar artery, though which the median nerve and the brachial artery, radial artery and ulnar artery and their branches were exposed. The radial branches of artery and their diameter in themselves and the ulnar branches of artery were observed and measured, the distance between these branches and the fork of radial and ulnar artery were measured, the median and its branches anatomical characteristics and the distance of no intersecting branches between nerve and artery were observed and measured.　Results　There was no intersecting branches between the median nerve and brachial artery and its average length was 6.04 cm, and the interval between the median nerve and brachial artery was loose and easy to be retracted. The medial branches of the artery were smaller in number and diameter than the lateral branches of the artery, making it easy to retract the artery laterally. The branches of the median nerve almost all extended medially, and the angle between the branch and the main trunk was very small, making them almost parallel. Therefore, the medial retraction of the median nerve can be easy.　Conclusion　The anterior anatomical structures of the elbow can be clearly and easily exposed through the anteromedial neurovascular interval approach, and the vessel and nerve can be protected.

Technique of precise anatomical study on the bloodless-surgical approach of inter-prerenal-fascia planes in urological laparoscopic operations

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  130-136.  doi:10.13418/j.issn.1001-165x.2017.02.003

Abstract ( 640 )  

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Objective　To investigate the surgical technique of precise anatomical study on the bloodless-surgical approach of inter-prerenal-fascia planes in urological laparoscopic operations（IpULO）.Methods　Autopsies, 320 slice CT scan images, and clinical laparoscopic surgery cases were included in this study to observe the morphological characteristic of the inter-prerenal-fascia planes.　Results　Inter-prerenal-fascia planes are the multiple-layer and avascular fascia in the anterior space of the kidney filled with spider silk lattice-like white fibrous tissue. There are seven important surgical planes involved in the IpULO procedure, which included from top to bottom: the interfascial plane of the Told’t, the plane between the colonic fusion fascia and the prerenal fusion fascia, the plane between the colonic fusion fascia and the prepancreaticoduodenal fusion fascia, the plane between the prerenal fusion fascia and the postpancreaticoduodenal fusion fascia, the plane between the prerenal fusion fascia and the anterior lamella of renal fascia, the plane between the perirenal fat and the anterior lamella of renal fascia, the subfascial plane of the anterior lamella of renal fascia.　Conclusion　Surgical approach is the key to accurate dissection operations like IpULO. Inter-prerenal-fascia planes are an important anatomical level in IpULO surgeric approach, which could significantly reduce erroneous dissection during IpULO procedure.

Adult man Meckel’s diverticulum: one case report

FAN Guang-bi, TANG Hua-jun

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  136.  doi:10.13418/j.issn.1001-165x.2017.02.028

Abstract ( 428 )  

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S2 transverse screw fixation of zone Ⅲ fracture of dysmorphic sacra: an anatomical and image study

ZHANG An-wei, GAO Shi-chang, TAN Shan, YANG Ming-ming, LU Chao

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  137-143.  doi:10.13418/j.issn.1001-165x.2017.02.004

Abstract ( 683 )  

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Objective 　To investigate the safety parameters of S2 transverse screw when the sacroiliac screw cannot be transversely placed into the first sacral(S1) vertebra to fix zone Ⅲ sacral fractures.    Methods    The 3-D models of 96 pelvis were reconstructed by Mimics software based on CT data, and the virtual S1 transverse sacroiliac screws were placed. When the transverse sacroiliac screw cannot be safely inserted in S1, it would be regarded as a dysplasia. There were 34 S1 vertebrae which belonged to the dysplasia group, and the other paired 34 S1 vertebrae according to gender were classified to the normal group. Placement of the S2 transverse sacroiliac screws were simulated in 68 S2 vertebrae, and then the parameters of screw paths were measured respectively. The soft tissues on pelvic surface were generated by Mimics, and then the body surface projections of S2 transverse screw's entry point B, anterior superior iliac spine’s vertex M, iliac crest point N were determined as B1, M1, N1, respectively. At the same time, the lengths of B1M1, B1N1 and M1N1 were measured in section.　Results　There was significant difference in the lengths of the line B1M1, which were (140.94±16.64) mm and (129.37±14.93) mm in male between the normal group and the dysplasia group (P<0.05), and the lengths of the line B1M1 were (143.95±16.27) mm and (132.07±16.84) mm in female with statistical difference between the normal group and the dysplasia group (P<0.05). The lengths of the line B1N1 in the normal group and the dysplasia group were (69.92±6.73) mm and (72.64±7.46) mm in male with no statistical difference (P>0.05), and were (60.80±7.05) mm and (58.85±7.81) mm in female with no statistical difference (P>0.05). The lengths of the line M1N1 were (157.58±16.83) mm and (150.48±13.21)mm in male of the normal group and dysplasia group, which showed no statistical difference (P>0.05). Similarly, there was no significant difference in the lengths of the line M1N1, which were (156.79±15.84) mm and (151.49±16.59) mm in female between the two groups (P>0.05).　Conclusion　When the sacroiliac screw cannot be transversely placed in dysplasia S1 vertebra including lumbosacral transitional vertebrae, sacrum not recessed in pelvis andacute alar slope. A 7.0 mm sacroiliac screw can be inserted in S2 vertebra for fixing zone Ⅲ sacral fractures. Under fluoroscopic monitoring, the body surface entry point of S2 screw can be determined by touching the bony landmarks of the anterior superior iliac spine andiliac crest.

One case report of ectopic intestinal tract

HONG Shao-kun1, YANG Sheng-ping2, JIANG Han1, ZHANG Si-yu1

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  143.  doi:10.13418/j.issn.1001-165x.2017.02.029

Abstract ( 550 )  

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Quantification and distribution of lymph nodes in the central neck compartment: clinical anatomic study

ZHANG Hua, LIANG Xiao-yan, WANG Ming-hua, WANG Geng

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  144-146.  doi:10.13418/j.issn.1001-165x.2017.02.005

Abstract ( 2632 )  

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Objective　To study the quantification and distribution of lymph nodes in central neck compartment(CNC).　Methods　The data of 304 patients who had papillary thyroid cancer that underwent unilateral/bilateral central neck dissection (CND) from June 2013 to June 2016 were analyzed. The fresh CNC specimen was separated into four sublevel (prelaryngeal region, pretracheal region, left paratracheal region, right paratracheal region), and underwent pathologic examination, respectively. The number of lymph nodes was counted.　Results　The lymph nodes yielded in CND were as follows: bilateral CCN: (9.86±3.36)(4~20)； left CCN: (6.24±2.23)(2~14)； right CCN: (7.77±2.79) (2~15). The lymph node distribution of CND was as follows: precricoid region: (1.29±0.75) (0~4); pretracheal region: (2.62±1.26)(0~7); left paratracheal region: (2.38±1.34)(0~6); right paratracheal region: (3.97±1.97)(0~10). The ratio of the four region was 12.69%，24.47%，24.15%，and 38.47%, respectively. The lymph node distribution of the right paratracheal region was as follows: lateral region of the right recurrent laryngeal nerve: (1.35±1.27) (0~6); medial region of the right recurrent laryngeal nerve: (2.64±1.75)(0~9).    Conclusion    Our study was the first one to report  the quantification and distribution of lymph nodes in the central neck compartment in China, which can provide anatomic basis for surgeon during central neck dissection.

The feasibility study of cervical pedicle screwed with new individual-oriented template by 3D printing technology

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  147-150.  doi:10.13418/j.issn.1001-165x.2017.02.006

Abstract ( 645 )  

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Objectives　To establish a new individual-oriented template for cervical pedicle screw placement by 3D printing technology, in order to provide an accurate and safe method for cervical internal fixation operation.　Methods　6 cases of adult cervical specimens, and 64-slice spiral CT scanning data was adopted. The 3D digital models of cervical were reconstructed based on the anatomical characteristics of the cervical vertebral lamina. The reverse templates were designed, which reflected accurately morphological features of the posterior cervical spine elements. The navigation modules were obtained with the method of 3D printing, and the direction and depth of screw channel in the operation were ensured. Using 3D printing navigation templates, 24 cervical pedicle screws were inserted. Postoperative CT scan was used to measure the length of each pedicle screw channel and the width of pedicle in order to evaluate the relationship between cervical pedicle and screw position.　Results　The individual 3D printing navigation templates can exactly fuse with the cervical vertebral lamina. Postoperative CT data can confirm that 84 screws are placed entirely within the pedicle. The actual length of pedicle screw insertion was 100%, and the width of pedicle screw insertion was up to 94.05%.　Conclusion　The new 3D printing navigation template of cervical pedicle screw insertion is safe and convenient during the internal fixation operation, and the accuracy of cervical pedicle screw implantation can be improved.

Operation for complicated tibial plateau fractures with digital design and three-dimensional printing technique

LI Peng, PENGWen-biao, LI Jian-yi, LIN Gang, HUANG Xu-ke, SUN Xiang-hua, PENG Guo-rui,ZHANG Ting-shuai, WANG Wen-song

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  151-155.  doi:10.13418/j.issn.1001-165x.2017.02.007

Abstract ( 572 )  

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Objective　To explore the effectiveness of internal fixations for complicated tibial plateau fractures using digital design and three-dimensional printing technique. 　Methods　A retrospective analysis was performed on 40 cases of complicated tibial plateau fractures at our department from October 2013 to September 2015．There were 27 male and 13 female patients．According to the Schatzker classification, there were 19 cases of typeⅣ，15 cases typeⅤ，and 6 cases typeⅥ．Among them, 20 patients (3D group)underwent 3D printing assisted operations for the following procedure: first construct 3D models, followed by virtual fractures reductions for choice of the most appropriate plates and printing of real-size 3D models; Afterwards, the fractures reduction was simulated with prebent plates, and 20 patients (control group) underwent conventional open reduction and internal fixation operations. The operation time, intraoperative bleeding, and incision length in 3D group, and knee functional scores were compared between the two group．Results　All 40 patients were significantly less than those in the control group (P<0.01). Allpatients achieved bony union after follow-up 8~13 months (mean, 10 months). The Rasmussen scores in 3D group were higher than those in the control group (P<0.01).　Conclusion　By using digital design software and three-dimensional (3D) printing technique, we can achieve individualized operation and precise treatment, which can lead to less blood loss and shorter hospital stay.

Clinical application of accurate lumbar pedicle screws placement assisted by 3D printing navigation modules

YAN Bin, SUN Yong-jan, OUYANG Han-bin, YANG Yang, WU Yi, LING Qin-jie, HUANG Hua-jun, HUANG Wen-hua

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  156-159.  doi:10.13418/j.issn.1001-165x.2017.02.008

Abstract ( 625 )  

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Objective　Lumbar individualized navigation modules were used in clinic to evaluate the feasibility and accuracy.　Methods　we selected two adult patients with lumbar vertebral compression fracture and adopted 3D reconstruction, digital design and 3D printing to make 12 lumbar individualized navigation modules which were applied in operationin order to assist implanting lumbar pedicle screws.  Then, the postoperative X-ray and CT examination were used to evaluate the efficacy of the screws implanting.　Results　A total of 12 lumbar pedicle screws were implanted and all of them were located within the pedicle. The success rate of implantation was 100%.　Conclusion　By means of digital design and 3D printing navigation modules, we can realize accurate andindividualized implanting lumbar pedicle screws.

Effect of nerve growth factor on survival of cross-boundary perforator flap in rats

YANG Xi，Li Guo-dong，WANG Teng，HE Xiao-qing，XU Yong-qing

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  160-165.  doi:10.13418/j.issn.1001-165x.2017.02.009

Abstract ( 596 )  

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Objective　To evaluate the nerve growth factor (NGF) effect on survival of dorsal cross-boundary perforator flap of SD rats.　Methods　60 adult SD rats were divided into the experimental group and the control group equally，in the dorsum of which a cross-boundary perforator flap with an area of about 3 cm×10 cm was harvested. The experimental group was injected subcutaneously with NGF solution (10 nmol·ml-1·kg-1); the control group was injected with 0.1 mol/L PBS solution (1ml/kg). 3 and 7 days after surgery, VEGF and CD34 of the local tissues of flap were tested via Blot Western；Angiography was performed by the micro-CT to detect Three-dimensional morphological alteration of microvasculature using factorial design analysis of vascular volume and total length. At day 7, survival area of the flap was measured before the observation of expression of KDR and TrkA in vasculature by immunohistochemical stain.    Results    Day 3, there was no statistically significant differences in the expression of VEGF between two groups (P=0.088); the expression of CD34 in the experimental group was higher than that in the control group (P=0.004); Day 7, there were higher expression of VEGF and CD34 in the experimental group (P<0.05)；Morphological analysis showed that there is an interaction between NGF and time in the increase of vascular volume (F=33.304, P<0.05) and the total length of vessels (F=8.493, P=0.01); Compared with the control group, the flap survival area of the experimental group was significantly higher (P<0.05). The expression of KDR in experimental group was markedly superior to the control group.   Conclusion    NGF can promote the survival of thecross-boundary perforator flap in SD rat.

Expression changes of pEGFR after decompression of compressed spinal cord injury in rats

GONG Rui, SUN Shan-quan, ZHONG Yuan, ZHANG Wei, ZHAO Qi, MU Ke-jie, XUE Jun

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  166-171.  doi:10.13418/j.issn.1001-165x.2017.02.010

Abstract ( 440 )  

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Objective　To investigate the changes of pEGFR, pAkt1 expression in rat after decompression of compressed spinal cord injury(CSCI), and its correlation with nerve structure and function change，providing experimental basis for the development of therapeutic strategies and the development of medication for the treatment of CSCI after decompression.　Methods　The CSCI model was established first with a self-made device, which then underwent spinal decompression. The motor functions were monitored by Basso, Beattie & Bresnahanlocomotor rating scale. The pathological changes in axonal myelinated fibers were estimated by luxol fast blue (LFB). Epidermal growth factor receptor (EGFR), and phosphorylated Akt1 (pAkt1) were detected by double-labeling immunofluorescence and western blotting assays.　Results　The motor functions and number of myelinated nerve fibers were increased along with time extending after decompression. The expression of EGFR and pAkt1 was also increased after decompression, which was consistent with the changes of motor functions and number of myelinated nerve fibers.　Conclusion　The structure and function of the injured nerve can be restored to a certain extent, and the expression of pEGFR is closely related to this phenomenon after decompression. It suggests that the activation of EGFR is involved in the endogenous repair of CSCI after decompression.

The expression and cellular distribution of Id2 in myoblast C2C12 under different stimuli

LAI Gui-hua, HU Xiao-fang, ZHANG Xiang, LU Xing-hao, YU Peng, YU Lei

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  172-176.  doi:10.13418/j.issn.1001-165x.2017.02.011

Abstract ( 581 )  

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Objective　TO observe the expression and distribution of Id2 after myoblasts were induced to proliferation, apoptosis and differentiation with various stimuli.　Methods　Cultured C2C12 cells were treated with 25~300 µmol/L different concentration of H2O2, 100 ng/ml or 500 ng/ml of LPS, and 2% horse serum to induce proliferation, apoptosis or differentiation. After treatment, RT-PCR and immunofluorescence were used to detect the expression level and the cellular distribution of Id2 in C2C12 cells. Results　After treatment with 25 µmol/l or 50 µmol/l of H2O2, expression of Id2 in C2C12 cells was 80.5% and 55.5%  higher than control cells, and Id2 were present evenly in the both nucleus and cytoplasm. LPS of 100 ng/ml and 500 ng/ml also induced Id2 expression, 21.7% and 40.2% higher than control cells，but at a weaker level, and the majority of Id2 was in the nucleus of C2C12, with the detectable signals in the cytoplasm. On the contrary, with differentiation of C2C12 cells after treatment with 2% horse serum, Id2 expression decreased and most Id2 migrated into cytoplasm.  Conclusion  Different expression and distribution of Id2 could be observed after induction of myoblasts to proliferation, apoptosis and differentiation with various stimuli. And the result has demonstrated that Id2 could regulate regeneration of skeletal muscle. Ithas indicated that Id2 is a very impossible regulatory factor of regeneration of skeletal muscle after injury.

Establishment and identification of myeloid cell-specific SETD4 knockout mice

HUANG Meng-yi, ZHONG Yu-yun, HUANG Sui, Sun Jiang, Li Yue, WANG Juan, JIANG Yong, LIU Jing-hua

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  177-182.  doi:10.13418/j.issn.1001-165x.2017.02.012

Abstract ( 593 )  

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Objective　To elucidate the function of SETD4, we established myeloid cell-specific SETD4 knockout mice. 　Methods　Setd4flox/+ mice were inbred to obtain Setd4flox/flox mice, which then bred with FLP mice to obtain the Setd4fl/+/flp mice. After crossing with C57BL/6 mice, Setd4fl/+ mice were obtained, while Setd4fl/+/Lyz2-Cre were obtained after crossing with Lyz2-Cre mice. And then Setd4-/-/Lyz2-Cre mice were generated by mating Setd4fl/+/Lyz2-Cre with Setd4fl/+ mice. PCR was used to identify the genotype of offspring. The mRNA level of SETD4 in peritoneal macrophages and liver were detected by quantitative real time PCR to confirm the knockout efficiency.　Result　The mRNA expression of SETD4 in peritoneal macrophages of myeloid cell-specific SETD4 knockout mice was significantly lower than the wildtype mice, while no significant difference could be detected in the liver.　Conclusion　Based on FLP/FRT、Cre/Loxp recombination system, myeloid cell-specific SETD4 knockout mice were successfully established for further research.

Effect of aspirin on epithelial-mesenchymal transition, migration and invasion in MCF-7 cell induced by platelets

NIU Hong-ling， HUANG xiao-ping， LIU Xiao-long， LI Xiang-zhi， XIAO Gang， LIU Li-xin

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  183-187.  doi:10.13418/j.issn.1001-165x.2017.02.013

Abstract ( 422 )  

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Objective　To identify the effect of aspirin on epithelial-mesenchymal transition, migration and invasion in MCF-7 cells induced by activated platelets.　Methods　MCF-7 cells were treated with different concentrations of aspirin, platelets activated with arachidonic acid, and different concentrations of aspirin combined platelets activated with arachidonic acid, respectively. Scratch test and transwell test were used to determine the capacities of migration and invasion. Meanwhile, the expression of E-cadherin and Vimentin which linked to epithelial-mesenchymal transition (EMT) was measured by Western Blot.　Results After the intervention of activated platelets, the migration and invasion capabilities of MCF-7 cells were enhanced (P<0.05). The expression of E-cadherin was decreased and Vimentin was increased obviously. After the treatment of low and high concentration aspirin combined with platelets, the migration and invasion capabilities were decreased compared with the group which was treated only with activated platelets(P<0.05). The expression of E-cadherin was elevated and Vimentin was obviouslt reduced. When MCF-7 cells were treated with low concentration (0.5 mmol/l) and high concentration (2.0 mmol/l) of aspirin only,there was no significant difference in the migration and invasion capabilities(P>0.05) compared with the control group without intervention. Meanwhile, Western Blot showed no obvious changes in the expression of E-cadherin and Vimentin (P>0.05).　Conclusion　Results in vitro experiments indicated that aspirin could inhibit the abilities of epithelial-mesenchymal transition (EMT), migration and invasion in MCF-7 cells through suppressing the activation of platelets.

Alteration of ionized calcium binding adapter molecule-1 in paraventricular nucleus of hypothalamus induced by substantia nigra lesion by 6-hydroxydopamine

ZHANG Yi-min, LIAN Hui, FU Sheng-qi, REN Tong-ming, CAI Jun-yan, WANG Zhi-yong

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  188-192.  doi:10.13418/j.issn.1001-165x.2017.02.014

Abstract ( 353 )  

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Objective　To observe the expression of ionized calcium binding adapter molecule-1 (Iba1) in rat paraventricular nucleus of hypothalamus (PVN) induced by substantia nigra lesion by 6-hydroxydopamine (6-OHDA).　Methods　According to random number table, a total of 30 male SD rats were randomly divided into a 6-OHDA group and a normal control group. 6-OHDA was injected into the bilateral substantia nigra (SN) of the rats in the 6-OHDA group, and the same volume of saline was injected into the same position of the rats in the normal control group. After sixweeks, the rats were sacrificed and the brains were obtained. Nissl staining was used to detect the Nissl bodies in the SN, and immunofluorescent assay and Western blot analysis were used to detect TH expression in the SN and Iba1 expression in the PVN, and RT-PCR were used to detect Iba1 in the PVN.　Results　Compared with the normal control group, the number of TH immunoreactive neurons in the SN of the 6-OHDA group decreased from (58±5) to (10±2) (P<0.05), and the protein level of TH decreased from (0.71±0.1) to (0.28±0.12) (P<0.05). The number of  Iba1 immunoreactive cells in the PVN of the 6-OHDA group increased from (7±2) to (14±3) (P<0.05), and the level of Iba1 protein increased from (0.1±0.08) to (0.19±0.06) (P<0.05).　Conclusion　The changes of Iba1 expression in PVN may be associated with gastric emptying dysfunction in patients with Parkinson’s disease.

Effects of herbal steam-wash therapy on IL-1β and TGF-β1 concentrations in the knee joint fluids of knee osteoarthritis

WANG Guan-jie, ZHANG Lei, XIE Li-jun, ZHOU Xin, LIU Gang, GUO Xiao-guang, FU Shi-jie

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  193-198.  doi:10.13418/j.issn.1001-165x.2017.02.015

Abstract ( 339 )  

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Objectives　To observe the effects of herbal steam-wash therapy on knee osteoarthritis(KOA),in terms of WBC, IL-1β and TGF-β1 concentrations.　Methods　9 SPF old cynomolgus monkeys as KOA animal models were randomly divided into a steam-wash group (n=3), a traditional group(n=3) and a control group(n=3). Other 6 SPF youth cynomolgus monkeys were selected as a healthy group. The left knee of cynomolgus monkeys in the steam-wash group or traditional group were treated with herbal steam-wash therapy or traditional herbal compress therapy for 6 weeks, separately. The WBC, IL-1β and TGF-β1 concentration were detected from joint irrigation fluids before treatment and 2 weeks, 4 weeks, 6 weeks after treatment. Analysis of variance for repeated data was performed.　Results　(1)Articular cartilage degeneration of aged cynomolgus monkeys could be seen by HE staining; (2) In regard to WBC and IL-1β concentration before treatment, the steam-wash group, traditional group and control group compared with the normal group was significantly decreased (P<0.05). On the contrast, the concentration of TGF-β1 increased significantly (P<0.05). (3) At 2 weeks, 4 weeks, 6 weeks after treatments, WBC and IL-1β concentration decreased significantly than those before treatments in the steam-wash group and traditional group (P<0.05). (4) In regard to WBC and IL-1β concentration at 2 weeks, 4 weeks, 6 weeks after treatments, the steam-wash group and traditional group compared with the control group were significantly decreased (P<0.05), which decreased more in the steam-wash group compared with the traditional group (P<0.05). (5) The TGF-β1 concentration increased significantly at 2 weeks and 4 weeks after treatments (P<0.05). (6) In terms of TGF-β1 concentration at 2 weeks, 4 weeks after treatments, the steam-wash group and traditional group compared with the control group were significantly increased (P<0.05), which increased more in the steam-wash group compared with the traditional group (P<0.05).    Conclusions　The IL-1β, TGF-β1 concentrations and WBC in the knee joint fluids from cynomolgus monkey models of KOA were abnormal. Herbal steam-wash therapy and traditional herbal compress therapy could decrease the IL-1β concentration and increase the TGF-β1 concentration in knee joint, which is helpful for treatment of KOA. Moreover, the effect of herbal steam-wash therapy is better than traditional herbal compress therapy.

Construction and validation of a training model for laparoscopic partial nephrectomy using isolated porcine kidney

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  199-202.  doi:10.13418/j.issn.1001-165x.2017.02.016

Abstract ( 449 )  

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Objective　To constructa training model for laparoscopic partial nephrectomy (LPN)using isolated porcine kidney, as well as to evaluateits efficacy in LPN training.　Methods　Adipose and other tissues outer to the renal fascia were removed from the isolated porcine kidney. Two concentric circles with different diameters of 28 mm and 32 mm were placed on the surface of the porcine kidney, respectively. The trainees, including 6 experts, 6 intermediates and 8 novices, were asked to perform a LPN to evaluate the validity of the training model. The operative time,the suture time, the damage of two concentric circles, and the length of the wounds after suturewere recorded.  Likert scale was used by 6 experts to evaluate the appearance, the anatomical structure, the operation texture, and the overall realistic simulation of the model.　Results　In Likert scale, quality assessment of the model for anatomical structure was 5.00±0.00, for appearance was 4.33±0.52, for operation texture was 4.33±0.52, and for overall realistic simulation was 4.67±0.52. There were significant differences among the three groups in operative time, suture time, damage of two concentric circles, and length of the wounds after suture (P<0.05).　Conclusion　The training model was suitable for advanced training of LPN with its advantages in simplicity, economy and high fidelity of operation simulation.

Biomechanical study of soft tissue reconstruction in treatment of distal radioular joint instability

LAN Wan-li，HUANG Dong，KUANG Yi-zhen，ZUO Jie-yi, CHEN Zhi-ying, CAI Hui, LIU Xiao-chun

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  203-206.  doi:10.13418/j.issn.1001-165x.2017.02.017

Abstract ( 693 )  

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Objective　To compare the biomechanical effects of two soft tissue reconstruction procedures on the reconstruction of distal radioulnar joint stability, and to provide the basis for clinical application.    Methods　Eight adult upper limb specimens were obtained, the injury model made and the operation mode simulated. The pronation and supination torque was compared among the normal group, injury group, palm long tendon group and flexor carpi radialis group when the wrist was located at dorsiflexion 30°, neutral position and flexion 30°.　Results　There was significant difference in pronation and supination torque between the normal group and injury group (P＞0.05). The difference between the normal group and palm long tendon group was not statistically significant. There was no statistically significant difference of torque between the normal group and  flexor carpi radialis group when the wrist was located at dorsiflexion 30 ° and neutral position，but was statistically significant at flexion 30° (P＞0.05).　Conclusion　Radioulnar ligament injury can cause instability of the distal radioulnar joint. The reconstruction of the radioulnar ligament can restore the stability of the joint with the palmaris tendon graft. After the ligament reconstruction with transposition of the partial flexor carpi radialis, the stability of the wrist in dorsiflexion 30 °and neutral position was restored, but in flexion 30 ° when there is still joint instability.

Effect of materials in the treatment of endodontic diseases on the dentin’s fracture resistance

YI Si, WU Bu-lin, TANG Lei, XU Wen-an, LI Jian-yi, CHEN Jia-jing, SONG Ying, XU Chu, XU Di-wei

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  207-210.  doi:10.13418/j.issn.1001-165x.2017.02.018

Abstract ( 370 )  

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Objective　To investigate the effect of Biodentine and MTA on the dentin’s fracture resistance.　Methods　40 fresh extracted Chinese rural dogs’ canines were collected and randomly divided into 5 groups. The crowns and the cementum of the teeth were dissected. Each tooth was prepared with unity sample at the length of about 25 mm. Five groups’ samples were filled with different medicines. The three-point flexural strength and flexural modulus of the experimental specimens were determined by applying a vertical splitting load through a specially shaped steel rod. The maximum load value of root fracture was tested after three months.    Results    The average three-point flexural strength of the five groups was sequentially: (154.77±16.51) MPa; (125.00±15.72 ) MPa; (140.81±11.99) MPa; (139.26±16.09) MPa; (120.17±14.21) MPa. The average three-point flexural strength of the five groups were in order: (19.50±1.03)GPa ; (9.62±1.34) GPa ; (17.08±1.14)GPa ; (15.73±2.14) GPa ; (15.73±2.14) GPa; (7.63±1.11) GPa. The data were analyzed by one way ANOVA and LSD method (P<0.05). The risk of pulpless root fracture may increase obviously as time goes by. The differences of the effect of Biodentine and MTA on the dentin’s fracture resistance remains no statistically significant. Compared with the positive control group, MTA and Biodentine did not increase or restore the fracture resistance of dentin. But compared with the negative control group and Vitapex, Biodentine and MTA could significantly increase the fracture resistance of dentin.　Conclusion　As a new biological dentin substitute materials, compared with the traditional calcium silicate material-MTA, Biodentine did not have the obvious advantage in improving the flexural properties of dentine.

Application of ilioinguinal perforator flap for repairing soft tissue defects of the extremities

GU Rong, WANG Hai-wen, JIANG Xin-min, MEI Xiong-jun, ZHONG Da-qiang

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  211-216.  doi:10.13418/j.issn.1001-165x.2017.02.019

Abstract ( 416 )  

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Objective　To evaluate the clinical efficacy of ilioinguinal perforator flap for repair of soft tissue defects of the extremities.　Methods　Twenty nine patients with soft tissue defects of the extremities complicated with deep tissue exposure or bone defects were recruited. All participants underwent ilioinguinal perforator flap transplantation including superficial iliac circumflex artery perforator flap repair in 8 cases, deep iliac circumflex artery perforator flap in 4, superficial epigastric artery perforator flap in 8, vascularized iliac osteocutaneous chimerical perforator flaps of deep circumflex iliac artery in 3 and ilioinguinal conjoined perforator flap in 6.  The minimal flap size was 5.0 cm×6.0 cm, and the maximal flap size was 35.0 cm×15.0 cm. The flap donor site was directly sutured.    Results    All flaps survived after transplantation. Two patients presented with arterial blood flow disorders induced by subcutaneous hematoma of the flaps, and blood supply was restored after the stitches were partially removed. One patient experienced vascular crisis and blood supply was restored after surgical exploration. Twenty -two patients were followed up for 1 to 24 months, with 5 months on average. The flaps were characterized with soft texture and flat shape,the two-point discrimination distance ranging from 10.0 mm to 20.0 mm. The iliac bone graft in the recipient site grew well. The fracture was completely healed. Slight scar hyperplasia in the donor site was observed in 2 patients, and linear scars were observed the remaining cases.　Conclusion　Ilioinguinal perforator flap transplantation has multiple advantages, such as hidden donor site, direct suture and no major arterial injury. It can be applied for flexible reconstruction for bone defects, or harvested as a large-sized conjoined perforator flap（or chimeric perforator flap）and undergo flap thinning, making it an ideal approach for repairing soft tissue defects of the extremities.

To explore a beautiful method of using orbital septum aponeurosis flap and frontal muscle flap to correct serious blepharoptosis

FU Fu-ren, XIE Yi-de

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  217-219.  doi:10.13418/j.issn.1001-165x.2017.02.020

Abstract ( 522 )  

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Objective　To explore a beautiful method of treating serious  blepharoptosis.　Methods  To form the frontal muscle flap and orbital septum aponeurosis flap, the frontal muscle flap was overlapped between levator palpebrae superioris and orbital septum aponeurosis flap; two flaps and levator palpebrae superioris were overlapped and sutured in order to suspend the upper eyelid to  correct serious blepharoptosis.Results　12 cases with 12 eyes were treated with this method. Postoperative follow-up for 6 months to 18 months showed that the efficacy of 10 cases was satisfying, symptom in one case improved  ,and  one case needed a second reconstruction.　Conclusion　Through this method for correction of serious recurrent blepharoptosis by suspension offrontal muscle flap overlapped with levator palpebrae superioris and orbital septum aponeurosis flap, a better function and cosmetic result could be achieved. The eyelid system that it forms is very consonant with the biological structures.

Treatment strategy and effect of maltracking of patellofemoral joints in total knee arthroplasty

HUANG Yuan-xia, DUAN Yong-zhuang, WANG Li-min, Xu hai-bin

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  220-223.  doi:10.13418/j.issn.1001-165x.2017.02.021

Abstract ( 833 )  

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Objective　To summarize the effect and treatment methods in correcting the maltracking of patellofemoral joints in the total knee arthroplasty (TKA).　Methods　From June 2012 to December 2014, in 52 patellofemoral maltracking patients (58 knees with TKA ) with patella in lateral dislocation propensity, we used the methods of adjusting the tension between lateral retinaculum and medial retinaculum of patella, patella forming or adjusting the position of the tibial prosthesis properly, or employed two or three methods mentioned above,to correct the maltracking of patellofemoral joints when the TKA was conducted.　Results　No thumb test was negative in operation, and there was no outward dislocation of the patella after operation. Incisions healed by first intention. in  2 cases, hemarthrosis occurred  due to larger-range intraoperative lateral support release in order to correct apparent valgus, which was then managed and relieved with the symptomatic  approach. No other complications occurred. All patients were followed up for 17~47 months (32 months on average). Genu valgum or genu varum was not found in all cases, Flexion deformity of knee joints with 5~10° (8°on average) was found in 4 cases. At the end of follow-up, KSS score was 78~89 points, with an average of 84 points, and KSS knee function score was  82~91 points, with an average of 86 points. The X-ray films from the very beginning after surgery to the end of follow-up showed the prosthesis was in a normal position with no signs of loosening or infection.　Conclusion　In order to correct the maltracking of patellofemoral joints in TKA, releasing lateral retinaculum and tightening medial retinaculum of patella, patella forming and dressing , adjusting the position of the tibial prothesis properly, or employing the two or three kinds of methods mentioned above were efficient methods and beneficial to the recovery of knee joint function after operation.

The effects of alternative gait orthosis on walking ability, activity of daily living and quality of life in patients with thoracolumbar spinal cord injury

TANG Dan, LIU Si-wen,DENG Xiao-qian,LIAO Lin-rong,YANG Zheng-hui, YANG Xin-hua，HUANG Guo-zhi

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  224-227.  doi:10.13418/j.issn.1001-165x.2017.02.022

Abstract ( 526 )  

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Objective　To investigate the effects on walking ability, activity of daily living (ADL) and quality of life (QOL) after fitting the alternative gait orthosis (AGO) in thoracolumbar spinal cord injury (SCI) patients.　Methods　60 patients with complete SCI were randomly divided into an AGO group (30 subjects) and a control group (30 subjects).  All patients received a standard rehabilitation training (including muscle strength training, balance training, transferring training, wheelchair using and ADL training).  Patients in the AGO group received an additional 8 weeks of standing and walking training. Outcome measurement including the walking ability, ADL and QOL assessment were taken before rehabilitation training, before fitting orthosis and after fitting respectively.　Results　After 4 months of treatment, AGO group patients can use the orthosis to walk; average 10 m walking time was 87.27 s, average 6 min walking distance was 46.35 m; ADL ability in the treatment group was significantly improved when compared with the control group (P<0.01); the improvement in physiological and psychological aspects of QOL score was statistically significant (P<0.05).　 Conclusion　The using of AGO can improve the walking ability, ADL ability and QOL for patients with the thoracolumbar SCI, implicating that AGO should be widely applied in the future.

Effect and safety analysis of treatment of ischemic necrosis of femoral head in adult patients treated with transplantation of bone flap pedicled with femoral muscle pedicle

ZHANG Jian, YIN Fu-yu, PENG Wu-xun

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  228-231.  doi:10.13418/j.issn.1001-165x.2017.02.023

Abstract ( 515 )  

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Objective　To explore the curative effect and safety of the transplantation of the bone flap carrying the quadratusfemoris in the treatment of ischemic necrosis of femoral head in adults.　Methods　From January 2013 to January 2016 in our hospital, 96 patients undergoing transplantation of the bone flap carrying quadratusfemoris was enrolled as the research object. The necrosis of the patients was divided into phase I, II and III in three stages, respectively, according to the international bone association research circulation staging criteria. The efficacy of the flap onthe necrosis of various stages three stages and safety of the situation was evaluated.　Results　  Three patients with different stages of Harris score after treatment was significantly higher than that before treatment, the difference was statistically significant (P<0.05); with the increase of age, the healing rate showed significantly increasing trend, and the difference was statistically significant (P<0.05); in patients with senior clinical stage, the excellent and good rate of patients showed significantly decreased trend and the difference was statistically significant (P<0.05); observation of complications in patients with different stages showed that there was no difference concerning the incidence of the complication after flap transfer, proving the efficacy of this therapeutic approach (P<0.05).　Conclusion　Transplantation of the bone flap carrying the femoral muscle for treatment of avascular necrosis of the femoral head has a very significant effect, and the recovery time of the patients is relatively fast.

The definition of the chimeric (perforator) flap classification and clinical application progress

LIU Li,WEI Zai-rong

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  232-235.  doi:10.13418/j.issn.1001-165x.2017.02.024

Abstract ( 901 )  

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Advance in the posterior operative strategy of atlantoaxial dislocation associated with cranio-cervical junction abnormalities

LIU Rui-duan, JIN An-min

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  236-237.  doi:10.13418/j.issn.1001-165x.2017.02.025

Abstract ( 439 )  

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Variation of bilateral small saphenous veins in a male cadaver

HE Yan, GUO Cheng-cai, GUO Yi-xuan, CUI Shu-hui, JIANG Wen-yang, LI Zhen-zhong

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  238.  doi:10.13418/j.issn.1001-165x.2017.02.026

Abstract ( 505 )  

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Three middle colic arteries and the right ovarian vein variation: a case report

WU De-xi, PENG Xiao-chun, YI Bin-qian, LIU Li-yuan, LUO Xiao-feng

Chinese Journal Of Clinical Anatomy. 2017, 35(2):  239.  doi:10.13418/j.issn.1001-165x.2017.02.027

Abstract ( 613 )  

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