Table of Content

25 May 2017 Volume 35 Issue 3

  

Applied anatomic study on reconstructing the medial patellofemoral ligament by using the adductor magnus tendon

ZHANG Liang, GAO Jian-ming, XIANG Yang, CHEN Wei-nan, ZONG Xu-hua, WANG Ya-dong

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  241-244.  doi:10.13418/j.issn.1001-165x.2017.03.001

Abstract ( 559 )  

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Objective　To evaluate the surgical feasibility and possible risks of reconstructing the medial patellofemoral ligament（MPFL） using the adductor magnus tendon，and explore the methods of the fixation techniques. Methods  Anatomical characteristics of adductor magnustendon, the medial patellofemoral ligament morphology, and peripheral vascular nerve adjacent relationship were observed on 30 cadaveric knees. The distance from adductor tubercle to the MPFL femoral attachment，and the distance from adductor tubercle to transitional part were measured. Surgical simulation was operated on the cadavers. Results    Length of adductor magnus tendon (distance from the adductor tubercle to the adductor hiatus) was (105±14)mm（77~129 mm），length of the medial patellofemoral ligament was (46±6) mm（33~57 mm)，the distance from the adductor tubercle to the MPFL femoral insertion was (9±2) mm(6~13 mm)，and the distance from the adductor tubercle to transitional part was (124±11)mm（102~144 mm）.     Conclusions    Fixation of graft with a length of 55 mm in the medial border of the patella for the reconstruction of the MPFL is feasible. Considering the anatomical risk on the operation，the adductor magnus tendon as a reconstruction graft of the MPFL is a good choice.

Study on applied anatomy of free hallux nail flap of second toe chimeric composite flap for thumb reconstruction

XIAO Xiang-jun, LIU Ming-jiang, LIAO Hui-wen, LIU Chang-xiong, WANG Zheng-gang, HUANG Xin-feng, HUANG Xiong-jie

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  245-248.  doi:10.13418/j.issn.1001-165x.2017.03.002

Abstract ( 570 )  

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Objective　To provide the anatomical basis for free hallux chimeric 2nd toe nail skin flap for composite tissue flap for thumb reconstruction.　Methods　10 fresh cadaveric foot specimens were dissected after perfusion with red latex. Systematic observation of hallux toe and 2nd toe arterial and venous distribution was performed, and  the length and diameter were measured; Free hallux chimeric 2nd toe nail skin flap composite tissue flap for thumb operation design was simulated.　Results　1st dorsal metatarsal artery in the 1th toes web space deep issued 2nd branches: the lateral plantar proper artery of Hallux the medial plantar proper artery of the second toe. The lateral plantar proper artery of Hallux (Bifurcation into the flap) has a length of (1.82±0.12) cm, anda  diameter of (1.08±0.06) mm; The medial plantar proper artery of the second toe has a length of (0.90±0.16) cm and diameter of (0.82±0.13) mm. Veins were located in  two layers. The 1st and 2nd dorsal superficial veins drain into the saphenous vein at the medial aspect of the foot and ankle. The reconstructed thumb's vascular pedicle underwent no compression.　Conclusions　The arterial and venous vessels of the 1st and 2nd toes can provide the hallux 2nd toe nail skin flap and 2nd toe of composite tissue flap with blood supply. No compression will occur in the reconstructed thumb’s vascular pedicle. Suitable for design free hallux chimeric 2nd toe nail skin flap composite tissue flap for thumb.

A study clinical significance about measurement of the acromion and the coracoacromial ligament

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

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  249-251.  doi:10.13418/j.issn.1001-165x.2017.03.003

Abstract ( 1065 )  

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Objective    To measure the anatomical parameters of acromion andcoracoacromial ligament at the side of acromion and provide the morphological data.   Methods    36 fresh frozen adult shoulder specimens were used. All specimens were scanned by MSCT; mimics15.0 was adopted for analyzing these data and reconstructing the scapula. In 3D reconstruction software, the length of the acromion, width and thickness of acromion were measured.  Then dissection of thecoracoacromial ligament was performed. Data of coracoacromial ligament at attachment point on acromion were measured using vernier caliper.  Results    The length of the acromion is (46.27±2.88) mm,the width is (25.71±1.52) mm, and thickness is (8.10±1.14) mm; The width of the coracoacromial ligament at the attachment point of acromion is (14.27±1.19) mm, thickness is (4.05±0.38) mm.  Conclusions   Understanding of the anatomy of coracoacromial arch and acromion can provide facilitate diagnosis and treatment of shoulder joint disease.

An anatomic study on design of the posterior tibial artery perforator flap

KUANG Yi-zhen, HUANG Dong, LAN Wan-li, CHEN Zhi-ying, ZUO Jie-yi

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  252-255.  doi:10.13418/j.issn.1001-165x.2017.03.004

Abstract ( 1792 )  

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Objective　To provide anatomical basis for posterior tibial artery (PTA)intramuscular perforator flap.　Methods　Eight pieces of adult fresh calf specimens were dissected and the distribution of PTA perforators   and branches was analyzed. PTA perforator-based microdissected thin flap, conjoined flap, chimeric perforator flap and polyflap were designed and harvested.　Results    The average amount of septocutaneous perforators given off from PTA was 4.8 (3 to7), and the mean outer diameter was (1.10±0.29)mm; three relatively constant perforators were located in (6.7±1.1), (15.8±1.8) and (22.6±1.7) cm, respectively, above the medial malleolus. PTA perforators divided into cutaneous branches,periosteal branch and muscular branches beneath the deep fascia. The perforators from the periosteal branch mainly concentrate on the middle segment of the calf. Perforators which divided into two cutaneous branches with an initial outer diameter great than or equal to 0.5 mm are mainly located in the middle and upper segments of the calf.　Conclusions　The first and second perforators of PTA are relatively constant in the middle and upper segments of the calf, with larger outer diameter and longer pedicle, which can divide into multiple branches supplying various tissues. It is suitable for harvesting PTA perforator-based microdissected thin flap, conjoined flap, chimeric perforator flap and polyflap.

Variation of location and feature of thyroid gland :one case report

ZHENG Zi-cheng, MU Bo-kun,WU Yue

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  255.  doi:10.13418/j.issn.1001-165x.2017.03.028

Abstract ( 590 )  

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Anatomic parameters of the screw channel in the posterior margin of the obturator

FENG Kai，CAO Sheng-lu，GUO Dong-hong, LING Wei，PENG Geng，WANG Gang

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  256-260.  doi:10.13418/j.issn.1001-165x.2017.03.005

Abstract ( 521 )  

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Objective　To provide evidence of anatomy for the placement of screws in the screw channel in the posterior margin of the obturator.    Methods    CT scan data of 50 normal adults was collected for the reconstruction of three-dimensional hemi-pelvic models. The screw channel of each pelvis was confirmed using a novel method of axial perspective. After successful implantation of a virtual screw, the entry point and entry angle were measured. The data were verified on 13 bony hemi-pelvic specimens.   Results   The mean maximum screw diameter was （6.48±1.07）mm in male and （5.87±1.34）mm in female; the mean maximum screw length was （98.03±4.08）mm in male and （87.34±4.76）mm in female. The average OA value was （7.93±2.30）mm in male and (3.77±1.37）mm in female; the average AB value was （55.99±4.83）mm in male and （63.66±4.74）mm in female. The average ∠θ was （79.17±9.89）° in male and （71.81±10.61）°in female, while the average ∠ψ was （108.72±6.13）° in male and （98.12±7.43）°in female. All the parameters were statistically significant (P<0.05). A Kirschner wire with a diameter of 3.5 mm was successfully implantedin each of the 12 hemi-pelvic bony specimens among 13 hemi-pelvic bony specimens.   Conclusions    It’s feasible to implant a lag screw, which is at least 3.5 mm in diameter, into the screw channel in the posterior margin of the obturator. The parameters can be used for the design of the targeting device for this screw channel.

Cone-beam computed tomography analysis of root canal configuration of 924 mandibular first molarsin Southern Chinese Subpopulation

CI Bo-wen,WU Bu-ling, MA Dan-dan, LIN Si-dou, YAN Ling-ling, HUANG Wen-hua

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  261-265.  doi:10.13418/j.issn.1001-165x.2017.03.006

Abstract ( 401 )  

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Objective　To investigate the root canal configuration of mandibular first molars by using cone beam computed tomography (CBCT).　Methods　The CBCT imaging data of 500 patients, who were enrolled in Department of Stomatology, Nanfang Hospital between December 2014 and December 2015, were inspected by two endodontists. A total of 924 mandibular first molars were examined. The number of root, root canals and root canal configuration and the incidence of calcified canalwere observed and recorded. Statistical analysis was performed using Chi-squared test.　Results　The bilateral symmetry of root canal configuration is 76.2%(323). Among all the mandibular first molars, 76.7%(709) had double roots and 23.3%(215) had three roots, i.e. the incidence of distolingual root was 23.3%.  According to Vertucci’s classification, 71.97% (665) of the mesial roots were type IV, 23.70%(219) were type II; 49.35% (458) of the distal roots were type I, 31.82%(292) of them were type IV.When distolingual roots exist, the distance between root canal orifice of distolingual and distobuccal was (2.94±0.27) mm. The incidence of calcified canal in mandibular first molars was positively correlated with age.　Conclusion　The root canal configuration of the mandibular first molar in a southern Chinese subpopulation is various; CBCT is an effective tool for detecting additional distolingual roots and should serve as a favorable tool for diagnosis in root canal therapy for dental practitioners.

The effect of Vitamin C on macrophage proliferation, migration and phagocytic activity

FAN Zhi-hao, LI Yuan-yuan, LI Li-xia,WANG Xiang-hai, PAN Meng-jie, TAN Dan-dan, WEN Jin-kun, QIAN Chang-hui, LI Zhen-lin，GUO Jia-song

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  266-270.  doi:10.13418/j.issn.1001-165x.2017.03.007

Abstract ( 1153 )  

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Objective　To investigate the effects of Vitamin C (VC) on macrophage proliferation, migration and phagocytic activity.　Methods　Macrophages isolated from SD rats were cultured in a basic medium supplement with or without VC for 24 hours. Then the proliferation of macrophages was assessed by BrdU and WST assays, while the phagocytic activity was detected by the phagocytosis of lumispheres which were administrated into the culture medium for 3 hours, and the migration was measured by scratching test and Transwell assay.　Results　The percentage of BrdU positive cells was significantly increased in the VC treated group while the intensity of WST  test was higher in VC group than that of control group (P<0.05). The number of lumispheres in each macrophage of VC group was much more than that of control group(P<0.05). Moreover, VC could accelerate the migrating rate of macrophages when the cells were tested by scratching test and Transwell assay (P<0.05).　Conclusion　VC could enhance the proliferation, migration and phagocytosis  of macrophages.

The bio-reactivity analysis of  HSNGLPL peptide grafted-polyurethane

XIAO Jiang-wei, SHI Dan-dan, ZHU Rong, GU Rui-cai, WU Gang, LIAO Hua

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  271-275.  doi:10.13418/j.issn.1001-165x.2017.03.008

Abstract ( 429 )  

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Objective　To study the biocompatibility of HSNGLPL peptide grafted- polyurethane in vivo and in vitro.　Methods　HSNGLPL peptide solution, HSNGLPL peptide grafted polyurethane with different concentration, and BDO- PU are injected or implanted into tibialis anterior muscle of B6 mice, or co-cultured with C2C12 cell in vitro. CCK8, H&E, immunofleorecence was used to explore the material-induced inflammatory and immuno-reactivity in vitro and in vivo.　Results　HSNGLPL peptide grafted-polyurethane is biocompatible in vivo. BDO-PU induced a conspicuous monocytes/macrophages infiltration and myofiber degeneration, the inflammatory invasion and myofiber necrosis are mainly detected in the site around the implants. In contrast, peptide grafted-PUs induced intramuscular inflammation is more complex and sustained more than 56d. The number of apoptotic macrophages in muscle containing peptide-PU significantly lower than that containing BDO-PU.　Conclusions　HSNGLPL peptide grafted PUs triggers the more severe inflammation response than that of BDO-PU, and eventually change biocompatibility of PU material in vitro and in vivo.

Expression of Beclin1 and LC3 in dexamethasone-induced rat critical illness myopathy

QU Hui-ying, BAO Cui-fen, YU Di, QIN Shu-jian

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  276-281.  doi:10.13418/j.issn.1001-165x.2017.03.009

Abstract ( 447 )  

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Objective　To investigate the expression of critical illness myopathy on autophagy-related factors Beclin1 and LC3 in rat skeletal muscle.　Method　SD rats were divided into control and experimental groups; Experimental groups were divided into 3 time points, i.e., 7, 9 and 11d（n=10）.Experimental groups underwent intraperitoneal injection of dexamethasone 5 mg/kg once per day, and the healthy control group was injected with normal saline. The muscle function defect was determined by footprint method. The expression of skeletal muscle autophagy-related factors Beclin1 and LC3 was examined by immunohistochemistry and western blot analysis.　Results　Compared with the control group, rats in the experimental groupdemonstrated muscle function impairment symptoms of varying degrees ,which was most serious at 11d time point. Western blot results showed that Beclin1 and LC3 positive expression in the control group, or Beclin1 and LC3 expression were significantly higher in the experimental group than that in the control group. Immunohistochemistry confirmed the same trend.　Conclusion　Beclin1 and LC3 may play an important role in cell autophagy of skeletal muscle in critical illness myopathy in rats.

Effects of berberine on the expression of Nrf2/Keap1 in hypoxia reoxygenation induced myocardial cells

WANG Song-hai, CHE Yi-hong, CHEN Jie

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  282-285.  doi:10.13418/j.issn.1001-165x.2017.03.010

Abstract ( 484 )  

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Objective　To examine the effect of berberine on hypoxia reoxygenation induced apoptosis in myocardial cells and to explore the potential mechanisms involved.　Methods　H9C2 cardiac muscle cells were divided into: normal control group (NC group), simple berberine group (BR group), hypoxia reoxygenation group (HR group) and drug treatment group (divided into LBR group: 1.5×10-6 mol/L, HBR group 1.5×10-4 mol/L). Myocardial cell vitality was detected by MTT, nucleus morphological changes were examined using Hoechst 33258 dye and Nrf2 and Keap1 protein expressions were detected by Western blot.　Results　Compared with that in NC group, simple berberine exerted no effect on myocardial cells in BR group. Compared with those in HR group, the cell vitality in treatment groups increased((65.2±1.6)%; (82.3±1.4)%; P<0.01)，and apoptosis decreased significantly(P<0.05). Western blot results showed that berberine increased the expression of the antioxidant-related protein Nrf2, and reduced the level of Keap1. Conclusion　Berberine has significant protective effect on hypoxia reoxygenation induced apoptosis in myocardial cells possibly by enhancing the release of Nrf2 and decreasing the expression of Keap1.

Changes of dopamine receptor 1 and dopamine receptor 2 expression in dorsal motor nucleus of vagus induced by substantia nigra lesion by lipopolysaccharide

LIAN Hui, ZHANG Yi-min, FU Sheng-qi, WANG Zhi-yong

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  286-290.  doi:10.13418/j.issn.1001-165x.2017.03.011

Abstract ( 635 )  

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Objective    To observe the expression of tyrosine hydroxylase (TH)、dopamine receptor 1 (DR1) and dopamine receptor 2 (DR2) in rat dorsal motor nucleus of vagus (DMV) induced by substantia nigra (SN) lesion by lipopolysaccharide (LPS).　Methods　According to the random number table, a total of 30 female SD rats were randomly divided into a LPS group and a normal control group. LPS was injected into the bilateral SN of the rats in the LPS group, and the same volume of saline was injected into the same position of the rats in the normal control group. After six weeks, rotating rod experiment, gastric emptying, immunofluorescent assay and western blotting analysis were used to detect TH expression in the SN and TH, DR1 and DR2 expression in the DMV.　Results　Six weeks later，the LPS group rats were identified successfully, and the gastric emptying ability was reduced, the number of TH immunoreactive neurons in the DMV of the LPS group increased from (7±3) to (12±2) (P<0.05), the number of DR1 immunoreactive neurons decreased from (28±5) to (18±6) (P<0.05) and the number of DR2 immunoreactive neurons increased from (20±3) to (33±4) (P<0.05). In the dorsal medulla, the level of TH protein increased from (0.16±0.02) to (0.43±0.04) (P<0.05), the level of DR1 protein decreased from (0.78±0.05) to (0.36±0.03) (P<0.05) and the level of DR2 protein increased from (0.43±0.03) to (0.58±0.07) (P<0.05).　Conclusion　The changes of TH, DR1 and DR2 expression in DMV of LPS group rats may be associated with gastric emptying dysfunction in patients with Parkinson’s disease.

Effect of Capn4 in repairing DNA damage of nasopharyngeal carcinoma cell CNE2

WANG Hui, WANG Feng, WU Li-xian, ZHENG Ming

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  291-295.  doi:10.13418/j.issn.1001-165x.2017.03.012

Abstract ( 474 )  

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Objective    To investigate the effect of Capn4 on the repair of nasopharyngeal carcinoma cell line CNE2 induced by radiation and its possible pathways.   Methods    The protein levels of Capn4 in CNE2 and 293T cells were examined by Western blot. The Capn4 knockdown cells using shRNA was constructed in CNE2 cells and further identified by Western blot. Highly Connected Cell Imaging Analyzer was used to analyze the Mean Fluorescence Intensity of γ-H2AX in CNE2 cells after radiation and CNE2 cells with down-regulation of Capn4. Non-homologous end joining (NHEJ) pathway-specific plasmids EJ5-GFP were transfected into CNE2 cells with Fugen6 HD and CNE2 cells with downregulation of Capn4. The positive rate of GFP was detected by Highly Connected Cell Imaging Analyzer. The downregulation of Canp4 on NHEJ repair pathway of DNA damage was induced by radiation influences.    Results    The expression levels of Capn4 were significantly higher in CNE2 cells than in 293T cells. The shRNA inhibited Capn4 expression in CNE2 cells. Downregulation of Capn4 expression could inhibit the DNA damage of CNE2 cells induced by radiation（P<0.01）. Downregulation of Capn4 expression could inhibit the repair of NHEJ pathway in CNE2 cells after DNA damage（P<0.01）.    Conclusion    Capn4 is highly expressed in nasopharyngeal carcinoma CNE2 cells. Downregulation of Capn4 expression can inhibit radiation-induced DNA damage repair, which may be achieved by inhibition of NHEJ pathway.

Detection of bone metastasis by small animal micro-PET/CT scan in nude mouse prostate cancer bone metastasis animal models

ZHONG Zhi-hong, ZHOU Wei, YU Hao-tao, YAN Wei-ming, SHEN Hua-wei, ZHANG Pin

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  296-300.  doi:10.13418/j.issn.1001-165x.2017.03.013

Abstract ( 491 )  

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Objective　To investigate the viability of small animal micro-PET/CT scan  for detection of prostate cancer bone metastasis in nude mouse prostate cancer bone metastasis models. 　Methods　23 nude mice were divided into control group (2 mice),orthotopic injection group(7 mice),intracardiac injection group(7 mice),intratibial injection group(7 mice), randomly. 40 days after the tumor cells injection, the animal were taken for PET/CT scanning (orthotopic injection group &intratibial injection group) and high-resolution micro-CT scanning(intratibial injection group). After the examination, the animals were sacrificed and dissected to identify metastasis tumor tissue. Suspicious bone metastasis was fixed in 10% formalin for histological examination.　Results　In the orthotopic injection group, no obvious bone destruction was detected (0/7). In the intracardiac injection model, one upper tibia bone destruction was detected by PET/CT scanning, which was confirmed by the high-resolution micro-CT scanning and HE stain; In the intratibial injection model, all animals formed various degrees of bone destruction(7/7) and the high-resolution micro-CT scanning showed various degrees of bone destruction clearly.　Conclusion　PET/CT scanning can identify the location of bone metastasis and the degrees of bone destruction clearly, which can serve as a promising method for cancer bone metastasis research.     

The proprioceptive changes of the ACL and hamstring in the cynomolgus monkeys’ ACL injury of one knee as a model

ZHANG Lei, GUO Xiao-guang, QI Ji, ZHOU Xin, WANG Guo-you, FU Shi-jie, LI Yi-kai

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  301-306.  doi:10.13418/j.issn.1001-165x.2017.03.014

Abstract ( 410 )  

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Objective　To explore the changes of proprioceptors of bilateral anterior cruciate ligaments and hamstring muscle and its causes after injury of the unilateral anterior cruciate ligament in cynomolgus monkeys. a.　Methods　We  chose 6 normal cynomolgus monkeys and randomly selected 3 monkeys to establish unilateral ACL injury model under arthroscopy. All the knee joints  were divided into three groups: the normal group (3 normal knees), and the model group A (3 uninjured knees in the models ) and the model group B (3 injured knees in the models). Then we respectively harvested the ACL and hamstrings to conduct HE and the gold chloride  staining  for demonstration of the basic shape of ligament and the morphology and quantity of proprioceptors.　Results　We observed the four types of proprioceptors in the ligament and hamstring in three groups. 4 weeks after operation, wecompared the morphology and quantity of all proprioceptors in the normal group and the model group A, and no significant change and difference in statistics were observed (P>0.05). In the model group B, the Ruffini's corpuscles, the Pacinian corpuscles and the Golgi tendon organs had morphological variation, and the number of various types of proprioceptors had declined, and the difference was significant in statistics (P<0.01). Nevertheless, the morphology of free nerve endings had no change. In addition, Ruffini's corpuscles had the largest number of morphological variation, followed by Pacinian corpuscles and Golgi tendon organs in a declining order, significant differences in statistics were observed(P<0.01).　Conclusions　The injured ACL can make the number of proprioceptors decrease in the same side, and even the morphological variation, and the hamstring’s proprioceptors in the same side also have the corresponding changes through reflective effects of the ACL-hamstring reflex arc. However, the injury will not affect the contralateral proprioceptors’ morphology and quantity in a short period of time.

Biomechanical study of a novel transoral atlantoaxial lateral mass fusion cage used for irreducible atlantoaxial dislocation

MO Shao-dong, AI Fu-zhi, LI Ke-wei, LI Ke-ke, CHEN Shu-jin

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  307-311.  doi:10.13418/j.issn.1001-165x.2017.03.015

Abstract ( 517 )  

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Objective  To compare the stabilities of the lateral mass fusion cage and iliac crest autograft combined with Transoral Atlantoaxial Reduction Plate (TARP) system and posterior C1-C2 pedicle screw-rod system.  Method　Cage was designed based on the three-dimension parameters of 40 postoperative patients operated with TARP. Range of motion (ROM) in flexion-extension, left-right bending and axial rotation of 6 cadaveric specimens with different treatments were recorded.  Results  The measured data indicated that feasible cage design were in 3 sizes: 13/12/7/16°，12/11/7/18°，11/10/7/20°(length/width/height/sagittal angle);ROM of TARP (combined with Cage or ilium) was smaller compared with posterior C1-C2 pedicle screw-rod system and difference between left and right bending was statistically significant.  Conclusion　The stiffness was analogous between TARP system (combined with cage or iliac crest autograft) and posterior C1-C2 pedicle screw-rod system. Furthermore, cage combined with TARP may simplify surgeric procedure and decrease the incidence of clinical complication.

Finite element analysis of four different kinds of internal fixation for acetabular fracture of T type

ZHANG Yong-qiang,ZHANG Ying,XIA Yuan-jun, XIE Hui-bing, DAI Yuan-yuan, CHEN Ze-peng

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  312-317.  doi:10.13418/j.issn.1001-165x.2017.03.016

Abstract ( 534 )  

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Objective　The anatomical structure of T-type acetabular fracture is very complex with diverse mechanisms of injury, it's difficult to develop a unified surgical gold standard in the clinical treatment. Through the establishment of an effective T-type acetabular fracture of finite element model, the biomechanical stability difference of four different methods of internal fixation was compared.　Methods　Finite element modeling software was used to build a model of T-type acetabular fracture, and the relevant finite element software was used to establish the following 4 different internal fixation model: retrograde lag screws for two columns (A), the reconstruction plate for anterior column combined with lag screws for posterior column (B), reconstruction plate for posterior column combined with lag screws for anterior column (C) and reconstruction plates for two columns (D). Loading analysis was carried out with the models in a sitting or standing position.　Results　In standing and sitting positions , the maximum displacement and the mean node displacement of anterior and posterior column fracture lines of T-type acetabular fracture were both A＞B＞C＞D.　Conclusion 　Application of double-column reconstruction plate fixation treatment of T-type acetabular fractures has the best biomechanical stability ,followed by reconstruction plate for posterior column combined with lag screws for anterior column.

Anatomy and biomechanics research of reconstruction of the deltoid ligament

LIN Hao，XU Shi-ming，HUANG Yong-jun，MOU Yong，ZHUORi-bo，GUO Hong-juan，ZHENG Li-bin

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  318-321.  doi:10.13418/j.issn.1001-165x.2017.03.017

Abstract ( 831 )  

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Objective　observation and measurement of the deltoid ligament were performed through cadaver dissection so that anatomical and biomechanical basis for repair and reconstruction of ankle ligament could be provided.　Methods 　10 cases of adult fresh cadaver ankle specimens were dissected for measurement of the length, width and thickness of each component. The X-ray films were taken under the valgus stress. The medial space of the ankle joint (Mcs) was measured, and the anteroposterior space of the ankles was measured. The triangular ligament were incised from in a superficial-to-deep direction, and the measurement was repeated. 　Results　The ankle ligaments were divided into two layers. When the ankle ligaments were in the complete state, the mean ankle space width of the ankle joint was (2.67±0.38) mm, (2.42±0.35) mm and (2.55±0.24) mm in the plantar flexion, neutral and dorsiflexion, respectively. When the ankle joint in the neutral position and the maximum dorsiflexion, no significant difference of the medial malleolus space could be found after the superficial layer of the triangular ligament was cut when compared to that in complete state (P>0.05), whereas significance could be found when the deep layer of the deltoid ligament was cut (P<0.05). When the ankle joint was at the maximum plantar flexion, there was no significant difference (P>0.05) of the medial malleolus spaceafter ligament disruption compared to that in complete state.　Conclusions  (1) Triangular ligament consists of four ligament bundles, and having good understanding of the origin and insertion of each ligament bundle is the basis for clinical anatomical reconstruction. (2)Applying external rotation stress test with the ankle in plantar flexion, neutral position and dorsiflexion diagnosis of triangular ligament injury can be more comprehensive and accurate.

Clinical analysis of two surgical approaches for treatment of closed rupture of Achilles tendon in 43 cases

XIONG Hong-tao, ZHUANG Yong-qing, FU Xiao-kuan, FANG Xi-chi, WEI Rui-hong

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  322-326.  doi:10.13418/j.issn.1001-165x.2017.03.018

Abstract ( 796 )  

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Objective　To summarize and analyze the actions of two kinds of approaches and surgical methods on postoperative complications and curative effects of Achilles tendon rupture reparation.　Methods　From2002.1 to2015.12, 43 cases of patients with closed rupture of Achilles tendon underwent surgical treatment, 25 caseswith one long traditional continuous posterior median incision medial 1cm beside Achilles tendon was assigned into the conventional approach group, and 18 cases with 3cm long short oblique incision of S-shape on the posterior ankle and proximal 2 paired small incisions on the edge of proximal Achilles tendon were assigned into the modified approach group.Bunnell method was used in all Achilles tendon suture. The complications of wound dehiscence, cutaneous nerve injury and recurringAchilles tendon rupture and curative effects of 2 kinds of approaches were analyzed. 　Results　All patients were followed up for 9 months to 5 years. In the conventional approach group, the wound dehiscence problem was found in 4 case, and recurring Achilles tendon rupture was found in 1 case, and no cutaneous nerve injury was found. In the modified approach group, sural nerve injury was found in 1 case, no wound healing was found in 4 cases and recurring Achilles tendon rupture was found in 1 case. The incidence of wound dehiscence in the two groups was higher than that in the conventional group (P<0.05). There was no significant difference between the two groups of Achilles tendon rupture and cutaneous nerve injury (P>0.05). According to the Arner-indholm score standard, 6 months after the Achilles tendon repair, the excellent and good rate of the modified approach group was higher (P<0.05). 　Conclusion　In the modified approach, one short S-shape incision obliquely across the Achilles tendon on posterior ankle along the direction of skin folds  with pairs of small incision on the edge of proximal Achilles tendon resulted in less postoperative complications and better curative effect.

Evaluation of the effect of respiratory electrical stimulation training in patients with functional constipation by surface electromyography signal

YE Yun-yi, ZHANG Ming-sheng, LI Xin-ping， ZHANG Lei， LIANG Gui-ying

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  327-330.  doi:10.13418/j.issn.1001-165x.2017.03.019

Abstract ( 522 )  

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Objective 　To adopt electromyography for measuring abdominal muscles and diaphragmatic surface electromyographic change, and to use CSS for evaluation of the effect of respiratory electrical stimulation training in patients with functional constipation.　Methods　The study enrolled 31 patients with functional constipation，who were randomly divided into control group and treatment group. The control group was treated with biofeedback therapy (16 cases), and the treatment group was treated with respiratory electrical stimulation and pelvic floor biofeedback (15 cases).Surface electromyography technique was used to measure the surface electromyogram of the diaphragm and the lower abdomen，respectively, before treatment and after treatment in two groups with CSS，Glazer method was used to evaluate the parameters of pelvic floor muscle.　Results    After 2 weeks of treatment， severity score of patients with chronic constipation in the two groups lower than that before treatment（P<0.05）.And the score of the treatment group was lower than that of the control group（P<0.05）. root mean square value of the diaphragm and rectus muscle in patients of the two groups is better than that before treatment（P<0.05）. But there was significant difference between the treatment group and the control group（P<0.05）.After treatment，the Glazer method was used to evaluate the baseline amplitude values in two groups of patients, which demonstrated a lower value after treatment（P＜0.05）. The Anterior baseline amplitude of the treatment group was lower than that of the control group, and the difference was statistically significant（P＜0.05）.　Conclusion　The respiratory electrical stimulation training can effectively improve the contractility of diaphragm and abdominal muscles and reduce the excessive activity of pelvic floor muscles, and enhance pelvic floor biofeedback in the treatment of functional constipation.

Multiple intraoperative monitoring of neuroelectrophysiology in surgical treatment for intraspinal occupying lesion

CHEN Yi, YE Jin, LIN Zhi-xiong, WU Jing-ming, LI Wen, LU Yong-hui, BAI Bo, LU Wei-jie

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  331-335.  doi:10.13418/j.issn.1001-165x.2017.03.020

Abstract ( 510 )  

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Objective　To investigate the efficacy of combined monitoring of motor evoked potentials withtrans-cranial electrical stimulation (TES-MEP), somatosensory evoked potentials(SEP), free and tirgger EMG for surgical treatment forintraspinal occupancy surgery occupying lesion.    Method    Combined SEP, TES-MEP, free and trigger EMG monitoring were employed in forty-two cases of surgical treatment forintraspinal occupancy surgery occupying lesion,  including one cervicalcase, fourteen thoracic cases, thirteen thoracolumbar cases, eleven lumbar cases, and three sacral cases. SEP and TES-MEP were used to monitor the precise status of sensory and motor pathways in spinal cord. Free and trigger EMG responses were used to more accurately explore and distinguish distribution of nerve tissues in and around theintraspinal occupancy.All cases were performed after surgery.    Results    ①SEPwas successfully achieved in 47(100%)cases. TES-MEP was successfully achieved in 44(93.6%)cases. Combined motor and sensorymonitoring was successfully achieved in 44(93.6%)cases. The abnormality of SEP was observedin 10 cases(19.1%), while the abnormality of MEP was observed in eight cases(17.0%). False negative and positiverate were 0% with combined SEP and TES-MEP monitoring. 10 positive cases of evoked potential were all caused by operations. Eight of them recovered gradually after the alarm in time to take measures. The other two cases who were only positive in TES-MEP failed to recover and postoperative muscle strength decreased. The symptoms were alleviated in six cases with SEP waveforms getting better. ②34 cases of EMG?response was observed. Postoperative urination dysfunction occurred in one case in which the intraspinal lesion was wrapped by tight cauda equina. However, this patient recovered in the twelfth day after operation.   Conclusions    ①During surgical treatment for intraspinal occupancy surgery occupying lesion,combined application of  SEP and TES-MEP can reflect the physiological and pathological conditions of spinal cord after ruling out the interfering factors, and improve the monitoring effect . ②Intraoperative monitoring of free and trigger EMG can not only accuratelyexplore and distinguish distribution of nerve tissues in and around the intraspinal occupancy, but also respond to the nerve irritation timely, and prevent iatrogenic nerve injuries.

Study on effects of supracondylar fractures of three-dimensional printing technique on physician-patient communications

LIN Gang, LI Peng, XIAO Ju-jiao, LI Jian-yi, PENG Wen-biao, HUANG Xu-ke, SUN Xiang-hua

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  336-340.  doi:10.13418/j.issn.1001-165x.2017.03.021

Abstract ( 502 )  

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Objective　To explore the surgical strategy of internal fixations for supracondylar fractures of femur using Mimics18.0 digital software combining with three-dimensional (3D) printing technique.　Methods　Thin slice CT scan data of 10 cases of complicated supracondylar fractures of femur and the data of all the internal fixations were imported into Mimics18.0 software to reconstruct 3D models, where virtualfracturesreductions were performed,standard parts library of internal fixations were established, and the most appropriate plates and screws were chosen. A 1:1 3D femur model was printed to simulate the surgery based on the digital design. Comparisons were made on the plate positions, screw passage lengths and screw directions to determine the final internal fixations. After that, the fracture reductions and internal fixations were performed in the reality surgery. An evaluation scale was handed out to patients and their relatives to investigate their altitudes to surgery simulations and 3D printing models.　Results　3D printing is of great use in reductions of supracondylar fractures. In simulated surgery of the typical case, 1 reconstruction plates and 8 screws were implanted in the 3D printing model, and the plate positions and the screw directions were in high accordance with those measured in Mimics 18.0 software. The comparisons between simulated surgery and digital design on screw length had nosignificantdifference(P>0.05).The effectiveness of reality surgery was also consistent with the simulated surgery. Patients also had high satisfactions with the surgical strategy of using 3D model before operation. Conclusion　Three-dimensional (3D) printing and digital design technique are of great value in individualized surgery and precise treatment, and can result in good physician-patient communication effects.

Conservative treatment of cervical spondylitic myelopathy with a large cervical disc herniation: a case report and review of literature

LIN Chu-hua, LI Ying-bin, LI Yi-kai

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  341-345.  doi:10.13418/j.issn.1001-165x.2017.03.022

Abstract ( 737 )  

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Objective　To explore the choice of treatment programs of cervical spondylitic myelopathy and the cause of natural absorption of herniated cervical intervertebral disc.　Methods　A case of cervical spondylitic myelopathy with a large cervical disc herniation treated with conservative treatment was reported. The literature of about the controversy on surgical and conservative treatment of cervical spondylitic myelopathy and natural absorption of herniated cervical intervertebral disc was reviewed.　Results　The treatment manners of cervical spondylitic myelopathy include two types, namely, surgical treatment and conservative treatment. Surgery is the preferred treatment for cervical spondylitic myelopathy because traction and manipulation cannot be applied on some patients with cervical spondylitic myelopathy. The advantages and disadvantages of surgical versus conservative treatment for patients with CSM remain controversial. The mechanism of natural absorption of herniated cervical intervertebral disc is unclear.　Conclusion　Early diagnosis and treatment are of great importance for patients with CSM because they can significantly affect their prognosis. The mechanism of natural absorption of herniated cervical intervertebral disc needs further research.

Anatomical characteristics of rabbit sternocleidomastoid muscle and establishment of congenital torticollis model

ZU Wen-xuan, JIANG Bang-hong, LAI Gui-hua, ZHAO Li, ZHANG Li, XU Jing

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  346-349.  doi:10.13418/j.issn.1001-165x.2017.03.023

Abstract ( 826 )  

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Objective    To study the position, morphology and adjacent structures of the rabbit sternocleidomastoid muscle, and establish a rabbit model of congenital torticollis.  Methods    Twenty New Zealand white rabbits were used in this study,which were dissected for observation of the anatomic relationship of the sternocleidomastoid muscle with surrounded vessels and nerve. Different hardening agents were injected in different segments of sternocleidomastoid muscle to evaluate the optimal model making method. Then the range of injection above the surface was estimated.    Results   The best project was 0.75ml/kg anhydrous alcohol injected into the lower segment of sternocleidomastoid muscle. The range was an approximate 2 cm2 parallelogram areas, a nearly 18 degree angle of the upper part of the sternum, with a height of about 2.3 cm and a width of about 0.85 cm.   Conclusion　This experiment provides an anatomical basis for establishment of congenital torticollis model, and effectively improves the success rate of modeling.

The technique of making cast specimens of the bladdar、urethra、seminal vesicle and ejaculatory duct

LI Zhe-yu, XIAO Zhao-ming, LIU Chang, WU Kun-cheng, XU Guang-wei, LUO Bao-hua, LUO Shi-wen, MA Zi-wei, LUO Jian-heng, HE Shan-li, LIANG Hai-bing, OU YANG Jun

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  350-351.  doi:10.13418/j.issn.1001-165x.2017.03.024

Abstract ( 535 )  

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Research progress in fine dissection of tarsal tunnel and tarsal tunnel syndrome

YANG Yong, FU Yuan-shan

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  352-354.  doi:10.13418/j.issn.1001-165x.2017.03.025

Abstract ( 587 )  

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Change of intervertebral disc height during degeneration and its clinical significance

YANG Lu, XING Hao-ran, CHEN Jing-jing, YAN Ping,WANG Xu, LI Na, XIONG Kun

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  355-358.  doi:10.13418/j.issn.1001-165x.2017.03.026

Abstract ( 640 )  

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The femoral arteriovenous fistula combined with angioma：a case report

XIA Hong-li, LIU Guo-li，WU An-sen， ZAHAO Rong, LI Min-cai

Chinese Journal Of Clinical Anatomy. 2017, 35(3):  359.  doi:10.13418/j.issn.1001-165x.2017.03.027

Abstract ( 398 )  

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