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Chinese Journal of Clinical Anatomy
(Founded in July 1983 Bimonthly)
Responsible Institution: China Association for Science and Technology
Sponsor: Chinese Society of Anatomical Sciences
Editing and Publishing: Editorial Board of Chinese Journal of Clinical Anatomy
Advisor: ZHONG Shi-zhen
Editor-in-chief: OUYANG Jun
Former Editor-in-chief: XU Da-chuan
Overseas Distributor: China International Book Trading Corporation (P.O. Box 399, Beijing, China, Code No. BM5961)
Address: 1023 Shatainan Road, Guangzhou, 510515, China
Tel: (020)61648203
E-mail: journal@chjcana.com
CN: 44-1153/R
ISSN: 1001-165X

Table of Content

    25 July 2017 Volume 35 Issue 4
      
    The applied anatomical comparison of two combined approaches in treatment of communicating tumors in the jugular foramen region
    XU Ling-ling, WANG Yu-hai
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  361-366.  doi:10.13418/j.issn.1001-165x.2017.04.001
    Abstract ( 653 )  
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    Objective To provide anatomical basis for the clinical application of communicating tumors in the jugular foramen region through comparing the combined far-lateral paracondylar-partial transcondylar approach with the combined infralabyrinthine-suboccipital retrosigmoid approach. Methods The exposed areas of the jugular foramen region and the corresponding anatomic marks were compared by simulating these two kinds of combined approaches under microscope in 16 cadaveric adult heads; Meanwhile, the exposed status of the extracranial segment of jugular foramen region after removal of the atlas transverse process was observed. Results These two kinds of combined approaches can reveal the intracranial segment and limited extracranial segment of the jugular foramen region. The combined far-lateral paracondylar-partial transcondylar approach is superior to reveal the posteromedial area of jugular foramen,while the combined infralabyrinthine-suboccipital retrosigmoid approach is superior to reveal the posterolateral area of jugular foramen. The occipital condyle and jugular process are anatomical landmarks of the former. The stylomastoid foramen and jugular process are anatomical landmarks of the latter. Atlas transverse process resection can extend the exposure of extracranial segment of the jugular foramen region(retrostyloid parapharyngeal space). Conclusions With the aid of atlas transverse process resection, the combined far-lateral paracondylar-partial transcondylar approach is suitable for management of communicating tumors in the jugular foramen region whose major part was medial to the foramen, while the combined infralabyrinthine-suboccipital retrosigmoid approach is more suitable for management of communicating tumors in the jugular foramen region whose major part was lateral to the foramen.

    Anatomy of the sphenopalatine artery on the vascularized pedicled endonasal flap
    HUA Shun-de, YANG Shao-chun, HUANG Jun, YI Ren-hui, DING Guan-fu, LUO Mu-yun
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  367-370.  doi:10.13418/j.issn.1001-165x.2017.04.002
    Abstract ( 604 )  
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    Objective To study the anatomical characteristics of sphenopalatine artery and its branches in order to offer anatomical evidence for harvest of endonasal flap. Methods Twenty sides of 10 adult cadaver heads were used. The sphenopalatine arteries and their branches were observed using microscope. Results The sphenopalatine artery is the main blood supply of the lateral nasal wall. It divides into two major branches (the posterior lateral nasal artery and the septal artery) before or after traveling through the sphenopalatine foramen. The posterior septal artery divided into 2 branches in the anterior wall of the sphenoid sinus. The distance between the main stem or the superior branch of the posterior septal artery to sphenoid ostium was (3.95±0.74) mm, and the main stem or the inferior branch of the posterior septal artery to arch of choana was (8.96±1.69) mm, approximately 10 mm anteroinferior to the posterior end of the middle turbinate. Conclusion Familiarity with the anatomic features of sphenopalatine artery and its branches to obtain endonasal flap has important significance. When harvesting the nasoseptal flap, the posterior superior incision should not venture lower than the level of the inferior aspect of the sphenoid ostium and the inferior incision should be near the arch of the choanae. When harvesting the inferior turbinate flap and the middle turbinate flap, We should pay more attention to the area which is 10 mm anterior to the posterior attachment of inferior turbinate on the lateral nasal wall close to the inferior turbinate and 10 mm anteroinferior to the posterior end of the middle turbinate.

    Anatomic characteristics and clinical significance of dorsal interosseous nerve
    SUN Bin, XIA Yu-jun, LI Jun-jie, KONG Xiang-quan, WANG Shu-guang, JIN Li-xin
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  371-375.  doi:10.13418/j.issn.1001-165x.2017.04.003
    Abstract ( 2490 )  
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    Objective To study the anatomic features of dorsal interosseous nerve and its muscular branches and to provide morphological basis for positioning surface positioning. Methods 60 dorsal interosseous nerves and its muscular branches from 30  embalmed arm specimens of adult cadavers were dissected. The courses and the bifurcation points of dorsal interosseous nerve were explored. The distances from each bifurcation point respectively to the latera humeral epicondyle(LHE), the Lister's tubercle of the radius (LTR) and the styloid process of ulna (SPU) were measured. The surface position of dorsal interosseous nerve was determined by the “three circle intersection localization method” and “nerve segmentation method”.   Results  There were 4 main bifurcation points of the nerve trunk after dorsal interosseous nerve sent out extensor digitorum branch, extensor digiti minimi branch, and extensor carpi ulnaris branch. The 4 bifurcation points were named O,O1,O2 and O3. Three points, i.e, LHE, LTR and SPT were taken as the center of a circle,and the distance from the bifurcation point to the three points as the radius to draw three circles. The intersection points or regions can be used as the surface location of the nerve. Dorsal interosseous nerve was divided into 7 segments, which were segment above O, segment between O and O1, segment below O1, segment between O and O2, segment below O2, segment between O2 and O3, and segment below O3.    Conclusion    According to the clinical manifestation of dorsal interosseous nerve injury and bifurcation point combined with “three circle intersection localization method” and “nerve segmentation method”, the location of nerve injury could be identified.

    A case of double tibialis anterior and multi-belly third peroneus
    MU Bo-kun,ZHENG Zi-cheng, WU Yue
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  375.  doi:10.13418/j.issn.1001-165x.2017.04.029
    Abstract ( 521 )  
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    The microanatomical study of the plantar artery arch artery and the tip arch artery of the second toe  
    TANG Lin-feng, JU Ji-hui, LIU Yue-fei, ZHOU Rong, HU Chang-qing, YANG Kai-hang, GUO Quan-wei, HOU Rui-xing
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  376-379.  doi:10.13418/j.issn.1001-165x.2017.04.004
    Abstract ( 897 )  
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    Objective    To investigate blood supply features of the plantar digital artery toetip arch and arch branch artery.    Methods   8 fresh adult foot specimens were selected and the red latex was perfused from the dorsal artery, then the second toe plantar arteries were dissected to observe the occurrence rate of the plantar artery arch, location and vascular caliber, the origin of the the plantar artery arch artery, direction of travel, number of branches and vessel diameter.   Results   The intact plantar toetip arches were roughly constant.  The overall average external diameter for this structure in the second toe was 0.64 mm, ranging from 0.5 mm to 0.8 mm, the overall average distance from the distal toetip skin to the plantar arch was 11.1mm, ranging from 9.5 mm to 13.0 mm. Dissection showed that all plantar arches had five main arch branches. In order to facilitate description,we named the five main arch branches as the first,second,third,fourth and fifth arch branch from tibial side to fibular side of the second toe.  Conclusion  The location and number of the plantar digital artery toetip arch artery was relatively constant, suggesting we could use the mini-axial flap pedicled with the toetip arch artery for aesthetic refinements in reconstructed fingers.

    A case concerned with variation of mandibular retromolar foramen
    ZHANG Yan, YIN Xue-min
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  379.  doi:10.13418/j.issn.1001-165x.2017.04.030
    Abstract ( 487 )  
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    The anatomical observation on the morphological difference between the type I lumbosacral transitional vertebra with the normal fifth lumbar and its clinical significance
    DU Xin-ru, DU Rui-yong
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  380-383.  doi:10.13418/j.issn.1001-165x.2017.04.005
    Abstract ( 752 )  
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    Objective To investigate the morphological differences between  the body of  the type I lumbosacral transitional vertebrae(type I LSTV) with that of the fifth lumbar vertebrae for the clinical diagnoses of  the type I LSTV. Methods 60 cases of the type I LSTV and 60 specimen of the fifth lumbar vertebrae were obtained, all of which had relative intact structure in birth. All specimen were measured by the uniform criterion for the following items: (1) the anteroposterior diameter and the transverse diameter of the vertebrae(both sides); (2) the anterior-vertical diameter, the posterior-vertical diameter and the anterio-posterior vertical diameter ratio of the vertebrae. The pedicle diameters of the type I LSTV All data were analyzed with the SPSS13.0 by the independent sample t-test.   Results  Compared with the fifth lumbar vertebrae, the superior antero-posterior diameters of the type I LSTV  are 1~2 mm longer in average than the normal L5; its inferior antero-posterior diameters, longer 1mm; its superior transverse diameters, 2~3 mm longer; its inferior transverse diameters, 2~3 mm longer; its anterior-vertical diameters, 0.7~1.2 mm higher; its posterior- vertical diameters, 0.8~1 mm higher. There is significant difference between the type I  LSTV and  the normal L5(P<0.01); There are no significant differences between each group of the those in the anterio-posterior vertical diameter ratio of the vertebrae.    Conclusion    Most diameters of  the type I LSTV is larger than the normal L5 but they have the similar shapes, it is difficult to identify them only on the lumbar lateral X-ray, CT and MRI film because of  those similar  morphologic characters . The pedicle  screw of the lumbosacral transitional vertebrae type I is the same as that of the normal fifth lumbar vertebrae in clinical practice.

    Anatomic research of minimally invasive surgical route for presigmoidal approach exposing jugular tubercle by virtual reality skill
    FENG Xu, QIAN Zeng-hui, TANG Ke, LI Yi-ming, LI Jing-shan, LIU Ai-hua
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  384-387.  doi:10.13418/j.issn.1001-165x.2017.04.006
    Abstract ( 586 )  
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    Objective To discuss the anatomic features of Kawase approach based on virtual reality image model. Methods Image data of CT and MRI scan performed to fifteen adult cadaver heads were used to establish virtual reality three-dimensional anatomy model of skull base. The lines between landmark points of craniotomy and petrous bone drilling were used as axis to outline cylinders simulating surgical routes of Kawase approach. Anatomic exposures in two surgical routes were observed and measured. Results Route 1 of Kawase approach involved superior petrous sinus and the end of route involved pon at the root entry zone of trigeminal nerve. Route 1 involved partial trigeminal nerve and superior cerebellar artery. Route 2 of Kawase approach involved superior petrous sinus, inferior petrous sinus and basal sinus. And then, ipsilateral trigeminal nerve, ipsilateral abducent nerve, basal artery, contralateral abducent nerve and trigeminal nerve were passed through. The end of route 2 was the intersection between axial line of cylinder and the root of contralateral trigeminal nerve. The volumes of route 2 and osseous structures, brainstem, artery, vein, greater superficial petrosal nerve and ipsilateral trigeminal nerve involved were more than those of route 1 with statistical significance. The volume difference of the temporal lobe between the two route did not reach statistical significance. Conclusions Kawase triangle forms a surgical window through which the direction of route will change the operative range. The route which passes through the superior edge at the root of the temporal bone zygomatic process will be helpful to expose the brainstem ventral space.

    An anatomical symmetry study of distal radius in adults via three-dimensional deviation analysis
    ZHANG Yi, DENG Yu-ping, WANG Mian, TAN Jin-chuan, OUYANG Han-bin, HUANG Wen-hua
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  388-393.  doi:10.13418/j.issn.1001-165x.2017.04.007
    Abstract ( 597 )  
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    Objective To evaluate the anatomical symmetry of the bilateral distal radius in adults using morphological measurement. Methods Three-dimensional reconstruction was carried out using the CT scans of 15 pairs of distal radius of the volunteers enrolled. The radial models were sectioned in distal 1/3 parts. Two geometric measurements of bilateral distal radii, volume and surface area, were obtained from each object. Furthermore, quantification and visualizationof the anatomical symmetry of bilateral distal radius were conducted using the three-dimensional deviation analysis method.  Results Regarding the surface area, the maximal percent difference between the left and right distal radius was no more than 5.6%(P=0.004). Similarly, regarding the volume, the maximal percent difference between the left and right distal radius was no more than 9.1%(P=0.005). Results of the three-dimensional deviation analyses showed that the maximal mean negative deviation was -0.40 mm while the maximal mean positive deviation was 0.34 mm. Moreover, it was observed that the relatively high deviation distributed in those regions away from the joint facets. Conclusions The bilateral distal radii show an excellent anatomical symmetry. In clinical practice, for the anatomical reconstruction of the distal intra-articular radial fracture, the mirror model of the intact radius can be used as reference to guide the fracture reduction precisely during operation. This has great significance for the restoration of the postoperative function of the radiocarpal joint.

    Computer-assisted anatomical evaluation of the posterior naris in 1 to 3-year-old children
    LIAO Da-hong, ZHANG Fei, WANG Hui
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  394-396.  doi:10.13418/j.issn.1001-165x.2017.04.008
    Abstract ( 715 )  
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    Objective To analyze the anatomical and developmental characteristics of the posterior naris in 1 to 3-year-old children, and to provide evidence for the diagnosis and treatment of diseases of theposterior naris in 1 to 3-year-old children. Methods Coronal CT scans of 240 cases(1~3 years old children) were studied with the imaging station. Reference data were identified on these images using imaging station. The sizes of the posterior naris were identified and measured.  Results The average of the transverse and vertical diameter for the left side of the posterior naris in 1~2 years old children was (8.98±0.69) mm and (14.42±1.34) mm, respectively. The average of the sectional area for the left side of the posterior naris was (92.75±14.76) mm2. The average of the transverse and vertical diameter for the right side of the posterior naris was (8.93±0.71) mm and (14.25±1.24) mm, respectively. The average of the sectional area for the left side of the posterior naris was (92.31±13.54) mm2. The mean of the transverse and vertical diameter for the right side of the posterior naris in 2~3-year-old children was (9.51±0.74) mmand (15.60±1.55) mm, respectively. The average of the sectional area for the right side of the posterior naris was (108.72±18.05) mm2. The average of the transverse and vertical diameter for the right side of the posterior naris was (9.54±0.71) mm and (15.76±1.32) mm, respectively. The mean of the sectional area for the right side of the posterior naris was (108.66±17.43) mm2. Conclusions The size of posterior naris in 1~3 years old children can meet the normal ventilation volume, and a smaller value may cause nasal obstruction and dyspnea. Chronic stuffy noses and breathing difficulties can affect the intelligence and facial development.

    The protective effect and its mechanism of Antrodia camphorata enzyme on the cytotoxicity injury of PC12 cells induced by amphetamine
    CHI Dan-lu1, SUN Yu1, PAN San-qiang2
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  397-401.  doi:10.13418/j.issn.1001-165x.2017.04.009
    Abstract ( 365 )  
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    Objective   To investigate the protective effect and its mechanism of Antrodia camphorata enzyme on the cytotoxicity injury of PC12 cells induced by  Amphetamine (AMPH).  Methods  PC12 cells were treated with 3.5 mmol/L AMPH or 3.5 mmol/L AMPH pus Antrodia camphorata enzyme. The morphological changes of the cells were observed under the light microscope. Cell viability assay was measured by MTT method. Caspase-3 levels were detected by Western blot, and the changes of reactive oxygen species(ROS) and apoptosis of cells were analyzed by flow cytometer.   Results   (1)AMPH damaged structure of PC12 cells, and resulted in cell apoptosis. Antrodia camphorata enzyme reduced cell apoptosis, and increased the survival rate of cells. (2)Antrodia camphorata enzyme reduced generation of ROS in PC12 cells. (3)Compared to AMPH group, procaspase-3 (35 kd) level was increased while procaspase-3 (17 kd) level was reduced in Antrodia camphorata enzyme group.  Conclusion  Antrodia camphorata enzyme has a protective effect on the cytotoxicity of PC12 cells induced by AMPH. Its mechanism may be related to inhibition of the  mitochondrial apoptosis signal pathway and reduction of reactive oxygen species in  cells.

    Effects of chloroquine on the expressions of autophagy related proteins after focal cerebral ischemia-reperfusion in rats 
    XIAO Xue-jin, LI Dan-dan, LIANG Jia, LI Xia, QIN Shu-Jian, BAO Cui-fen
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  402-408.  doi:10.13418/j.issn.1001-165x.2017.04.010
    Abstract ( 453 )  
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    Objective   To investigate the effects of chloroquine on the expressions of autophagy related proteins after focal cerebral ischemia-reperfusion in adult rats.  Methods   A total of 75 healthy SD rats were randomly allocated to sham-operation, model and chloroquine(CQ) 20,40 and 60 mg/kg groups. A model of middle cerebral artery occlusion (MCAO) for 2 h was induced by suture method. The CQ 20,40 and 60 mg/kg groups were injected intraperitoneally immediately following MCAO in the 3 medication groups. Neurological deficit scores and TTC staining were evaluated, and then the expressions of autophagy related proteins in area of cerebral ischemia-reperfusion were analyzed by immunofluorescence and Western blot technique at 24 h after reperfusion.   Results ①Neurological deficit scores in the sham-operation, model, CQ 20, 40 and 60 mg/kg groups were 0, 2.67±0.49, 2.93±0.26, 2.40±0.51 and 1.93±0.7 respectively. Compared with the infarction area of the model group by TTC staining, the CQ 20 mg/kg group was significantly increased, the CQ 40 mg/kg group was almost like the model group,the CQ 60 mg/kg group was significantly decreased. ② Compared with the model group, the results of immunofluorescence and Western blot technique showed  only a trace expressions of proteins(Atg5, Atg7, Beclin1 and Atg12 ) in the sham operation group (P<0.05), and the same pattern of expressions were observed in the CQ 20 mg/kg group. However there was significantly reduced expressions in the CQ 60 mg/kg group (P<0.05).  Conclusion The CQ have has two fold  effects, i.e., the CQ 20 mg/kg group can aggravate the damage, whereas the CQ 60 mg/kg can alleviatereduce the damage. The mechanism of CQ in the prevention and treatment of cerebral ischemia-reperfusion injury in rats may be associated with the dose of the expressions of some autophagy related proteins.

    Effects of different ischemic duration on post-ischemic and reperfusion rat cerebral blood flow detected by LSCI
    TIAN Zhi-hui, LIAO Wei-guo, YU Jian-ye, WANG Li-sheng
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  409-412.  doi:10.13418/j.issn.1001-165x.2017.04.011
    Abstract ( 483 )  
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    Objective To investigate the effects of different ischemic duration on post-ischemic and reperfusion rat cerebral blood flow. Methods Laser speckle imaging system (LSCI) was used to detect the effects of different ischemic duration on post-ischemia and reperfusion rat cerebral blood flow. At the same time, the dynamic changes of capillary flow and diameter, no reflow phenomenon and hypoperfusion were analyzed. Results During 2h middle cerebral artery occlusion (MCAO) ischemia, perfusion of cerebral blood flow decreased to (35±10)% of the baseline, reflecting a state of hypoperfusion. With the prolongation of ischemic time, no reflow phenomenon was aggravated. Hypoperfusion in 2 h group was approximately 10% less than that in 30 min group during the period of ischemia and reperfusion. Conclusion The long ischemic duration on post-ischemic and reperfusion may be one of the main reasons for the increase of the degree of brain injury.The established LSCI method can be applied to real-time monitoring of MCAO rat cerebral blood flow, which is easy to operate, sensitive, stable and reliable.

    Metformin protects osteoarthritis in mice by regulating the AMPK signaling pathways
    TAN Qing-mei, YANG Cheng, LIAO Jian-wen, Zou Qingbao, Huang Aijun, LIN Li, ZHANG Cong-xin
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  413-418.  doi:10.13418/j.issn.1001-165x.2017.04.012
    Abstract ( 661 )  
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    Objective Study the effect of metformin on osteoarthritis and chondrocyte differentiation in mice. Methods Mice were divided into a control group and an experimental group whose anterior cruciate ligament and medial meniscus excision were done in the right knee of both groups for arthritis model; Aftersuccess of model establishment, the experimental group was given metformin (2mg/kg/d) and the control group was given saline as intervention treatment for 8 weeks; Then through the HE, sarranine O-fast green slice staining and Micro-CT structural change was observed and  grading was performed according to Mankin ratings; The AMPK, mTOR activity and degree of autophagy of articular cartilage in two groups were tested  by Western Blot; Chondrocytes were cultivated in vitro and stimulated by metformin to observe the cell morphology, and amount. The cell activity was determined by MTT method .The cell activity of  AMPK, mTOR and autophagy were detected by Western Blot. Results (1)We succeeded in establishing the model of osteoarthritis in mice and found metformin could protect the osteoarthritis by Micro - CT, HE and sarranine O-fast green slice staining and Mankin ratings. (2) Western Blot results showed metformin activated AMPK and enhanced autophagy to protect osteoarthritis. (3) MTT method showed metformin inhibited Chondrocytes differentiation,and Western Blot results showed metformin promoted chondrocytes autophagy. Conclusions Metformin activates AMPK signaling pathways, inhibits mTOR signaling pathways, protecting chondrocyte autophagy,thus protects osteoarthritis in mice.

    Effect of the lateral pterygoid muscle on the anterior disc displacement with reduction of temporomandibular joint under different occlusal position
    YIN Xue-min, ZHANG Yan, LI Zi-wen, LIU Xiao, SONG Meng-yang, WANG Fang-yuan, LIU Xiao-hao
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  419-424.  doi:10.13418/j.issn.1001-165x.2017.04.013
    Abstract ( 743 )  
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    Objective To analyze the effect of lateral pterygoid muscle on anterior disc displacement with reduction of temporomandibular joint (TMJ) under different occlusal position. Methods Lateral pterygoid muscle was loaded under different occlusal position to simulate and biomechanically analyze the TMJ anterior disc displacement with reduction by using the established digital simulation model. Results Under the maximum jaw opening status, the disc region with the highest stress concentration occurred in the lateral part of the intermediate zone; the tendency of displacement  appeared between the intermediate zone and the posterior band to form a tearing region. Under the intercuspal position, the disc region with the highest stress concentration occurred in the posteroir band and there was not a tearing region between the intermediate zone and the poster band. Conclusions The results indicate that the function of the lateral pterygoid muscles can lead to the stress concentration on intermediate zone of the articular disc under the maximum jaw opening status, resulting in a tearing region in the articular disc.

    Establishment of acetabular anterior wall fracture model and comparison of biomechanical stability of different internal fixation methods
    XU Bo-wen, ZHANG Qing-song, AN Si-qi, PEI Bao-rui, LI Hao, DAI Shi-long, WU Xiao-bo
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  425-430.  doi:10.13418/j.issn.1001-165x.2017.04.014
    Abstract ( 625 )  
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    Objective To establish the acetabular anterior wall fracture model and compare the biomechanical stability of 4 kinds of internal fixation methods. Methods 20 fresh adult half pelvis specimens were selected to establish the acetabular anterior wall fracture model. The fracture models were randomly divided into 4 groups. Models in group A was fixed with a reconstruction plate along the upper margin of the pelvis, in group B was fixed with a reconstruction plate along the inner margin of the pelvis, and in  group C was fixed with an antegrade lag screw, and in group D was fixed with a retrograde lag screw. The axial compression experiments were performed to measure the horizontal displacement of the fracture end in each group, and the shear rigidity was calculated. The biomechanical stability of the 4 groups was compared. Results Under the same load, the horizontal displacement of the fracture end: group A >group B >group C>group D; the internal fixation shear rigidity: group D>group C>group B>group A. There was no significant difference between the 4 groups in the horizontal displacement and the shear rigidity of internal fixation when the load was 400 N (P>0.05). When the load was 800 N to 2000 N, there was no significant difference between group C and group D in the horizontal displacement and the shear rigidity of internal fixation (P>0.05), and there was significant difference between the other groups (P<0.05). Conclusions The acetabular anterior wall fracture model established in this study can be used for biomechanical analysis of acetabular anterior wall fracture. The stability of lag screw fixation was higher than that of reconstruction plate fixation, and the stability of antegrade lag screw fixation was similar to that of retrograde lag screw fixation.

    A novel double-endobutton device assisted shoulder arthroscopy in treating Neer type IIB distal clavicle fracture
    LIU Gang, ZHANG Lei, ZHANG Bao-lu, WANG Guo-you, ZHOU Xing, GUAN Tai-yuan, GUO Xiao-guang, FU Shi- jie
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  431-436.  doi:10.13418/j.issn.1001-165x.2017.04.015
    Abstract ( 433 )  
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    Objective   The aim of this study was to assess the effect of a novel double-endobutton device assisted arthroscopy in treating Neer type IIB distal clavicle fractures.   Methods   We retrospectively analysized 40 patients with Neer type IIB distal clavicle fractures .They were randomly divided into 2 groups: one was the novel double-endobutton group (A, 20 patients), the other hook plate group (B, 20 patients). The measurement of CMS, VAS scores and incision length, blood loss were employed to assess the outcome of two groups.    Result    (1) The specific values were as follows: incision length:(2.99±0.71) cm, (6.10±0.98) cm (P<0.05); the blood loss: (53.50±4.82) ml, (95.50±6.69) ml (P<0.05);  (2) For CMS part, the A group was significantly better than group B 1 month after surgery (P<0.05); compared with group B, the post-op 1 month and 1 year VAS Scores were significantly better (P<0.05), the preoperative and 6 months were with no statistical difference.   Conclusion   The novel double-endobutton device assisted arthroscopy in treating Neer type IIB distal clavicle fractures is a minimally invasive strategy with better clinical outcomes, which has lots of advantages including a short incision, less bleeding, lower cost, early functional exercise and without a second operation.

    Combined suture anchor with improved Kessler technique in repair of quadriceps tendon rupture     
    FENG Zhi, JIANG Liang-Bin
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  437-440.  doi:10.13418/j.issn.1001-165x.2017.04.016
    Abstract ( 783 )  
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    Objective The purpose of this study is to report results of combined suture anchor with improved Kessler technique in repair of quadriceps tendon rupture. Methods From May 2014 to June 2016, 21 patients with quadriceps tendon rupture were treated by combined suture anchor with improved Kessler technique. Of 21 cases, 17 were male and 4 were female, aged 16~68 years (mean, 33.3 years). The left side was involved in 15 cases and the right sidein 6 cases. The causes of injury included sport injury in 13 cases and collision damage in 9 cases. The time from injury to operation was 3 hours to 7 days (mean, 2.1days). Protection was advised within 6 weeks, and knee flexion exercise was initiated 6 weeks later. The angle of knee flexion was measured 6 months after operation and the efficacy evaluation had also been performed using Lysholm scores at the same time. Results All patients were followed up thoroughly, which found no loosening of prolapse in any of the patients.  There were no statistically significant differences in the angle of knee flexion between two groups (P>0.05).  There were statistically significant differences in the pretherapy group and post-treatment groups (P<0.05) and there were no statistically significant differences in Lysholm scores between two groups after operation (P>0.05). Conclusion Suture anchor repair of quadriceps tendon rupture in the end point is an effective way.

    The medial supra-malleolus perforator flap for the clinical treatment of diabetic foot ulcers
    YANG Ya-dong, ZHOU Juan, TANG Wen, ZHANG Fei, WEI Xiao-jun
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  441-444.  doi:10.13418/j.issn.1001-165x.2017.04.017
    Abstract ( 523 )  
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    Objective To explore the clinical application of the supra-malleolus perforator flap for repair of diabetic foot ulcers.Methods   From March 2012 to March 2015. There were 38 feet in 32 patients  developed diabetic foot ulcers with at least wagner II grade. The first medical treatment was to control blood glucose, then the supra-malleolus perforator flap was adopted to repair diabetic foot ulcers.Results  The flaps survived totally in 38 feet,and the distal partial necrosis and secondary free-skin grafting were further conducted in 2 cases. Thirty-two cases were followed-up for 2 to 18 months,the circulation,color and texture of the flaps were excellent.The appearance and function of ankle joints were good.Conclusion   The supra-malleolus perforator flap  has sufficient blood supply and a high survival rate;It is convenient in design,dissection and without sacrifice of major arteries. So,it is an effective method to repair diabetic foot  ulcers. This method is effective in improving the quality of life of patients.

    Repair of soft-tissue defects at the forefoot using the distal pedicled neurocutaneous island flaps at the medial aspect of the foot
    LI Chu-yan, LI Wen-qing, YAO Hai-bo, ZHU Xiao-di, CHEN Chuan-huang, WANG Wen-sheng, MAO Ren-qun
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  445-447.  doi:10.13418/j.issn.1001-165x.2017.04.018
    Abstract ( 493 )  
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    Objective  To evaluate the application of the distally  pedicled neurocutaneous island distal at the medial aspect of the foot for repair soft-tissue defects at the forefoot. Methods From January 2012 to September 2016, 10 cases of forefoot soft tissue defects were treated with the distal pedicled neurocutaneous island  flaps  at the medial aspect of the foot. Results Flaps in 9 case survived, and in one case partial necrosis developed. Additionally, after six months to one year follow-up, all of the ten cases were evaluated as satisfactory. For instance, the flaps had a good external appearance of color and texture without swelling and ulceration. Conclusion The study suggests that the method of the distal pedicled  neurocutaneous island  flaps at the medial aspect of the foot would be a potential tool for repair of soft-tissue defects at the forefoot, because it was reliable and the flaps had the characteristics of soft, good appearance and minimal donor-site damage.

    Clinical application of computer-assisted navigational template for Salter osteotomy
    WU Xian-kui, LI Pei, LI Xu, SHI Qiang, LIU Liang-hong, XIE Qing-xiang
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  448-452.  doi:10.13418/j.issn.1001-165x.2017.04.019
    Abstract ( 428 )  
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    Objective To develop and validate a navigational template for Salter osteotomy by digital technology. Methods Between April 2012 and June 2015, 21 children with unilateral developmental dislocation of the hip underwent Salter osteotomy. Preoperative CT scan pelvic images were obtained. Applying digital technology, Salter osteotomy were simulated and navigational templates for assisting in accurately cutting out a triangular bone graft from  ilium were  designed and manufactured. Then the navigational templates were use in the operations. The acetabular indexes(AI) of both hips were measured before and after surgery and at the latest follow-up. The efficacy wasevaluated according to Mckay clinical effects grading standard and Severin X rays grading standard. Results The AIs of both hips measured before and after surgery and at the last follow-up were analyzed with repeated measures analysis of variance. There is significant main effect in time(F=357.72, P=0.00) and in part (F=221.05, P=0.00). There is significant interaction effect between time and part(F=1984.82, P=0.00). There is significant difference between all the time levels(P=0.00).The Pearson correlation analysis indicates that the reduction of  AIs of the disordered hip joints is positively related to the angels of the navigational templates(r=0.91,P=0.00) or to the apex angles of the triangular bone grafts from  iliums(r=0.96,P=0.00). According to Severin X rays grading standard, 14 cases were excellent, 5 cases were good, and 2 cases were poor. The excellent and good rate was 90.48%. According to Mckay clinical effects grading standard, 13 cases were excellent, 7 cases were good, and 1 case was poor. The excellent and goodrate was  95.24%. Conclusion The computer-assisted navigational templates can assist in cutting out triangular bone grafts from  ilium more rapidly and more accurately in Salter osteotomy. It can improve the success rate and accuracy of the operations, and shorten the operation time.

     

    The anatomical features of cubital tunnel influence on the outcomes of in situ decompression treatment for cubital tunnel syndrome
    JIA Ke-feng
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  453-455.  doi:10.13418/j.issn.1001-165x.2017.04.020
    Abstract ( 554 )  
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    Objective To explore anatomic feature of cubital tunnel, and to provide reference for the decompression treatment of cubital tunnel syndrome. Methods We selected 81 patients with cubital tunnel syndrome, and divided these patients into two groups, in accordance with the feature of cubtial tunnel. Group A: It included the patients whose thickness of cubital tunnel retinaculum was ≥1.40 mm, or the cubital tunnel retinaculum was replaced by epitrochleo-anconeus. There were 39 cases in all. Group B: It included the patients whose thickness of cubital tunnel retinaculum was<1.40 mm, there were 42 cases. Two groups were treated by in situ decompression treatment. The patients were followed up for 12 months. We compared the efficacy rate of two groups. Results There was statistical significance of the effective rate of two groups (P<0.05). The effective rate of group A was 92.31%. The efficacy rate of group B was 76.19%. Conclusions For the patients whose cubital tunnel retinaculum was thicken or is replaced by epitrochleo-anconeus, the origin of cubital tunnel syndrome was that the ulnar nerve was compressed by the thickened cubital tunnel retinaculum or the epitrochleo-anconeus. Therefore, the result of in situ decompression treatment was better, however, for those with a thinner cubital tunnel retinaculum, the result of in situ decompression treatment is poor. For these cases, we consider that the cubital tunnel syndrome is caused by the excessive stretch of the ulnar nerve when the elbow full flexion rather than it being compressed.

    The preliminary study of modified anterolateral approach for total hip arthroplasty in supine position
    XIAO Zhi-qing, XU Zhou-fa, ZHU Jin-zhong, WANG Feng-long, WANG Ai-ming, CHEN Huan-wen, LIN Zi-hua, HUANG Shi-hai, DENG Zhi-sheng, LIU Yong
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  456-458.  doi:10.13418/j.issn.1001-165x.2017.04.021
    Abstract ( 435 )  
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     Objective  To analyze the effect and the key technical points of modified anterolateral approach for total hip arthroplasty in supine position.  Methods  During August 2013 to August 2016, 321 cases(170 males and 151 females) underwent the modified anterolateral approach for total hip  arthroplasty in supine position. The length of incision, intraoperative blood loss, operation time, postoperative ambulation time, claudication rate and trendelenburg positive rate 3 months postoperatively, and complications were recorded and Harris score was adopted for grading the function of the hip joint.  Results   The average length of incision was 8.4 cm (7.0~10.0) cm, the average amount of bleeding was 165 ml (110~300) ml, the average operation time was 40 min (30~50 min) , and the average postoperative ambulation time was 2.5 days (2~5 days). 3 months postoperatively the claudication rate and trendelenburg syndrome with positive rate were 3%, and nobody had dislocation and defective prosthesis position; the follow-up period with a range of 3 months to 3 years revealed that the average Harris score was 94.5 points.   Conclusion  The modified anterolateral approach for total hip arthroplasty in supine position was a good surgical option with merits such as small trauma and quick recovery, suggesting thai is worth for clinical promotion.

    Observation of the effect of induced membrane in the treatment of infective bone defects
    YIN Qu-dong, GU San-jun, SUN Zheng-zhong, WU Yong-wei, RUI Yong-jun, HU Hui-dong
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  459-462.  doi:10.13418/j.issn.1001-165x.2017.04.022
    Abstract ( 560 )  
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     Objective   To investigate the effect of induced membrane in the treatment of infective bone defects.   Methods   From January 2008 to December 2015, 38 patients with infective bone defects were treated with vancomycin bone cement packing and staged bone grafting. They were divided into encapsulation group with induced membrane(group A, 24 cases) and no-encapsulation group(group B, 14 cases).Bone healing, recurrence of infection and intervention of resurgery were recorded, grade of bone healing and adjacent joint functional recovery were evaluated according to Paley method, respectively.  Results   All patients were followed up for 12 to 51 months, with an average of 19.6 months. In group A, all healed by first intention, the clinical healing time was 3.0~7.0 months, with an average of 5.2 months; in group B, 1 case had bone nonunion, and the clinical healing time was 3.0~15.0 months, with an average of 6.64 months. 1 case with recurrence of infection was noted in group A whereas 3 cases were noted in group B. 3 cases required intervention of resurgery in group B whereas no case was noted in group A. The clinical healing time and intervention rate of resurgery were statistically different (P<0.05); a trend of higher recurrence rate in group B than in group A was noted although there was no significant difference between the two groups (P>0.05). At the last follow-up, there was no significant difference between the two groups in the grade of bone defect healing and the functional recovery of the adjacent joint (P>0.05).   Conclusion   The integrity of the induced membrane is related to bone healing, and the induced membrane formed after packing of antibiotic bone cement has a protective effect on the recurrence of infection.

    Treatment of postoperative bulky flap with stripping and lipsuction technique
    SONG Xiao-jun, WEI Xu-ming, NIU Yao-shen
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  463-465.  doi:10.13418/j.issn.1001-165x.2017.04.023
    Abstract ( 606 )  
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    Objective To report the treatment of postoperative bulky flap with fat stripping,lipsuction,and little incision technique in one operation. Methods The study involved 112 patients with bulky flap by fat stripping, lipsuction, and small incision technique to remove all the fat and fascia on one effort from July 2002 to May 2013. Results 111 patients achieved sufficient blood supply in flaps. The flaps had excellent contour and sensation with early function recovery. Only 1 flap sustained necrosis in surface. No patient got recurrence during 1~10 years of follow-up. Conclusions It has excellent clinical effect of treating bulky flap with fat stripping,lipsuction,and small incision technique. It also has the merits of easy operation,high security and thus is a surgeric method worthy of clinical use.

    Effects of ankle isokinetic muscle strength training on the balance function of elderly patients with stroke
    XU Wei-cheng, ZHANG Ming-sheng, BAI Wen-fang, WU Bo, ZHANG Lei
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  466-468.  doi:10.13418/j.issn.1001-165x.2017.04.024
    Abstract ( 458 )  
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    Objective To discuss the effects of ankle isokinetic muscle strength training on the balance function of elderly patients with stroke. Methods 40 elderly patients with stroke were randomized into control group (n=20), the treatmentgroup (n=20). The control group received routine rehabilitation treatment. On the basis of the control group, the treatment group added the isokinetictraining on ankle dorsiflexion and plantarflexion muscle groups. Before the treatment, two groups were measured with the balance function related indicators, including Berg balance scale (BBS), Timed up and go test (TUGT) and the parameter from the Prokin balance instrument, such as Y-COP Standard Deviation, Sway length, Sway area, Peak torque measurement on ankle dorsiflexion and plantarflexion muscle group. Three weeks after training the same indicators were measured again. Results After balance training, the balance function of two groups improved significantly (P<0.05). Compared with control group, all indicators in muscle strength group were better(P<0.05). Conclusions Ankle joint isokinetic muscle strength training can significantly improve the balance function and themuscle strength of elderly patients with stroke.

    Micro perfusion and quantitative analysis of the in vitro femoral head intraosseous artery
    QIU Xing, CHENG Liang-liang, WANG Ben-jie, YANG Lei, ZHAO De-wei
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  469-472.  doi:10.13418/j.issn.1001-165x.2017.04.025
    Abstract ( 593 )  
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    Objective To investigate the feasibility of pig femoral head micro perfusion and quantitative analysis of the intraosseous artery. Methods 12 pig femoral head specimens were perfused using contrast agent of gelatin barium sulfate suspension under surgical microscope. After micro CT scanning,the intraosseous artery three-dimensional digital model was reconstructed.  Results Micro perfusion and quantitative analysis of the pig in vitro femoral head intraosseous artery is possible. The reconstructed model is accurate, high resolution, which also contains artery structure, bone mass, and  bone structure.  Conclusion Micro perfusion of femoral head and quantitative analysis of the in vitro pig femoral head intraosseous artery provide a research technique to study the intraosseous artery morphology for study of femoral head avascular necrosis.

    Progress of clinical application of hepatic portal vein anatomy
    ZHANG Hui, ZHANG Shuo, FAN Xia, ZHOU Ting-yong
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  473-474.  doi:10.13418/j.issn.1001-165x.2017.04.026
    Abstract ( 397 )  
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    Research progress in the relationship between microglia and spinal cord injury
    MENG Ke, PU Yu-jie, ZHANG Xiao-ming
    Chinese Journal Of Clinical Anatomy. 2017, 35(4):  478-479.  doi:10.13418/j.issn.1001-165x.2017.04.028
    Abstract ( 603 )  
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