Table of Content

25 September 2019 Volume 37 Issue 5

  

Anatomical study of resecting ventral brainstem tumors through endoscopic endonasal transclival approach

WU Ping-hua, ZENG Hui-kun, MO Li-gen, ZHONG Shi-zhen, OUYANG Jun

Chinese Journal of Clinical Anatomy. 2019, 37(5):  485-490.  doi:10.13418/j.issn.1001-165x.2019.05.001

Abstract ( 713 )  

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Objective　To explore the anatomical feasibility of resecting ventral brainstem tumors using endoscopic endonasal approach.　Methods　Five formalin-fixed adult human cadaveric heads were dissected by endoscopic endonasal transclival approach to assess the exposed bone window, and observe the adjacent neurovascular structures.  Results  The mesencephalon, pons and medulla oblongata could be exposed in all specimens, but it was necessary to displace the pituitary gland to expose the mesencephalon completely. The lateral exposed margins were the cavernous carotid arteries and the inferior petrosal sinuses. The medulla oblongata and the superior cervical spinal could be exposed by resection of part of the anterior C-1 arch and the odontoid process. The exposed major neurovascular structures included the basilar artery and its branches, the vertebral artery and its branches, cranial nerves III - XII, and the first and second cervical nerves.　Conclusions　The whole ventral brainstem and the corresponding neurovascular structures can be exposed by endoscopic endonasal transclival approach. It is feasible to resect ventral brainstem tumors using such approach.

Anatomical study of the dorsal medial arterial network of foot and its clinical significance

YAO Hai-bo, LI Wen-qing, ZHU Xiao-di, LI Chu-yan, ZHANG Guo-lei

Chinese Journal of Clinical Anatomy. 2019, 37(5):  491-493.  doi: 10.13418/j.issn.1001-165x.2019.05.002

Abstract ( 379 )  

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Objective　To understand the blood supply foundation in the dorsal medial artery network of foot, and provide anatomical basis for the rational design of the dorsal medial flap of foot.　Methods　The origin, course, branch and anastomosis of the blood supply of the dorsal medial artery network of foot were observed by dissecting 20 adult cadaveric foot specimens perfused with red latex.　Results　There were four main sources of blood supply in the dorsal medial artery network of foot, including the cutaneous branches from medial anterior malleolus artery in the medial dorsal foot, the cutaneous branches from the medial tarsal artery in the medial dorsal foot, the cutaneous branches came from the superficial branches and deep branches of the medial plantar artery that were distributed in the medial aspect of the dorsum of foot, and the cutaneous branches from the great toe tibial arteries that were distributed on the edge of the abductor hallucis muscle.  Conclusion　According to the anatomical characteristics of the medial dorsal artery network, two types of pedicled flaps can be designed: medial cutaneous neurocutaneous vascular flap of foot and medial fasciocutaneous flap based on the cutaneous vascular chain.

The design and drilling accuracy evaluation of personalized guide device in coracoclavicular ligament reconstruction

LI Wen-rui, DU Bing-ran, LI Jian-yi, FAN Tian-cheng, LI Lu-tao

Chinese Journal of Clinical Anatomy. 2019, 37(5):  494-497.  doi:10.13418/j.issn.1001-165x.2019.05.003

Abstract ( 540 )  

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Objective　To design a personalized guide device for coracoclavicular ligament reconstruction and to evaluate its drilling accuracy and efficiency.　Methods　A personalized guide device for coracoclavicular ligament reconstruction was designed by using computer-aided design software and 3D printing. Ninety human shoulder specimens were obtained and randomly assigned into free-hand, C-ring and personalized groups for transclavicular-transcoracoid drilling with minimally invasive incisions. The surgical duration, the tunnel location zones and distances from the tunnel edge to the coracoid’s medial and lateral edges were measured.　Results　The surgical duration in the freehand group, the C-ring group and the personalized group were (203±33) s, (267±62) s, and (155±14) s, respectively. There were 13, 28 and 30 coracoid tunnels of the three groups located in the ideal middle zone, respectively. The absolute differences between distances from the tunnel edge to the coracoid’s medial and lateral edges in the three groups were (3.7±2.0) mm, (2.0±0.9) mm, and (0.9±0.5) mm, respectively. The differences were all statistically significant. Conclusion　The personalized guide device achieved higher drilling accuracy and efficiency, which is a new choice for transclavicular-transcoracoid drilling in coracoclavicular ligament reconstruction with minimally invasive incisions. 

Three-dimensional anatomical characteristics of airway and mandible and anesthetic intubation in patients with obstructive sleep apnea hypopnea syndrome

JI Xue-xia, QIU Qian-qi, ZHOU Guo-bin, MA Jue, JI Wen-jin, WANG Zhi-peng, WANG Sheng

Chinese Journal of Clinical Anatomy. 2019, 37(5):  498-502.  doi:10.13418/j.issn.1001-165x.2019.05.004

Abstract ( 603 )  

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Objective　To evaluate the three-dimensional anatomical characteristics of airway and mandible, the methods and times of anesthesia intubation in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).   Methods　30 patients with normal airway and 30 patients with OSAHS airway who underwent general anesthesia in our hospital and had been scanned by head and neck spiral CT from March 2016 to March 2019 were collected. Dolphin software was used to reconstruct and analyze the airway of the patients. The three-dimensional reconstruction and measurement of the mandible were performed. At the same time, the methods and times of anesthesia intubation were recorded.    Results   The airway volume, sagittal minimum cross section area, horizontal minimum cross section area and coronal minimum cross section area in OSAHS patients were significantly lower than those in normal patients (P<0.05). The mandibular distance of OSAHS patients was lower than that of normal patients, and the difference was statistically significant (P<0.05), whereas the angle of mandible was not significantly different from that of normal patients (P>0.05). The methods and times of anesthesia intubation in OSAHS patients were significantly different from those in normal patients (P<0.05).   Conclusion　There are significant differences in three-dimensional anatomical characteristics of airway and mandible in patients with OSAHS. The anatomical characteristics of airway and mandible can be used as a reference for airway evaluation and endotracheal intubation before general anesthesia.

Study on the positional relationship between the arcuate eminence and superior semicircular canal by the thin-slice CT scanning

LI Meng-xing, CHENG Kai-liang, GUO Ying, LI You-qiong

Chinese Journal of Clinical Anatomy. 2019, 37(5):  503-507.  doi:10.13418/j.issn.1001-165x.2019.05.005

Abstract ( 859 )  

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Objective　 To explore how to locate the internal auditory canal through the middle cranial fossa approach, focus on the identification of the arcuate eminence and the relationship between the arcuate eminence and the superior semicircular canal in Fisch’s method.　Methods　Sixty subjects aged 18~57 years without space occupying lesions in the petrous part of the temporal bone were selected for bilateral measurement (totaling 120 sides). Among them, half were male and half female. The temporal bone was scanned by CT and the three-dimensional coordinate system was established to measure the three-dimensional coordinate values of the arcuate eminence and the superior semicircular canal.　Results　The shape of the arcuate eminence was uncertain: about 15% of the samples had no obvious arcuate eminence structure, which led to the inability to locate it. The arcuate eminence did not correspond strictly to the superior semicircular canal. About 83% of the samples had the arcuate eminence located in the posterolateral part of the superior semicircular canal.　Conclusion　In internal auditory meatus surgery by Fisch's method, there are some difficulties in identification of the arcuate eminence. Most of the superior semicircular canals are not always below the arcuate eminence, but located posterolaterally to the arcuate eminence.

The morphological classification and clinical significance of the angulus superior scapulae based on CT three-dimensional reconstruction

ZHAO Hong-jin, GUO Xiao-guang, QIN Bo, WANG Guo-you, FU Shi-jie, ZHANG Lei

Chinese Journal of Clinical Anatomy. 2019, 37(5):  508-511.  doi:10.13418/j.issn.1001-165x.2019.05.006

Abstract ( 832 )  

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Objective　To explore the morphological classification and the clinical significance of the angulus superior scapulae based on CT three-dimensional reconstruction.　Methods　The CT three-dimensional reconstruction of scapular was classified according to the morphological characteristics. Reference points: A, the angulus superior scapulae; B, the lowest point of the scapular notch; C, the intersection between the scapula and the inner margin of the scapula; D, the vertical point of the point A on the line CE; E, the spinoglenoid notch; F, the lowest point of the subscapular angle. Parameters studied: the thickness of point A; the distance of AB, AC and AD; the angle of ∠A (the angle between the straight line AB and the straight line AC); the angle of ∠ACF in sagittal plane; the angle of ∠ACF in coronal plane.　Results　Under the CT three-dimensional reconstruction, the superior scapulae was classified into three types: Hilly type 48%, ∠A =(93.76±7.69)°; Mountain peak type 47%, ∠A=(86.69±6.23)°; and Chimney type 5%, ∠A =(85.33±7.10)°. Among them,the thickness of point A of Hill type and Chimney type was thinner than Mountain peak type (P<0.05). For the distance of AB, AC, AD and the angle of ∠A, ∠ACF (Coronal plane), there were statistical differences between Hill type and Mountain peak type (P<0.05). For the distance of AD and the angle of ∠A, there were statistical differences between Hill type and Chimney type (P<0.05).　Conclusion　Under the CT three-dimensional reconstruction, the superior scapulae is classified into three types: Hilly type, Mountain peak type and Chimney type. Different types of superior scapulae may have a potential effect in neck pain and the levator muscle syndrome.

Diffusion tensor imaging observation and clinical application of the lumbar intervertebral disc

LI Pei, HOU Xin-xin, XU Xin-chao, FU Sheng-qi

Chinese Journal of Clinical Anatomy. 2019, 37(5):  512-516.  doi:10.13418/j.issn.1001-165x.2019.05.007

Abstract ( 641 )  

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Objective　 To provide imaging basis for clinical diagnosis of the waist and leg pain caused by the lumbar intervertebral disc degeneration.　Methods　There were 200 persons with normal lumbar spine and 100 cases with lumbar intervertebral disc degeneration selected and scanned by diffusion tensor imaging (DTI). The region of interest of the lumbar intervertebral disc and the lumbar intervertebral disc degeneration was selected at workstation, and the apparent diffusion coefficient (ADC) value and the fractional anisotropy (FA) value of the region of interest were measured. The FA value and ADC value of lumbar intervertebral disc in different anatomic sites, age groups and different Pfirrmann grades of the lumbar intervertebral disc degeneration were compared.　Results　The FA value and ADC value of lumbar intervertebral discs in different anatomic sites had significant difference (P<0.05). The FA values of L1~2, L2~3 and L3~4 intervertebral discs were gradually decreased, and the FA values of L4~5 and L5~S1 intervertebral discs were gradually increased. The ADC values of L1~2, L2~3 and L3~4 intervertebral discs were gradually increased, and the ADC values of L3~4、L4~5、L5~S1  intervertebral discs were not changed significantly. There was no statistical difference in FA values among different age groups (P>0.05). There was statistical differences in ADC values (P<0.05), and the ADC values were gradually decreased with the ages. There were statistical differences in FA values and ADC values in the different Pfirrmann grades of lumbar intervertebral disc degeneration, and with the Pfirrmann gradation increasing, the FA values were gradually increased, and the ADC values were gradually decreased.    Conclusions    The ADC value of the lumbar intervertebral disc can be influenced by the different anatomic sites and age. The FA value and ADC value of DTI can quantitatively evaluate the degree of lumbar intervertebral disc degeneration, and provide imaging basis for clinical diagnosis of early lumbar intervertebral disc degeneration.

Effects of Puerarin on the expression of iNOS, CGRP, and PI3K/Akt signaling pathway in spinal cord anterior horn after brachial plexus root avulsion injury

WANG Yu, CHEN Chuan-qi, WANG Wen-sheng, YU Bao-jun, ZHANG Yi, LI Dan, CHEN Long-ju

Chinese Journal of Clinical Anatomy. 2019, 37(5):  517-522.  doi:10.13418/j.issn.1001-165x.2019.05.008

Abstract ( 392 )  

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Objective　To investigate the effect of Puerarin on the expression of iNOS, CGRP and PI3K/Akt signaling pathway in spinal anterior horn following brachial plexus root avulsion injury (BPRAI).  Methods　Fifty SD rats were randomly divided into a normal group, a model group, a low-dose group, a middle-dose group and a high-dose group with 10 rats in each group. BPRAI modeling was made in the model group, low-dose group, middle-dose group and high-dose group by avulsing the anterior roots and transecting posterior roots of right C5~7 segment of spinal nerve. Puerarin was injected intraperitoneally in the low-dose group, middle-dose group and high-dose group after the operation at doses of 50, 100 and 200 mg·kg-1·d-1 respectively. The normal group and model group were given intraperitoneal injection of saline of equal volume for 4 weeks. Nissl staining, immunofluorescence and Western blot were used to observe the survival rate, the expression of iNOS and CGRP of alpha motorneurons (α-MNs), and PI3K/Akt pathway related proteins in the spinal cord on the injured side.    Results    At the 4th week, low, middle and high doses of Puerarin could inhibit the loss of α-MNs (P<0.05 or P<0.01); middle and high doses of Puerarin could inhibit the expression of iNOS (P<0.05); high doses of Puerarin could significantly promote the expression of CGRP protein (P<0.05 or P<0.01); low, middle and high doses of Puerarin could significantly inhibit the expression of p-Akt1/2/3 (P<0.01).  Conclusions    Puerarin can ameliorate the death of alpha-MNs induced by BPRAI. The protective effect of Puerarin may be related to its inhibition of iNOS expression and promotion of CGRP expression, and PI3K/Akt signaling pathway is involved in its regulation.

Endogenous estrogen regulates the expression of myocardial L-type calcium channel α1C subunit (CACNA1C) in septic mice

FENG Ying , LIU Bo-yi, FANG Zhi-cheng, CHEN Li, CHEN Wei, ZHENG Xiang

Chinese Journal of Clinical Anatomy. 2019, 37(5):  523-527.  doi:10.13418/j.issn.1001-165x.2019.05.009

Abstract ( 412 )  

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Objective　To investigate the effect of endogenous estrogen on myocardial L-type calcium channel α1C subunit (CACNA1C) in septic mice.　Methods　Female Kunming mice underwent bilateral ovarian ablation, a model of sepsis was established by cecal ligation puncture (CLP) 30 days after surgery. The experimental mice were divided into 5 groups: sepsis group (S group), ovariectomy+sepsis group (QS group), sham group (C group), ovariectomy+sham group (QC group), ovariectomy+estradiol benzoate (QE group). The expression levels of left ventricular CACNA1C were detected by real-time PCR and Western blot at 3 h, 6 h, 12 h, and 24 h after CLP. The expression and distribution of CACNA1C was detected by immunohistochemistry 3 h after CLP.　Results　The expression of CACNA1C in QC group was significantly higher than that in the C group, while the expression level of CACNA1C in the QE group was significantly lower than that in the QC group. At 3 h after CLP, the expression of CACNA1C in the S group was significantly higher than that in the control and other time points. At 3 h, 6 h, 12 h and 24 h after CLP, the expression of CACNA1C in the QS group was significantly lower than that in the control group, and there was no significant difference among the four time points.　Conclusion  The expression of CACNA1C is significantly increased after bilateral ovarian ablation. Replenishment of estradiol benzoate after lateral ovarian ablation can reverse the increase of CACNA1C. The expression of CACNA1C is transiently increased at 3 h after CLP in normal mice, while the expression of CACNA1C at each time point after CLP in bilateral ovarian-extracted mice is significantly lower than that in the control group.

Investigating the effects of different concentrations of estradiol on senescence model of human umbilical vein endothelial cells induced by hydrogen peroxide

LIN Jie-qi, RUAN Yun-jun, YANG Ru-yu, WANG Yu-yan, SU Shuang, WU Sai-zhu

Chinese Journal of Clinical Anatomy. 2019, 37(5):  528-533.  doi: 10.13418/j.issn.1001-165x.2019.05.010

Abstract ( 200 )  

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Objective　To investigate the effects of different concentrations of estradiol on senescence model of human umbilical vein endothelial cells (HUVECs) induced by proper concentrations of hydrogen peroxide.　Methods　HUVECs were cultured and the senescence model was successful constructed induced by hydrogen peroxide, then the cultured cells were divided into the following five groups: a normal control, a senescence cells group, a low concentration 17β-E2 group, a physiological concentration 17β-E2 group and a high concentration 17β-E2 group. As results, we performed CCK-8 to detect cell viability, Western blot was conducted to evaluate the expression of the senescence related marker protein (p-Rb and Rb) and autophagocytosis related marker protein (P62 and LC3B), and the β-galactosidase staining also was tested to count the positive cells.　Results　As compared to the normal control, the senescence cells group had a higher protein expression value of p-Rb/Rb, decreased cells viability and more positive cells showed on β-galactosidase staining. On the contrary, in the physiological and high concentration groups, they not only had a lower protein expression value of p-Rb/Rb, increased cells viability, lesser positive cells showed on β-galactosidase staining than the senescence cells group but also had a decreased P62 protein expression and  increased expression of LC3-Ⅱ/LC3-I protein which was closely related to autophagocytosis.　Conclusion  17β-E2 with concentration-dependent efficacy can inhibit HUVECs senescence induced by a proper concentrations of hydrogen peroxide through up-regulation of autophagocytosis.

Overexpression of miR-128-3p inhibits cell invasion, migration and epithelial-mesenchymal transition by targeting MAPK1 in bladder cancer cell line 5637

ZHAO Yang, WAN Yin-xu, CHE Ji-zhong, XU Yan-kai, LI Qing-yuan

Chinese Journal of Clinical Anatomy. 2019, 37(5):  534-541.  doi:10.13418/j.issn.1001-165x.2019.05.011

Abstract ( 499 )  

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Objective　To investigate the effects of miR-128-3p overexpression on invasion, migration and epithelial-mesenchymal transition of bladder cancer 5637 cells.　Methods　The target gene of miR-128-3p was screened by the gene prediction software TargetScan. And the luciferase reporter assay was verified. The expression of miR-128-3p and MAPK1 was detected by RT-PCR. Cell invasion was detected by Transwell. Cell migration ability was measured by a scratch test. The expressions of E-cadherin, N-cadherin, ERK1/2, c-Myc and c-fos were detected by Western blot, and the expression of Vimentin was detected by immunofluorescence. The xenograft model was established by subcutaneous injection in nude mice. The tumor weight was measured 30 days later. And the survival curve was drawn. The amount of Vimentin, miR-128-3p, MAPK1, ERK1/2, c-Myc and c-fos in the transplanted tumor was detected.　Results　miR-128-3p had been targeted to inhibit the expression of MAPK1. After overexpression of miR-128-3p, the number of invasive cells and wound healing rate was decreased. E-cadherin expression was up-regulated. N-cadherin expression was down-regulated. Vimentin positive was decreased. The expression of ERK1/2, c-Myc and c-fos was down-regulated. Through the intervention of miR-128-3p, the weight of transplanted tumors was decreased. The survival rate of nude mice was increased. The expression of miR-128-3p was up-regulated. The expression of MAPK1 was down-regulated. The expression of Vimentin was decreased. And the expression of ERK1/2, c-Myc and c-fos was decreased.　Conclusion　Overexpression of miR-128-3p inhibits the invasion, migration, epithelial-mesenchymal transition and ERK1/2, c-Myc and c-fos pathways of bladder cancer cell line 5637 by targeting inhibition of MAPK1 expression.

Studies on the protection and effect of erythropoietin on lung damage after rat intestinal ischemia reperfusion 

XIAO Li, CHEN Xiao-qin, SHI Qing-ming, WANG Jing , NIE Zheng, LI Jian

Chinese Journal of Clinical Anatomy. 2019, 37(5):  542-546.  doi: 10.13418/j.issn.1001-165x.2019.05.012

Abstract ( 174 )  

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Objective　To investigate the protective effects of erythropoietin (EPO) on lung injury after rat intestinal ischemia reperfusion.    Methods    Thirty male SD rats were divided into 5 random groups (n=6 each): an intestinal ischemia reperfusion group (IIR group), a 1000 U/kg EPO treated (low dosage EPO group), a 3000 u/kg EPO treated (middle dose-EPO group), a 5000 U/kg EPO treated (high dose-EPO group) and a sham-operation group (S group). The intestinal ischemia reperfusion model were established by clamping superior mesenteric artery for 1 hour and reperfusion for half an hour. The three treated groups were administrated with intraperitoneal injection of 1000 U/kg, 3000 U/kg and 5000 U/kg EPO 1 hour before reperfusion. Lung tissues was observed by HE staining. The protein levels of MMP-9 and Caspase-1 in the liver tissues were detected by immunohistochemical staining and Western blot.    Results    (1) In the IIR group, lung injury was induced by IIR, characterized as histological damage of edema, hemorrhage and neutrophil infilitration, which could be alleviated by EPO. (2)The immunohistochemistry and Western blot results showed that compared with the Sham group, the expression of active MMP-9 and Caspase-1 in the IIR group was increased; after EPO intervention, the MMP-9 and Caspase-1 was decreased. Compared with the L and H groups, the expression of MMP-9 and Caspase-1 in the M group was lower than that of the L and H group (P<0.05).   Conclusion　EPO has the protective mechanism on lung damage after rat intestinal ischemia reperfusion. The protective mechanism of EPO may be related to the inhibition of MMP-9 and Caspase-1 which mediated over-inflammation.

Preliminary study on the construction of primate model combined with disease of endometriosis and syndyome

LI Shu-ting, ZONG Li-li, HE Wei-feng, GAO Jie, RAO Jun-hua, LI Bi-hai, LIU Yi-yan, LIU Yu-jie, FENG Qian, WANG Ting-wei, LIU Ling-zi, WU Ting-feng, WANG Bi-yun, NIE Wei-zhe

Chinese Journal of Clinical Anatomy. 2019, 37(5):  547-552.  doi:10.13418/j.issn.1001-165x.2019.05.013

Abstract ( 396 )  

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Objective　To explore the method of constructing the primate model combined with disease of endometriosis and syndrome.　Methods　(1) Six female cynomolgus monkeys were randomly divided into a modeling group (n=5) and a control group (n=1). The modeling group was treated with transabdomal cervical cerclage while the control group was only observed through an open surgery. (2) The blood perfusion of the tongue was measured by PeriCam PSI perfusion speckle imager before the first modeling operation, at the modeling month and after the first, second and third months of modeling. (3) Laparoscopic exploration was performed three months after  the operation. Since no endometriosis lesions were found in the pelvis of the monkey, we changed the modeling method: the monkeys were re-assigned into the modeling group (n=4) and the control group(n=2). In the modeling group, the endometrial tissue fragments were collected during the menstrual period and intraperitoneal injection, and immunosuppressive agents were administered for three months.　Results:　(1) In the laparoscopy after three months of cervical cerclage, no endometriosis lesion was seen in the two groups. (2) The blood perfusion in the monkeys was significantly higher in the modeling group than that in the control group at 2 months after the operation (P<0.05).(3) The trend of blood perfusion  in the surface and base of the tongue of each monkey was consistent.(4) Three months after the intraperitoneal injection with the immunosuppressive agents, the modeling group had severe pelvic adhesions, vascular hyperplasia and hyperemia on the serosa of the uterine under the laparoscopy. The endometriosis lesions were found in one of the modeling monkeys.  Conclusion  The endometrial pelvic injection with the administration of the immunosuppressive agents is a feasible approach for constructing primate endometriosis models. The method of measuring the blood perfusion of the tongue of the cynomolgus monkey using PSI is easy and stable, and it may become a quantitative evaluation method for the tongue image of the disease syndrome combination model.

Finite element analysis of three internal fixation methods for scaphoid waist fracture

ZHANG Xu-lin, XU Yong-qing, HE Xiao-qing, MAO Yu-chi, YANG Ling-jian, YUAN Li-bo

Chinese Journal of Clinical Anatomy. 2019, 37(5):  553-558.  doi:10.13418/j.issn.1001-165x.2019.05.014

Abstract ( 582 )  

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Objective　To compare the biomechanical differences among three internal fixation methods by establishing a three-dimensional model of scaphoid waist fracture, so as to provide a method of selection of clinical internal fixation.　Methods　The wrist CT data of a healthy volunteer were selected. The application software was used to establish three internal fixation models of scaphoid waist fracture: a Kirschner wire fixation group, a Herbert screw fixation group, and a nail-feet-fixation device group. Load was applied to the neutral grip position and radial deviation-extension, and the deformation of the scaphoid, and the stress of the internal fixation device were analyzed.　Results　Among three internal fixation devices, the largest deformation of the scaphoid was under the action of the Kirschner wire, and the smallest was under the action of the nail holder. Under the two working conditions, the deformation of the scaphoid and the maximum stress of the fixture was different, but the trend was the same. Under the nail holder, both the scaphoid deformation and the maximum stress were the smallest. But the nail holder had an eccentric effect. When the load reached a critical value, the scaphoid healing surface was easily cracked or asymmetrically eccentric.　Conclusion　Kirschner wire fixation and nail-feet fixation is the worst and best in effect, respectively. The weight of the hand should be properly restricted after nail-feet fixation.

Effect of treatment of femoral neck fracture nonunion by percutaneous compression plate combined with ascending branch of lateral femoral circumflex artery iliac flap in young adults

LIU Xue-guang, SUN Zhen-zhong, SONG Sheng, ZHUANG Yin, DU Shi-hao, HAN Xiao-fei

Chinese Journal of Clinical Anatomy. 2019, 37(5):  559-562.  doi:10.13418/j.issn.1001-165x.2019.05.015

Abstract ( 532 )  

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Objective　To investigate the effect of percutaneous compression plate(PCCP) combined with ascending branch of lateral femoral circumflex artery iliac flap in treatment on nonunion cases of femoral neck fractures in young adults.　Methods　From June 2013 to March 2016，8 young adults patients with nonunion cases of femoral neck fracture were treated by PCCP combined with ascending branch of lateral femoral circumflex artery iliac flap. Among the 8 patients, 7 were male and 1 was female, whose age ranged  from 19 to 42 yrs, with an average 26.5 yrs. For the fracture type, 1 case was Garden Ⅱ, 4 cases were Garden Ⅲ, 3 cases were Garden Ⅳ. Duration from first operation to the second was 7~15 months, averaging 9.2 months.　Results　All patients were followed up for 9 to 42 months, with a mean of 22.3 months. All fractures were healed, and the healing time was 3-9 months(4.6 months on average)．During the follow-up, the hips of 8 cases got good function, and the average Harris score was 91.7．Based on Matta evaluation,  7 cases were excellent in function，1 case was good ,the good rate being 100%.　Conclusion　PCCP covered by the iliac bone flap pedicled with the ascending branch is one of effective ways of treating nonunion cases of femoral neck fractures in young adults. It has advantages of lowing risk of complications, rigid fixation and early weight bearing．

Minimally invasive surgery for pyriform sinus fistula based on anatomical analysis

YU Jing, LV Lin-ya, ZHANG Jun, WANG Shan, YANG Chao, LI Chang-chun, KONG Xiang-ru, PENG Liang

Chinese Journal of Clinical Anatomy. 2019, 37(5):  563-567.  doi:10.13418/j.issn.1001-165x.2019.05.016

Abstract ( 680 )  

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Objective　To investigate the anatomical characteristics of congenital piriform sinus fistula (PSF) in children, and design a minimally invasive surgical method.    Method   From July 2012 to July 2018, 54 cases of PSF were divided into two groups. In the traditional group the thyroid or external fistula plane approach was adopted in 34 patients, while in modified group the inferior horn of thyroid cartilage approach was adopted in 20 patients. The anatomical characteristics about PSF were then studied. The following data were compared and analyzed between the two groups: the incision length, surgical duration, intraoperative blood loss,  hospitalization length, the rate of radical operation, complication and postoperative recurrence.　Results　Fistula was divided into infundibular and transitional parts. Infundibular was located behind or on the side of the posteroinferior cornu. Fistula had three types. Type I had terminal at the upper pole of the thyroid, Type II had terminal reaching the skin via the thyroid, and Type III had terminal reaching the skin directly. The incision length, surgical duration, intraoperative bleeding, hospitalization length and recurrence rate in the modified group were lower than those in the traditional group (P<0.01). After following-up of 6~18 months, the recurrence rate was 29.4% in the traditional group, but no recurrence was found in the modified group.  Conclusion　Piriform fossa fistulectomy is performed through posteroinferior cornu with advantages such as short operation path, quick recovery, and low recurrence rate. It is a better choice in management of PSF owing to its safety and effectiveness. 

Development and application of hollow melleable surgical lead wire in the treatment of intertrochanteric fractures

ZHANG Yuan-hua, CHEN Wei-jian, WANG Xiao-fei, CHEN Zhi-gang, WU Deng-jiang

Chinese Journal of Clinical Anatomy. 2019, 37(5):  568-572.  doi:10.13418/j.issn.1001-165x.2019.05.017

Abstract ( 418 )  

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Objective　 To investigate the development and application values of  hollow malleable lead wire in the treatment of intertrochanteric fractures. 　Methods　From August 2016 to May 2018, 84 patients with intertrochanteric fractures treated surgically in our hospital were enrolled and divided equally into a study group and a control group  according to the method of random number table. In the control group, the fractured block was fixed with a traditional thread during surgery, while in the study group the fractured block was fixed by the self-made hollow malleable lead wire. The intraoperative and postoperative related indicators of the two groups were recorded and compared.　Results　There were no statistical difference in the length of surgical incisions, surgical duration, volume of intraoperative blood loss, times of X-ray exposure and volume postoperative drainage between the two groups (P>0.05). The postoperative hospitalization length was shorter, and the time for fracture union and total weight-bearing was earlier in the study group than in the control group( P＜0.05). Excellent and good rate of hip function 6 months after surgery was higher in the study group (97.6%) than in the control group (78.6%)(P<0.05). Incidences of complication including lower extremity venous thrombosis, pulmonary infection, hip varus, incision infection, and loosening of the fixation was 4.8% 6 months after surgery, lower than 6.2% in the observation group (P<0.05).　Conclusion　The development and application of hollow malleable surgical lead wire in the treatment of intertrochanteric fractures can promote the rehabilitation of patients, improve hip function and reduce postoperative complications.

Clinical and pathological features of malignant peripheral nerve sheath tumors

CHEN Zai-li, HE Yu-cheng, HUANG Li-jin, ZHANG Guan-hua, XIA Hai-jun, LIU Tie-jian

Chinese Journal of Clinical Anatomy. 2019, 37(5):  573-577.  doi:10.13418/j.issn.1001-165x.2019.05.018

Abstract ( 933 )  

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Objective　To investigate the clinical and pathological features of malignant peripheral nerve sheath tumors (MPNST)，and increase the understanding of the diseases.　Methods　The clinical data of 22 cases of MPNST hospitalized in our hospital were collected. The pathological features and immunohistochemical phenotypes were observed by light microscopy and immunohistochemistry, and related literature review was carried out.　Results　Of the 22 MPNST patients, 10 were male and 12 female, whose age ranged between 15~82 years old, with a median age of 43 years. There were 3 cases located in the head and neck, 13 cases in trunk and proximal extremities, 5 cases in distal extremities, and 1 case with multiple locations over the body. The clinical manifestations were mainly local painless mass lumps. And the symptoms and signs were related to the location of the mass and the speed of progression. In the treatment, 19 patients underwent tumor resection, among which 6 were recommended for follow-up radiotherapy and 13 underwent chemotherapy (mainly with doxorubicin and ifosfamide). For immunohistochemistry, Vimentin (15/15), CD99 (8/8), IMP3 (10/11), S-100 protein (16/19) positive, and Ki-67 proliferation index ranged between 5%~80%. The 1-year case fatality rate was 45%, and the median survival time was 25 months. Local recurrence rate was 55% (12 cases), and distance metastasis rate was 32% (7 cases). Three cases got tumor free survival to date.　Conclusion　MPNSTs have special clinical and pathological characteristics. However, the clinical understanding of MPNST is insufficient. The study provides the key points of discrimination for this group of cases that can hopefully increase the diagnostic rate, and guide therapy and recovery.

Study of the effect of different treatment modalities on unilateral cleft lip and palate and its effect on the maxillofacial morphology

OU Bang-bin, LIU Ting-ting, LI Ying-xia

Chinese Journal of Clinical Anatomy. 2019, 37(5):  578-582.  doi:10.13418/j.issn.1001-165x.2019.05.019

Abstract ( 470 )  

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Objective　To study the effect of Millard (rotating propulsion) and modified Tennison (triangulation) in the treatment of unilateral complete cleft lip and palate and its effect on the shape of maxillofacial. 　Methods　According to the different treatment methods, 52 patients with an unilateral complete cleft lip and palate in our hospital were divided into a Millard treatment group and a modified Tennison treatment group (26 cases). Six months after operation, the clinical efficacy of the two groups was evaluated  before and after the operation. The nasal morphological indexes of the children included Enw (medial canthus distance), BAW (nasal height), BADH (bilateral alar height difference), CHW (oral angle distance), CL (nasal columella height), CW (columella width), NBD (nasal dorsal inclination),  And CD (tilt of nasal columella) were measured by photogrammetry, and the height of the healthy side and the affected side of the child were measured.　Results　In terms of the excellent rate of clinical repair, the Millard group and the modified Tennison group were 69.23% and 88.46%, respectively, and the modified Tennison group was higher than the Millard group (P<0.05). After treatment, the average BAW, CL and CW of the modified Tennison group were higher than those of the control group, and the average BADH and CD of the modified Tennison group were lower than those of the control group (P<0.05), and the difference of lip height between the healthy side and the affected side of the modified Tennison group was smaller than that of the Millard group (P<0.05).　Conclusions　The modified Tennison method is superior to the Millard method in the treatment of the unilateral complete cleft lip and palate. It can maintain the symmetry of nasal and lip morphology, have a better control the maxillofacial morphology of patients, and maintain the morphological mechanism of facial beauty. It is worthy of clinical application.

Analysis of the related factors of lumbar spondylolysis 

JIANG Huan-chang, WANG Ji-xing, YANG Xiao-dong, LAI Zhen, WU Jian-qun, WU Feng, XIAN Zhen-jie, LIU Zhi-xiang

Chinese Journal of Clinical Anatomy. 2019, 37(5):  583-585.  doi:10.13418/j.issn.1001-165x.2019.05.020

Abstract ( 718 )  

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Objective　To analyze the risk factors of lumbar spondylolysis, and provide reference for prevention and treatment of lumbar spondylolysis.　Methods　The body mass index, exercise intensity, spinal dysplasia and related spinal-pelvic structure parameters of 88 patients with slipping prophase L5 spondylolysis were analyzed. A control group with 88 normal volunteers were recruited in this study, and the corresponding indicators between two groups were statistically processed.　Results　There were statistical differences in relative metabolic rate, pedicle-facet angle, pelvic incidence angle, lumbar lordosis angle, lumbar isthmic width, lumbar sacralization, spina bifida occulta and family history between the slipping prophase lumbar spondylolisthesis group and the control group (P<0.05). Logistic regression analysis showed that relative metabolic rate, pedicle-facet angle, pelvic incidence angle and lumbar isthmic width were the risk factors for lumbar spondylolysis.    Conclusion    The occurrence of lumbar spondylolysis is related to many factors. A comprehensive understanding of its associated risk factors is helpful in reduction of its incidence and prevention its further development into slip.

The clinical significance of nerve roots secondary decompression on the therapy of severe spondylolisthesis

MA Zheng, SUN Bo, CHEN Kang, JIAO Jian-bao, CHEN Tao-ping

Chinese Journal of Clinical Anatomy. 2019, 37(5):  586-589.  doi:10.13418/j.issn.1001-165x.2019.05.021

Abstract ( 606 )  

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Objective　To study the effect of secondary decompression on nerve roots after surgical treatment for severe isthmic spondylolisthesis.　Methods　Clinical and imaging data of 36 patients with severe spondylolisthesis were studied retrospectively. All patients were treated with posterior lumbar intebody fusion(PLIF). Implanted pedicle screws and laminectomy decompression were performed  for the nerve roots after reduction of spondylolisthesis again. The surgical duration and intraoperative blood loss of all patients were recorded. The VAS score, Oswestry dysfunction index (ODI), Japanese Orthopaedic Association (JOA) score, spondylolisthesis angle and spondylolisthesis rate of all patients were analyzed before surgery, 3 months and 2 years after surgery to evaluate the clinical efficacy.     Results    Surgical duration was（96±22）min, and volume of blood loss was（152±68）ml. There was significant difference between 3 months after surgery and the preoperative period on VAS score, ODI index, JOA score, spondylolisthesis angle and spondylolisthesis rate (P<0.05). There was no significant difference between 2 years after operation and 3 months after surgery on VAS score, ODI index, JOA score, spondylolisthesis angle and spondylolisthesis rate(P>0.05).　Conclusion　Secondary decompression on nerve roots for severe spondylolisthesis can relieve nerve compression and get good clinical effect.

Evaluation of renal hemodynamics by color Doppler ultrasound during perioperative period of flexible ureteroscopic lithotripsy 

MU Liang, SUN Yuan, XU Jiao-jiao, LIU Li, WEI Ai-hua, NAN Shu-liang, GUAN Xiang-ping, LIANG Liang

Chinese Journal of Clinical Anatomy. 2019, 37(5):  590-592.  doi:10.13418/j.issn.1001-165x.2019.05.022

Abstract ( 403 )  

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 Objective   To evaluate renal hemodynamics in patients with single renal calculi during perioperative period of flexible ureteroscopic lithotripsy by color Doppler flow imaging (CDFI).   Methods  The hemodynamic of renal interlobar arteries of 61 patients with one renal calculi who underwent unilateral flexible ureteroscope lithotripsy from Jul. 2016 to Jun. 2018 were examined separately  prior to surgery  (Day 1) and after surgery (1 hour and Day 5) by CDFI. Parameters were analyzed statistically.    Results    There were significant differences in systolic flow (Vmax), diastolic flow (Vmin) and resistance index (RI) during perioperative period (P＜0.05). 1 h after operation, a statistically significant decrease of Vmax and Vmin, and increase of RI of renal interlobar arterial were found compared with preoperative measurements (P＜0.017). In the follow-up of 5 d after operation, Vmax and Vmin were higher than 1 h after operation, and RI was lower than 1 h after operation (P＜0.017). There was no significant difference between preoperative measurements and 5 d after operation(P＞0.017).   Conclusions   CDFI can be used to quantify the blood perfusion in kidney after flexible ureteroscope lithotripsy. Renal Vmax and Vmin decreasing and RI increasing can be found in a short timeframe during perioperative period, and the changes are reversible.

The vascular hybridization surgery for the lower limb arteriosclerosis obliterans : a case report

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

Chinese Journal of Clinical Anatomy. 2019, 37(5):  593-594.  doi:10.13418/j.issn.1001-165x.2019.05.023

Abstract ( 455 )  

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Fabrication and application of internal jugular vein puncture specimen by photoelectric display

WEI Zhao-wen, LI Si-ning

Chinese Journal of Clinical Anatomy. 2019, 37(5):  595-596.  doi:10.13418/j.issn.1001-165x.2019.05.024

Abstract ( 348 )  

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Progress on anatomy and clinical application of internal thoracic artery and its perforator 

LU yan-xue, LUO Sheng-kang

Chinese Journal of Clinical Anatomy. 2019, 37(5):  597-599.  doi:10.13418/j.issn.1001-165x.2019.05.025

Abstract ( 552 )  

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Research progress on ischial spine and its clinical application

AN Lei-lei, MIAO Ying-ying, LIU Heng-xing

Chinese Journal of Clinical Anatomy. 2019, 37(5):  600-602.  doi:10.13418/j.issn.1001-165x.2019.05.026

Abstract ( 636 )  

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Research progress in biological 3D printing stem cells

HUANG Da, LI Jin-sheng, LV Hao, ZHANG Hong-wu

Chinese Journal of Clinical Anatomy. 2019, 37(5):  603-607.  doi: 10.13418/j.issn.1001-165x.2019.05.027

Abstract ( 245 )  

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