Table of Content

25 November 2021 Volume 39 Issue 6

  

Anatomical basis of Wiltse approach in lumbar operation entering the interspace between multifidus muscle and longissimus muscle 

Shan Jianlin, Zhang Zhicheng, Cheng Mengmeng, Chen Hao, Jia Pu, Bao Li, Feng Fei, Tang Hai

Chinese Journal of Clinical Anatomy. 2021, 39(6):  631-634.  doi:10.13418/j.issn.1001-165x.2021.06.001

Abstract ( 834 )   PDF (3435KB) ( 215 )  

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Objective　To explore the anatomical basis of Wiltse approach in lumbar operation and to improve reliability and manipuility of the lumbar Wiltse approach．Methods　Twenty embalmed cadavers were used to observe the anatomical characteristics as follows: the relationship between sacrospinalis aponeurosis and multifidus muscle, the relationship between sacrospinalis aponeurosis and longissimus muscle,  whether the interspace between multifidus muscle and longissimus muscle was clear, whether there were stable anatomic signs to identify, and whether there was other structure in the surface or inferior part of sacrospinalis aponeurosis could be the anatomic signs of the interspace between multifidus muscle and longissimus muscle.　Results　Multifidus muscle could be seen as an independent part from sacrospinalis aponeurosis though it had few fibers. Longissimus muscle formed a starting point from sacrospinalis aponeurosis in the lumbar regions. The starting point extended from central-superfacial to inferior-lateral and formed fascia stretching to facet joints and accessory process that made up the native interspace between multifidus muscle and longissimus muscle. The fascia was taken as an anatomical sign, successful blunt dissection were made to expose facet joints directly in all 20 cadavers. There were no other special anatomical signs in the surface or in the inferior part of sacrospinalis aponeurosis to locate the interspace between multifidus muscle and longissimus muscle. In the interspace, segmental nerve and concomitant blood vessel can be seen definitely inside the longissimus muscle.　Conclusions　The Wiltse approach requires a comprehensive understanding of lumbar fascia, based on which ,the operation could be safe and feasible. 

Applied anatomical study of the lateral stability of proximal interphalangeal joint by the injury of proximal phalanx trochlea

Wang Shaohe, Fan Hongbin, Shi Guanqi, Chen Yangshu, Gao Di, Jin Zhewu, Wang Zhen, Du Bin, Hu Yibo, Wu Ke

Chinese Journal of Clinical Anatomy. 2021, 39(6):  635-637.  doi:10.13418/j.issn.1001-165x.2021.06.002

Abstract ( 285 )   PDF (1277KB) ( 138 )  

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Objective　To provide anatomical basis for the treatment of proximal interphalangeal (PIP) joint by the injury experiment of proximal phalanx trochlea.　Methods　Both of the upper hand specimens from 6 adults were dissected, and 36 fingers including index finger, middle finger and ring finger were selected for the study. The radial angle of PIP joints was measured when the  trochlea of proximal phalanx was intacted 10%, 20%, 30%, 40% and 50% of injuries at 0 °  PIP joint flexion. 　Results　The mean length of the two sides of the proximal phalanx was (10.25±1.12) mm, and the radial angle of PIP joints was (0.14±0.10) °. When 10% of injuries, it was (5.06±0.53) °, when 20% of injuries, it was (8.47±0.42) °, when 30% of injuries, it was (12.28±0.71) °, when 40% of injuries, it was (16.33±0.76) °, and when 50% of injuries, it was (20.03±0.75) °. The more severe the injury of the proximal phalanx trochlea, the larger the radial angle of PIP joints, meaning the more unstable the PIP joints (P<0.0001, Wilcoxon test).　Conclusions　The defect of the proximal phalangeal trochlea has a significant effect on the lateral stability of PIP joints. Lateral instability can occur when the injury reaches 10%.

Effect of the angle between cephalic vein and axillary vein or subclavian vein on PICC catheterization through cephalic vein approach

Chen Yuji, Huang Lan, Huang Jingya, Huang Jieqing, Zhu Ding, Yang Zhenshui, Liang Kun, Wei Li

Chinese Journal of Clinical Anatomy. 2021, 39(6):  638-641.  doi:10.13418/j.issn.1001-165x.2021.06.003

Abstract ( 204 )   PDF (776KB) ( 104 )  

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Objective　To explore the effect of the angle between cephalic vein and axillary vein or subclavian vein on PICC catheterization through cephalic vein approach.　Methods　A total of 38 (76 sides) cadaver donors were dissected, and the angle changes between cephalic vein and axillary vein or subclavian vein of male or female were measured and analyzed at 0° and 90° of upper limb abduction.  Results   The average diameter of cephalic vein into the anterior lateral wall of the axillary vein or subclavian vein was (7.27±2.94) mm, 95% confidence interval (95%CI) was (6.51~8.03) mm. The included angle between cephalic vein and axillary vein or subclavian vein has the following 3 types: acute angle, right angle and obtuse angle. When the upper limb abduction reached 0°, the included angle was (47.14±27.02) ° on average, the 95% CI was 40.97°~ 63.32°. However, the upper limb abduction reached 90°, the included angle was (63.88±24.26) ° on average, which was greater than when the upper limb abduction reached 0°, and the 95% CI was 53.96°~ 65.64°. There was no significant difference in the included angles between male and female with upper limb abduction at 0°, while the included angle of male was greater than that of female with upper limb abduction at 90°. At 0° and 90° of upper limb abduction, there was no significant difference in the angle between left and right sides.　Conclusions　The included angle of both male and female between cephalic veins and axillary vein or subclavian vein does not affect the duct to pass through during PICC catheterization through cephalic vein approach. However, in a few cases, the included angle is close to or greater than 90°, especially the male upper limb abduction 90° may increase the difficulty of catheter passing through the included angle, which should be paid attention to during operation.

Fine anatomy of recurrent laryngeal nerve entrance into the larynx

Jiao Mengsi, Fan Ning, Shi Yuqi, Liu Delong, She Cuiping

Chinese Journal of Clinical Anatomy. 2021, 39(6):  642-645.  doi:10.13418/j.issn.1001-165x.2021.06.004

Abstract ( 417 )   PDF (1398KB) ( 81 )  

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Objective　To provide meaningful reference and data for thyroid surgery through the dissetion of the entrance point of laryngeal recurrent nerve (RLN) into the larynx.　Methods　Forty formaldehyde fixed adult male corpse specimens, bilateral RLN were dissected, with ipsilateral cephalic margins of the trachea and the intersection of RLN as the vertex of the angle. The angle between the entry of bilateral RLNs into the larynx and the ipsilateral lateral margin of trachea, the vertical distance between the entry of bilateral RLNs into the larynx and the anterior superior margin of the first and second tracheal ring rings, and the horizontal distance between the entry of bilateral recurrent laryngeal nerves and the lateral margin of the ipsilateral first and second tracheal ring rings were recorded.　Results　 (1) The angle (α) between the throat entrance of bilateral RLN and the side edge of ipsilateral trachea was analyzed. There were 21 cases with 0≤ α <5°, accounting for 26.25%, 46 cases with 5°≤α <10°, accounting for 57.50%, and 11 cases with 10°≤ α <15°, accounting for 13.75 %,  2 cases with α ≥15°, accounting for 2.50 %. The left side angle was  (6.0±0.5)°(0~21°), and the right side angle was  (7.0±0.5)°(0~25°). (2) The vertical distances from the anterior upper edge of the first tracheal ring to the left RLN and right RLN were (19.72±0.52) mm and (21.21±0.43) mm, respectively. The vertical distances from the anterior upper edge of the second tracheal ring to the left RLN and right RLN were (20.91±0.49) mm and (21.42±0.39) mm, respectively. The horizontal distances from the lateral edge of the ipsilateral first tracheal ring to the left RLN and right RLN were (2.96±0.11) mm and (2.96±0.10) mm, respectively. The horizontal distances from the lateral edge of the second tracheal ring to the left RLN and right RLN on the same side were (3.49±0.12) mm and (3.50±0.52) mm, respectively. Conclusions The entry angle of bilateral RLNs into the larynx and the position of the first and second tracheal rings are relatively fixed. Better understanding of the fine anatomy of the RLN laryngeal entry can help to find the RLN laryngeal entry more efficiently and safely, can reduce the injury of the RLN during thyroid surgery, and thus reduce the incidence of surgical complications.

Fracture classification for distal pole of patella fractures based on CT

Xu Fusheng, Zhang Wei, Niu Fei, Cheng Anyuan, Xia Ping

Chinese Journal of Clinical Anatomy. 2021, 39(6):  646-648.  doi:10.13418/j.issn.1001-165x.2021.06.005

Abstract ( 328 )   PDF (1676KB) ( 69 )  

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Objective　To perform classification the distal pole fractures of patella based on three-dimensional CT.　Methods　 From May 2018 to November 2019, a retrospective analysis of 67 cases of the distal pole fractures of patella were classified by three-dimensional CT. The Kappa coefficients (K) was utilized to assess inter-observer and intra-observer reliabilities.　Results　The distal pole fractures of patella was divided into two types: a non-displaced fracture (type I) and a displaced fracture (typeⅡ).The displaced fracture was further divided into the following three subtypes: Type Ⅱa ( massive fractures, including one isolated fracture or two larger fractures), Type Ⅱb (comminuted fractures, multiple smaller fractures, including coronal plane and sagittal plane fractures), Type Ⅱc (cuff-like avulsion fractures, avulsion fractures along the entire arc of distal pole of patella, most of the fractures were comminuted and very thin). There were 8 cases of type I, 11 cases of type Ⅱa, 42 cases of type Ⅱb, and 6 cases of type Ⅱc under this study. The average K value of the inter-observer reliability was 0.782 (range 0.682~0.896), which was substantial agreement, and the average K value of the intra-observer reliability was 0.837 (range 0.786~0.884), which was perfect agreement.  Conclusions　The CT classification for the distal pole fractures of patella has high reliability and repeatability. It is simple and easy to remember, and has certain clinical implication.

The coincidence of coronary artery calcification with pathological diagnosis evaluated by DSCT

Liu Yunfei, Ma Yanhe, Wang Changyue, Li Zhiying, Guo Changying, Guo Lin

Chinese Journal of Clinical Anatomy. 2021, 39(6):  649-653.  doi:10.13418/j.issn.1001-165x.2021.06.006

Abstract ( 221 )   PDF (3074KB) ( 12 )  

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Objective　To evaluate the accuracy of dual-source CT and quantitative coronary artery calcification based on the pathological diagnosis.　Methods　Coronary arteries were scanned by contrasted-enhanced DSCT with an axial slice thickness of 0.6mm in vitro. The plaque with computed tomographic value more than 130 Hounsfield units was identified as calcified plaque. According to the arc of calcification in the cross section of coronary artery wall, calcified plaques can be divided as follows: mild calcification, moderate calcification, severe calcification. The coronary artery stenosis caused by calcified plaque was calculated. Pathological classification and coronary artery stenosis measured by pathology were used as comparison criteria.　Results　Histopathology detected 69 calcified plaques. 57 calcified plaques were found at DSCT. The sensitivity of DSCT for detecting mild、moderate and severe calcified plaques were 88.3%、100% and 100%, respectively. Compared with pathological diagnosis, DSCT overestimated coronary artery stenosis caused by mild, moderate and severe calcified plaques (3.2%±2.0%, 4.9%±4.7% and 14.7%±8.2%, respectively; P<0.05).　Conclusions Compared with histopathology, dual-source CT contrast enhancement scanning can detect and characterize different types of coronary artery calcification. Compared with histopathology dual source CT overestimates coronary artery stenosis caused by calcified plaque.

Study on the relationship between periventricular-intraventricular hemorrhages and cerebellar development in preterm infants 

Chinese Journal of Clinical Anatomy. 2021, 39(6):  654-659.  doi:10.13418/j.issn.1001-165x.2021.06.007

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Objective　To assess the effect of PIVH on the cerebellar development in VLBW premature infants by means of cranial ultrasound.　Methods　Two hundred VLBW premature infants with gestational age 25 to 31+6 weeks were enrolled and divided into with a PIVH group (n=67), and a without PIVH group (n=133). The differences in transverse cerebellar diameter, vermis height, vermis diameter, vermis circumference and vermis area between the two groups were compared.　Results　Transverse cerebellar diameter, vermis height, vermis diameter, vermis circumference and vermis area of preterm infants in the PIVH group were significantly lower than those of preterm ones in the without PIVH group at term equivalent age (P<0.05). There was no significant difference in weight (P=0.31) and head circumference (P=0.462). In subgroup analysis, Transverse cerebellar diameter of the preterm infants with grades Ⅲ、Ⅳ PIVH was significantly lower than those of preterm ones with grades Ⅰ、Ⅱ PIVH (P=0.012). There were no significant difference in weight, head circumference, vermis height, vermis diameter, vermis circumference and vermis between these subgroups.　Conclusions　PIVH may have a significant impact on cerebellar development in VLBW premature infants, especially those with a severe PIVH. The transverse cerebellar diameter is more affected than other indicators.

Multi-phase enhancement pattern of MDCT and morphological analysis of renal chromophobe cell carcinoma

Huang Qilin, Zhu Yuting, Chen Shaobin, Zhang Wei, Luo Min

Chinese Journal of Clinical Anatomy. 2021, 39(6):  660-665.  doi:10.13418/j.issn.1001-165x.2021.06.008

Abstract ( 174 )   PDF (3366KB) ( 155 )  

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Objective   To investigate the plain scan and multi-phase enhancement features of renal chromophobe cell carcinoma by multi-detector spiral computed tomography (MDCT).   Methods   Clinical data and MDCT signs of 67 cases (68 lesions) of renal chromophobe cell carcinoma were retrospectively analyzed. They were divided into two groups according to the tumor size (group A with the maximum diameter ≤4 cm and group B with the maximum diameter of >4 cm). The MDCT characteristics of the mass in the two groups were compared. The ratio (La0, La1, Lv1, Lp1) of the CT value of the solid part of the mass in plain scan, renal cortex stage, parenchymal stage and renal pelvis stage to the CT value of the ipsilateral adjacent renal cortex (La0, La1, Lv1, Lp1) were calculated and graded, and the enhancement mode of the mass was analyzed and statistically analyzed.   Results   There were significant differences in the percentage of calcification, central scar and small cortical vascular signs in the tumor and the percentage of compression of calices, pelvis and portal vessels by the tumor between group A and B (all P<0.05).There were significant differences among La1, Lv1 and Lp1 in the solid part of 68 masses (P<0.05). The enhancement peak value was the most in the dermato-pith junction or parenchymal phase, accounting for 61.76% (42/68), of which followed by the cortical phase, accounting for 33.82% (23/68), and there were significant differences in the dermato-pith junction or parenchymal phase and the cortical phase (P<0.05).   Conclusions   The partial MDCT features of renal chromophobe cell carcinoma are related to the size of the tumor, and the enhancement methods are varied. Careful observation of plain scan features and multistage enhancement features of the tumor is helpful for preoperative diagnosis and differential diagnosis.

Effects of gut microbiota on intestinal damage in high-altitude hypoxia

Wang Yuhao, Shi Yi, Li Wenhao, Wang Shu, Shen Xuefeng, Yang Jianjun

Chinese Journal of Clinical Anatomy. 2021, 39(6):  666-672.  doi:10.13418/j.issn.1001-165x.2021.06.009

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Objective　To explore the mechanism of gut microbiota in intestinal damage in high-altitude hypoxic environment.     Methods    Twenty C57BL/6 mice were randomly divided into a control group and an exposure group according to the ratio of 1:1. After the successful modeling of the 6000-meter high-altitude hypoxia model, the feces, blood and proximal colon tissue of these two groups were collected. The structure of gut microbiota in feces was determined by 16S rDNA analysis. The blood biochemical indexes were detected. The pathological changes of intestinal mucosal structure were observed by HE and PAS staining. The mRNA expression levels of ZO-1, Occludin, IL-6 and TNFα of colon tissue were measured by RT-qPCR.    Results    Compared with the control group, the red blood cell, hemoglobin and hematocrit values of the exposure group significantly increased. The high-altitude hypoxia model was successfully established. The 16S rDNA showed that the gut microbiota was disordered and the diversity declined, the content of the mucin-degrading bacteria Akkermansia and pathogenic bacterias Clostridium XVIII, Prevotella increased, the relative content of the short-chain fatty acids producing bacteria Roseburia, Odoribacter, Lachnospiracea, Butyricicoccus and Olsenella decreased. HE and PAS staining results showed that the interruption of colon epithelial continuity, atrophy of glands, shortening of crypts and reduction of goblet cells, which indicated the damage of intestinal structure and mucosal barrier. The expression levels of tight junction protein Occludin and ZO-1 mRNA decreased, which confirmed the disruption of intestinal mucosal of the exposure group. The expression level of inflammatory factors IL-6 and TNFα increased, which may be related to intestinal inflammatory reaction.   Conclusions   The intestinal damage caused by high-altitude hypoxic environment may be related to the change of gut microbiota. Gut microbiota disorder and diversity decreased, the relative abundance of pathogenic bacteria increased and probiotics decreased. These alterations cause the intestinal mucosal damage, intestinal inflammation, intestinal damage, and finally lead to high-altitude intestinal related diseases.

Study on aryl hydrocarbon receptor nuclear translocator  regulating hypoxic pathway to promote skeletal muscle regeneration in mice

Li Bin, Zhang Yuteng, Lu Feng

Chinese Journal of Clinical Anatomy. 2021, 39(6):  673-679.  doi:10.13418/j.issn.1001-165x.2021.06.011

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Objective　To explore the regulatory role of aryl hydrocarbon receptor nuclear transporter (ARNT) on skeletal muscle regeneration and to provide theories for improving muscle regeneration in aging population.　Methods　Mice skeletal muscle injury model was constructed. Skeletal muscle regeneration ability was explored between young and old mice, transgenic and wild-type mice, old hypoxia pathway activator (ML228) and DMSO mice following cryoinjury. Whole muscle was obtained and analyzed to evaluate the expressions of ARNT, hypoxia pathway and skeletal muscle regeneration related protein/ genes, as well as the blood flow in the lower limbs of mice.　Results　The regeneration ability of skeletal muscle decreased in aging mice. ARNT gene knockout in young mice hindered skeletal muscle regeneration, as well as down-regulated hypoxia pathway factor and the expressions of related genes. ML228 could restore the regenerative ability of damaged skeletal muscle.　Conclusions　The inhibition of hypoxia pathway by the decreasing of ARNT content  caused by aging is the main reason for the decreasing of skeletal muscle regeneration ability. The pharmacological activator of hypoxia signal improves the regeneration ability of skeletal muscle in the elderly is promising.

Irisin promotes angiogenesis in inflammatory state by inhibiting the JAK/STAT3 pathway

Hu Sihan, Xue Yuan, Jin Yesheng, Zhang Yuanshu, Shi Qin, Rui Yongjun

Chinese Journal of Clinical Anatomy. 2021, 39(6):  680-685.  doi:10.13418/j.issn.1001-165x.2021.06.012

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Objective　To investigate the effect of irisin on angiogenesis in human umbilical vein endothelial cell (HUVEC) under acute inflammatory state and its regulatory mechanism.　Methods　 (1)The effects of different concentrations (0.1, 1.0, 5.0, 10.0, 20.0 ng/ml) of irisin on HUVEC proliferation were detected by CCK-8; (2) Acute inflammatory state of HUVEC was induced by LPS. The effect of irisin on cell migration and tubular formation was studied by scratch and tube forming experiments. The gene expression of related cytokines IL-1β, IL-6, TNF-α and PDGF-BB was studied by RT-PCR; (3) The expressions of proteins Erk1/2, Jak and Stat3 in the JAK/STAT3 signaling pathway were detected by Western Blot.　Results　 (1) The change of concentrations of recombinant irisin did not affect the proliferation of HUVEC; (2) Irisin promoted cell migration and tubular formation of HUVEC in the state of acute inflammation, and inhibited the expression of inflammatory factors IL-1β, IL-6 and TNF-α in HUVEC in the state of acute inflammation, and increased the gene expression of tissue repair factor PDGF-BB; (3) Irisin inhibited LPS-induced activation of the JAK/STAT3 pathway.　Conclusions　Irisin suppresses JAK/STAT3 signaling pathway, relieves acute inflammatory state of HUVEC induced by LPS, and promotes angiogenesis.

METTL3 regulates SPRING1 and promotes lipid accumulation in macrophages

Jia Bo, Yang Zhou, Yu Guangli, Lv Yuncheng, Peng Tianhong

Chinese Journal of Clinical Anatomy. 2021, 39(6):  686-691.  doi:10.13418/j.issn.1001-165x.2021.06.013

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Objective    To investigate the effect and mechanism of METTL3 regulating SPRING1 on macrophage lipid accumulation.     Methods    After inducing the attachment of THP-1 cells with 100 ng/ml PMA, 50 μg/ml Ac-LDL was added to incubate THP-1 cells.  The protein levels of METTL3 and SPRING1 were detected by Western blot and the mRNA levels was detected by qRT-PCR. The total cholesterol (TC), cholesterol ester (CE) and free cholesterol (FC) were detected by high performance liquid chromatography (HPLC). SRAMP and RMBase websites were used to analyze the m6A modification sites on the SPRING1 mRNA. The Oil red O staining and plasma membrane red fluorescent-labeled probe Dil-Ac-LDL were used to observe the uptake of lipid droplets in macrophages.   Results   Compared with the control group, the protein level of METTL3 and SPRING1 in THP-1 cells was upregulated; the SPRING1 mRNA level was also upregulated after Ac-LDL incubation. Overexpression of METTL3 upregulated the expression of SPRING1 protein, increased the uptake Dil-Ac-LDL by macrophages. While METTL3 silence obviously downregulated the expression of SPRING1 protein. Cycloleucine, as a methylation inhibitor, can partially inhibit the promotion of METTL3 overexpression on SPRING1. Bioinformatics analysis showed that there were m6A modification sites in SPRING1 mRNA.   Conclusions    METTL3 upregulates the expression of SPRING1 and promotes lipid accumulation in macrophages.

The repair effect of novel mechanical sensing ion channels Piezo1 and TRPV4 protein siRNA double silencing on osteoarthritis rat model

Zhou Yongwei, Zhang Caihua, Li Xiaofei, Cai Xunzi

Chinese Journal of Clinical Anatomy. 2021, 39(6):  692-699.  doi:10.13418/j.issn.1001-165x.2021.06.014

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Objective   To explore the repair effect of siRNA double silencing of new mechanosensitive ion channels Piezo1 and TRPV4 on osteoarthritis rat model.    Methods    The osteoarthritis animal (OA) model of SD rats was established. According to the different treatment on rats, SD rats were divided into the following four groups: a blank control group, a siRNA-Piezo1 group, a siRNA-TRPV4 group and a double gene silencing group. HE staining and safranin solid green staining were used to evaluate the quality of the samples by modified Minkin's score and OARSI score. The expression of Aggrecan protein and Collagen II in articular cartilage were detected by immunohistochemical staining and RT-PCR.    Results    The result of the HE staining and safranin green staining showed that the scores of knee cartilage tissue in the siRNA-Piezo1 group and siRNA-TRPV4 group were significantly higher than that in the model group, the siRNA-piezo1 group and the siRNA-TRPV4 group (P<0.05). The results of immunohistochemical staining and RT-PCR showed that the expression of Aggrecan and Collagen II in the double gene silencing group was significantly higher than that in siRNA-piezo1 group and siRNA-TRPV4 group (P<0.05).    Conclusions    Piezo1 and TRPV4 protein siRNA double silencing mode can promote the expression of Aggrecan and Collagen II, and then play a certain role in the repair of osteoarthritis rat model. 

Comparison of the efficacy of seven antispasmodic drugs in the prevention of norepinephrine-induced vasospasm

Zhao Hu, Ma Qiming, Chen Shaofeng, Wu Dongfang

Chinese Journal of Clinical Anatomy. 2021, 39(6):  700-706.  doi:10.13418/j.issn.1001-165x.2021.06.010

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Objective　To explore the use of antispasmodic drugs to prevent norepinephrine- induced vasospasm. 　Methods　Sixty-four SD rats were randomly divided into 8 groups. The rats were pretreated with 7 kinds of antispasmodic drugs for 30 minutes（Prostaglandin E1, sodium nitroprusside, magnesium sulfate, papaverine, phentolamine, verapamil and lidocainehydrocloride). Normal saline was used as a control agent. Then 0.1 ml norepinephrine (1:1000) was added to trigger vasospasm. The perfusion intensity and diameter of the femoral artery and vein were monitored by a laser speckle blood flow imaging system. Spss19.0 was used to compare the perfusion difference between groups.　Results　In the control group (normal saline), local application of norepinephrine for 5 minutes reduced arterial perfusion by 91% and venous perfusion by 78%. Both sodium nitroprusside and phentolamine could prevent the vasospasm of femoral artery and vein (P<0.05); papaverine only prevented the spasm of the femoral artery, and prostaglandin E1 only prevented the spasm of the femoral vein.　Conclusions　Pretreatment with sodium nitroprusside and phentolamine can prevent norepinephrine-induced vasospasm. Sodium nitroprusside has the strongest preventive effect, followed by phentolamine.

Application of the Flow-through flap of descending branch of lateral circumflex femoral artery in the limb salvage treatment of high-voltage electrical injury of the upper extremity

Xue Jiajie, Wang Yaojun, Ren Zhongliang, Guo Lei

Chinese Journal of Clinical Anatomy. 2021, 39(6):  707-710.  doi:10.13418/j.issn.1001-165x.2021.06.015

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Objective　To explore the limb salvage effect of Flow-through flap of descending branch of lateral femoral circumflex artery in the treatment of high-voltage electrical injury of the upper extremity. Methods　From July 2017 to February 2019, five patients with high-voltage electrical injury of upper extremity were analyzed retrospectively. Extensive soft tissue necrosis and blood circulation disorder were found in all of the affected limbs. Emergency treatment including incision and decompression of the affected limb, removal of necrotic tissue, vascular exploration, transplantation of Flow-through flap of descending branch of lateral circumflex femoral artery were implemented to repair the wound and reconstruct the distal blood circulation of the limb. The wound area after thorough debridement ranged from 6.0 cm×4.0 cm to 17.1 cm×10.3 cm, and the flap area ranged from 7.2 cm×5.0 cm to 18.3 cm×11.5 cm. The donor area was closed directly in one stage.　Results　One patient developed subflap infection 7 days after operation and healed successfully after debridement and suturing. The other flaps survived well and healed in stage I. All patients were followed up for 6 to 18 months, with an average of 12 months. All the patients were successful in limb preservation, the skin flap was soft and satisfactory in shape, the ulnar and radial arteries of the affected limb were unobstructed, the blood supply of the hand and wrist was good, and the function was restored to a certain extent. There were lamellar scars in the donor region with only a small area of numbness.　Conclusions　The Flow-through flap of the descending branch of the lateral circumflex femoral artery can effectively reconstruct the blood supply of the limbs and repair the wounds at the same time, which is one of the ideal methods for limb salvage treatment in the high-voltage electrical injury of upper extremity.

Clinical effect of Kirschner wire loop plate and anatomical locking plate combined with ligaments suspended for the treatment of Neer IIb distal clavicle fracture

Li Yu, Ma Jianwen, Huang Yong

Chinese Journal of Clinical Anatomy. 2021, 39(6):  711-715.  doi:10.13418/j.issn.1001-165x.2021.06.016

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Objective 　To compare the difference of clinical effect between Kirschner wire loop plate and anatomical locking plate combined with ligaments suspended for the treatment of Neer IIb distal clavicle fracture.　Methods　According to different fixation methods, 46 patients with Neer IIb distal clavicle fracture who received treatment were divided into an observation group (22 patients with Kirschner wire loop plate) and a control group (24 patients with anatomical locking plate combined with ligaments suspended). Operation time, fluoroscopy frequency, intraoperative blood loss, incision length, fracture healing time, hospital stay, VAS pain score and Constant function score of shoulder joint and other indicators were evaluated.　Results　Intraoperative blood loss, incision length and fracture healing time in the observation group were significantly lower than those in the control group (P<0.05). While the operation time and fluoroscopy times in the observation group were significantly higher than those in the control group (P<0.05). There was no significant difference in the hospital stay between the two groups (P>0.05). The gap distance of beak lock in the observation group was lower than that in the control group (P<0.05). There were no statistical difference in the immediate VAS score and Constant function score between the two groups (P>0.05). At 3 months follow-up, the VAS score and the Constant function score of shoulder joint in the observation group were better than control group (P<0.05).　Conclusions　Kirschner wire loop plate for the treatment of Neer IIb distal clavicle fracture is safe and effective, and can effectively improve the quality of life of patients, which is worthy of extensive clinical promotion.

Comparison of the effect of ankle screw fixation in different directions after ankle fracture

Hu Xiunian, Liu Hui, Zhan Peng, Chen Rijiang, Liao Yuanjun, Lan Weibin, Qiu Hanmin, Chen Dongfeng

Chinese Journal of Clinical Anatomy. 2021, 39(6):  716-720.  doi:10.13418/j.issn.1001-165x.2021.06.017

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 Objective    To compare the effect of different fixation direction of posterior lateral approach on ankle fracture.    Methods    Forty-eight patients, including 20 males and 28 females, aged (51.88 ± 7.90) years old, 20 left ankles and 28 right ankles were collected for posterior malleolus fractures fixation by posterior lateral approach in floating position, respectively. According to the classification of Lauge-Hansen fracture of ankle joint, 36 cases had supination-extorsion and 12 had pronation-abduction. All posterior malleolus were fixed with screws, including 22 cases in the forward to backward fixation group and 26 cases in the backward to forward fixation group. The time of incision healing and complications, fracture healing time, the last follow-up were evaluated by AOFAS score and operation time between two groups were compared.    Results    Patients in the two groups were followed up for 10-20 months, with an average of (13±3.5) months. All patients were healed at stage I, there was no incisional infection, blood vessel and nerve damage. There was no statistical difference in operation time, fracture healing time, AOFAS score (P>0.5). Conclusions    The posterior lateral approach for fixation of posterior malleolus fractures has a good effect. Different screw fixation directions have similar clinical results,  so surgeons can choose the appropriate method based on their experience.

Personalized pressure of tourniquet in lower limb surgery 

Guo Xiaoze, Li Binglin, Zhuo Rongfeng, Li Zhan, Xia Qiong, Zhang Ying

Chinese Journal of Clinical Anatomy. 2021, 39(6):  721-726.  doi:10.13418/j.issn.1001-165x.2021.06.018

Abstract ( 133 )   PDF (2430KB) ( 94 )  

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Objective 　To analyze the relationship between thigh circumference (TC), systolic blood pressure (SBP) and tourniquet pressure in lower limb surgery, and discuss the personalized pressure of tourniquet.    Methods   Fifty-five patients who underwent lower limb surgery using tourniquet in General Hospital of Southern Theatre Command of PLA from April, 2018 to May, 2018 were included in the study. Patients were separately divided into groups according to the thigh circumference, systolic blood pressure and body mass index (BMI). The intraoperative tourniquet pressure, intraoperative blood bleeding, TC, SBP and BMI were recorded. The changes of tourniquet pressure and the correlation between tourniquet pressure and TC, SBP and BMI were recorded.    Results   In remarkable effect of hemostasis, there were significant differences in minimum pressure of tourniquet and the pressure difference between tourniquet and SBP in each group (P<0.05) . The tourniquet pressure was positively correlated with TC (r=0.734, P<0.05) and SBP (r=0.889, P<0.05), but it was not correlated with BMI (r=0.076, P>0.05), respectively.   Conclusions    The personalized tourniquet pressure can be set according to TC and BDP in lower limb surgery. Meanwhile, if the SBP is greater than 130 mmHg, the tourniquet pressure should add an extra 30 mmHg. In addition, there is no reference value for BMI in tourniquet pressure setting.

Effect of ultrasound-guided fine-needle passes number on sampling satisfaction rate

Chen Zhi, Chen Qingyun, Li Wangen, Liu Yucen, Li Chenzhong, Song Dandan, Li Zhangfang, Pan Daoyan, Hu Shidi, Song Yuqian, Zhang Tong

Chinese Journal of Clinical Anatomy. 2021, 39(6):  727-731.  doi:10.13418/j.issn.1001-165x.2021.06.019

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Objective　To compare the sample satisfaction rate of different  needle passes in ultrasound-guided fine-needle aspiration biopsy of thyroid nodules, and provide the basis for clinic operation. Methods　Ninety-five patients with 106 solid or mainly solid thyroid nodules were included in our hospital and randomly divided into a one-needle passes group, a two-needle passes group, a three-needle passes group. Fine needle aspiration biopsy of thyroid was performed under ultrasonic guidance. The obtained specimens were sent for cytopathological diagnosis which was classified according to the Bethesda System. Bethesda I was defined as unsatisfactory, and Bethesda Ⅱ~Ⅵ were defined as satisfactory. The satisfaction rate of specimens with different number of passes needles was compared.　Results　The overall satisfaction rate of nodule samples was 92.5% (98/106). There were no statistical differences in the satisfaction rate among the one-needle passes group, two-needle passes group, and three-needle passes group (90.2%, 93.9%, and 93.8%, respectively, P>0.05).　Conclusions　For solid or mainly solid thyroid nodules, the number of needle passes guided by ultrasound has no significant effect on sampling and the satisfaction rate of specimen with one needle passes is equivalent to that with 2 or 3 needles.

Application of 3D printing technology in the repair and reconstruction of bone defect in knee joint: one clinical case report

Lu Sheng, Luo Haotian, Chen Jiayu, Gao Ming, Liang Jinlong

Chinese Journal of Clinical Anatomy. 2021, 39(6):  732-737.  doi:10.13418/j.issn.1001-165x.2021.06.020

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Objective　To investigate the feasibility and effectiveness of 3D printing module for reconstruction of traumatic bone defects. 　Methods　A young female with an open fracture of the left knee associated with femoral condyle defect caused by traffic accident was included. The defect of lateral condyle of femur was repaired and reconstructed assisted by computer and 3D printing technique after the initial debridement and wound closure for 2 months, based on the original data of CT scans preoperative, the bone defect module and the femoral articular curvature surface model consistent with the anatomical shape of the healthy side were established by means of mirror operation, fusion registration and Boolean operation, and accurate preoperative planning was made. The corresponding 3D-module was made by rapid prototyping technology, and the femoral condyle of the defect was assisted to be shaped during the surgery, so as to achieve accurate repair and reconstruction of the bone structure. In the long-term follow-up after the operation, the effectiveness of the 3D printing module was evaluated by subjective sensation, image performance and HSS score.　Results　Postoperative follow-up was conducted from 1 month to 8 years, we detected that the pain, function, range of motion, muscle strength, knee flexion deformity and knee instability of the injured limb, and showed benign development. There were no significant adverse events or disabling factors except partial bone graft resorption, and the motor function of the injured limb met the needs of daily life during the follow-up. Postoperative follow-up of 1 month, 2 years and 8 years showed that the HSS scores were 44, 58 and 83 points, respectively.　Conclusions　3D printing module is a perfect way to assist intraoperative surgery because it can improve the accuracy of surgical operation for the repair and reconstruction of traumatic bone defects and provide new ideas for personalized treatment.

Reconstruction of the ligament surgery for dislocation of the first carpometacarpal joint by transposition of extensor pollicis tendon band

Wang Kai, Ju Jihui, Jin Guangzhe, Guo Liping, Li Yadong, Lu Zhaowei, Liu Shengzhe

Chinese Journal of Clinical Anatomy. 2021, 39(6):  738-740.  doi:10.13418/j.issn.1001-165x.2021.06.021

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Objective　To investigate the clinical effect of the first carpal metacarpophalangeal and dorsal radial ligament reconstruction with long hallus abdominis tendon flap in the treatment of the first carpal metacarpal dislocation.　Methods　From January 2015 to December 2019, five patients with the first carpal-metacarpal joint dislocation were treated with embole, Kirschner wire traction and fixation for arthroplasty, and the posterior oblique ligament and dorsal radial side of the first carpal-metacarpal joint were reconstructed with the long abdominis tendon flap ligament. Four weeks after operation, the fixation was removed and the Kirschner wire was removed to begin functional exercise. The operation effect was evaluated according to the X-ray films and the range of motion (ROM) of the thumb joint.　Results　Postoperative follow-up was 5 - 12 months (average 8 months). The last follow-up X-rays films showed no re-dislocation. ROM test showed that flexion and extension activities returned to normal in 4 cases. And one case had restricted contralateral palms.  Conclusions　Reconstruction of the first carpal metacarpal ligament using the long abductor hallucis tendon flap can restore joint stability and improve function.

Pneumothorax, pneumomediastinum and subcutaneous emphysema induced by colonoscopy: a case report and literature review

Liu Lu, Li Yaoqi, Zhu Chenglou, Peng Lingzhi, Xia Yu, Deng Weibo, Da Mingxu

Chinese Journal of Clinical Anatomy. 2021, 39(6):  741-744.  doi:10.13418/j.issn.1001-165x.2021.06.022

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Advances in applied anatomy of the Henle trunk

Yu Shizhe, Liu Qiaoyun, Yu Zhiyong

Chinese Journal of Clinical Anatomy. 2021, 39(6):  745-749.  doi:10.13418/j.issn.1001-165x.2021.06.023

Abstract ( 189 )   PDF (1211KB) ( 32 )  

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Selection of surgical approach based on three-column classification for acetabular fractures

Huang Fuming, Fan Shicai, Huang Haizhou, Zhou Jihui, Lin Shibang

Chinese Journal of Clinical Anatomy. 2021, 39(6):  750-754.  doi:10.13418/j.issn.1001-165x.2021.06.024

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Descending colon vein into left ovarian vein：a case report

Chen Ao

Chinese Journal of Clinical Anatomy. 2021, 39(6):  749.  doi:10.13418/j.issn.1001-165x.2021.06.025

Abstract ( 166 )   PDF (781KB) ( 42 )  

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