Table of Content

25 July 2022 Volume 40 Issue 4

  

Anatomical classification of posterior superior iliac spine and its clinical significance

Qi Ji, Li Jing, Wang Haizhou, Chen Ping, Lin Dingkun, Chen Haiyun, Ping Ruiyue, Xu Yanxiao, Li Yikai

Chinese Journal of Clinical Anatomy. 2022, 40(4):  377-382.  doi:10.13418/j.issn.1001-165x.2022.4.01

Abstract ( 1149 )   PDF (3716KB) ( 237 )  

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  Objective    To study the anatomical characteristics of posterior superior iliac spine and explore its clinical significance.    Methods    Two hundred and eighty dry hip specimens of humans were selected. The posterior superior iliac spine was point A, the anterior superior iliac spine was point B, the ischial tuberosity was point C, the highest point of the iliac spine was point D, the pubic tuberosity was point E, and the midpoint of the posterior edge of the articular surface was point F. The width of point A of the posterior superior iliac spine was W0, and the thickness of point A was H0. The maximum width of the posterior part of the iliac crest was Wmax, and the distance from point A to the posterior part of the iliac crest was D0. The width of the iliac crest was measured at 0.5 cm, 1.0 cm, 1.5 cm, and 2.0 cm from point A, which were recorded as W1, W2, W3, W4. The part of the iliac crest was taken as point G and the width of point G was denoted as W5. The lengths of AB, AC, AD, AE, AF, AG, and CD were measured, respectively.    Results    The morphology of the posterior superior iliac spine was roughly divided into the following 4 types: type I "V" (107 cases, accounting for 38.2%), type II "U" (121 cases, accounting for 43.2%), type III "W" (31 cases, accounting for 11.1%), type IV "Proliferative" (21 cases, accounting for 7.5%). The AB length of type Ⅰ was significantly shorter than that of type Ⅲ and Ⅳ, the AF distance of type Ⅰ was significantly shorter than that of type Ⅱ and Ⅲ. W0, W1 and H0 of type Ⅰ were significantly smaller than that of type Ⅱ, Ⅲ, and Ⅳ, and W0 of type Ⅲ was greater than that of type I, type II and type IV, all were statistically significant (P<0.05). Conclusions    There are 4 morphological variations of the posterior superior iliac spine, with a "U" shape as the main one, which has of certain clinical implication. 

Applied anatomy of the umbilical artery of adult male

Huo Jiechao, Yang Mei, Zheng Yin, Zhang Gaoli, Wan Shanshan, Liu Hui

Chinese Journal of Clinical Anatomy. 2022, 40(4):  383-386.  doi:10.13418/j.issn.1001-165x.2022.4.02

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Objective    To study the anatomical characteristics of umbilical artery in male specimens, so as to provide theoretical support for ligation of umbilical artery in clinical bladder cancer resection. Methods    Nineteen adult male cadavers (38 sides) fixed by formalin were collected randomly. The starting point, course, external diameter and branches of the umbilical artery were observed and analyzed.    Results    The umbilical artery originated from the internal iliac artery. The outer diameter of umbilical artery was (3.02±0.30) mm. We found there were five branch types of the umbilical artery. Ⅰ. several superior vesical arteries, accounting for 52.6% (20 sides). Ⅱ. several superior vesical arteries and one inferior vesical artery, accounting for 28.9% (11 sides). Ⅲ. two superior bladder arteries and one common trunk vessel of the inferior bladder artery and the obturator artery, accounting for 5.3% (2 sides). Ⅳ. several superior vesical arteries and one obturator artery, accounting for 7.9% (3 sides). Ⅴ. two superior vesical arteries and one seminal vesicle artery, accounting for 5.3% (2 sides).    Conclusions    The starting site of the umbilical artery is fixed, the diameter of the starting end is narrow and the number of branches is varied.

Study on distribution pattern of cutaneous nerves of ankle and dorsal foot based on Sihler's technique

Lai Baian, Li Hui, Yang Shengbo,

Chinese Journal of Clinical Anatomy. 2022, 40(4):  387-393.  doi:10.13418/j.issn.1001-165x.2022.4.03

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To reveal the overview of distribution pattern of the ankle and dorsal foot cutaneous nerves, and provide morphological guidance for sensory reconstruction in skin flap transplantation. Methods    The skin of ankle and dorsal foot with subcutaneous fat was removed from 24 adult cadavers, and the distribution pattern of cutaneous nerve was displayed by the modified Sihler's staining method.   Results   In the specimen stained with Sihler's staining, the distribution pattern of the cutaneous nerve branches can be seen by naked eyes. The saphenous nerve innervated (40.01±7.6) % of the anterior ankle, (30±6.7) % of the posterior ankle, and part of the medial border of the dorsal foot. The superficial peroneal nerve innervated the (60.03±6.8) % of anterior ankle. The medial dorsal cutaneous nerve innervated the medial dorsal foot, the dorsum of the first and second toe, and the medial half of dorsum of the third toe. 95.83 % of the intermediate dorsal cutaneous nerve innervated the lateral half of dorsum of the third toe, and the dorsum of the fourth and the fifth toe. The sural nerve innervated (70±5.3) % of the posterior ankle, and the dorsolateral cutaneous nerve innervated the dorsolateral border of the foot. The deep peroneal nerve distributed to the opposite side of the first and second toes. The density of the primary nerve branches was the highest in the anterior ankle, and the density of the secondary and subsequent nerve branches and the total nerve branches were the highest in the dorsomedial region of the foot.    Conclusions  In the flap transplantation of ankle or dorsal foot, it is suggested that the anterior ankle region or the medial dorsal foot region should be designed as the preferred donor site for sensory reconstruction or the recipient site with higher sensory needs.

Feasibility study on reconstruction of blood supply by anastomosing ruptured retinacular artery in the femoral head

Zhang Songqiang, Zhou Guangliang, Deng Wei, Zhang Xiangnan, Ju Faxin, Li Lei, Ju Wen, Zhou Zhenghu, Li Guanxing, Ju Jihui, Hou Ruixing

Chinese Journal of Clinical Anatomy. 2022, 40(4):  394-397.  doi:10.13418/j.issn.1001-165x.2022.4.04

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Objective    To investigate the feasibility of reconstruction of blood supply by anastomosing ruptured retinacular artery in the femoral head.     Methods     Twenty cases of fresh hip specimens of adult pig were randomly selected to infuse the femoral head with barium sulfate suspension through the extracapsular arterial ring. The distribution of each retinacular artery and running characteristics after entering the femoral head were observed. In the other 20 cases, the model of subcapital femoral neck fracture was established firstly. On the surface of the femoral head, a triangle bone groove was pried to expose the retinacular artery in the femoral head. The broken end of the blood vessel in the femoral head side were carried out with the broken end of the blood vessel in the femoral neck side by the end-to-end anastomose. Finally, the barium sulfate suspension was used to detect the patency of anastomotic vessels and perfusion of femoral head.    Results    In the 20 perfused specimens, there were three groups of retinacular arteries supplying blood to the femoral head. After entering the femoral head, the initial parts of the retinacular arteries in the femoral head all traveled along the cortex. In the other 20 cases, the barium sulfate suspension can pass the anastomotic stoma smoothly. After continuous perfusion, other arteries in the femoral head were filled with barium sulfate suspension.    Conclusions    It is feasible to anastomose the ruptured retinacular artery with the femoral head, which can restore the blood supply of the femoral head.

Digital evaluation of the age-related changes of the iliosacral screw pathway in adolescents

A Lamusi, Zhang Yuanzhi, Hu Xufeng, Liu Gang, Liu Yaou, Mo Weipeng, Hao Xiaodong, Li Yanbing

Chinese Journal of Clinical Anatomy. 2022, 40(4):  398-403.  doi:10.13418/j.issn.1001-165x.2022.4.05

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Objective    To explore the rule of the aging change of the screw pathway through digital analysis, measurement of the safety sacral screw pathway of adolescents.    Methods     The pelvic CT scan data of 160 healthy adolescent volunteers aged 10~17 years old were collected in this research. The width of the axial "narrow point" of the optimal transverse sacroiliac screw placement channel of the S1, S2 was measured bilaterally by three-dimensional reconstruction. The length of the screw pathway through the "trans-sacral trans-iliac" (TSTI) at the superior screw pathway, and the width of the long and short axis of the TSTI pathway projection of the S1 and S2 were measured at the same time, and the changes of the pathway with age were observed.    Results    S1 sacroiliac screw safety pathway width was left (8.96±2.02) mm, right (9.03±2.24) mm in male; left (8.26±1.96) mm, right (8.37±2.11) mm in female. Sacral length of S1 TSTI screw was (141.25±5.92) mm in male, (134.37±5.68) mm in female. S2 sacroiliac screw safety pathway width was ( left (6.49±1.98) mm, right (6.38±1.88) mm in male; left (6.21±1.76) mm, right (6.14±1.55) mm in female. Sacral length of S2 TSTI screws was (126.28±4.94) mm in male, (122.31±5.13) mm in female.    Conclusions    There are radiologically safe bony iliosacral screw pathways in both S1 and S2 in adolescents. With the increasing of age, the ratio of the width of the long and short axis of the TSTI pathway projection of the S1 and S2 gradually increases, and the growth rate of height is faster than that of width.

Three-dimensional CT measurement and analysis of mandible in adults in Inner Mongolia

Zhang Kai, Wang Yidan, Dai Lina, Yu Jinghong, Zhang Yunfeng, Jin Feng, Wang Haiyan, Li Xiaohe, Wen Yanxin, Wen Xin, Fan Jianjin, Xie Yuxuan, Ni Min, Zhang Tiexin

Chinese Journal of Clinical Anatomy. 2022, 40(4):  404-409.  doi:10.13418/j.issn.1001-165x.2022.4.06

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Objective  To provide anatomical parameters for adult mandibular defect repair, reconstruction and facial bone remodeling.    Methods    A total of 49 volunteers (21 males and 28 females) were recruited. Seventy-one mandibular shaft specimens were collected for CT scanning. Mimics software was used to establish three-dimensional models of mandible for 120 cases from Inner Mongolia, and mandible indexes of 120 cases from Inner Mongolia were measured. The mandible data of 120 cases from Inner Mongolia were compared bilaterally, in male and female, with modern mandible data from North China. Results    There were no statistical differences in all bilateral measurements between male and female volunteers (P>0.05), except for mandibular angle, male was larger than female, and female was larger than male in mandibular angle.    Conclusions    Compared with other areas of North China, Inner Mongolia population has wider mandible, more prominent jaw, smaller mandibular angle and stronger masticatory muscle. When designing mandibular prosthesis for people in Inner Mongolia, it is more appropriate to design the shape of thick mandibular body, large sagittal cross-section area and small body height and mandibular ramus height.

Application of CT image and reconstruction technique in clinical imaging anatomy of sacral vertebra 

Wang Shiming, Xiao Zhibo, Lu Yunfeng, Liao Junyi, Jin Rui, Li Qiaolin, He Xie

Chinese Journal of Clinical Anatomy. 2022, 40(4):  410-413.  doi:10.13418/j.issn.1001-165x.2022.4.07

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Objective    To observe the anatomical morphology of the sacral vertebra and the position relationship between the sacral vertebra and the pubic symphysis, which provides anatomic basis for the optimal design of the anteroposterior radiography position of the sacral vertebra.    Methods    Pelvic CT images of existing patients were collected randomly. The anatomical morphology of sacral vertebra and its relative positionship with pubic symphysis were observed and analyzed by CT image reconstruction technique.    Results    The sacral vertebra was concave in front, the bottom was upward and the tip was backward and downward. The angle A, between the long axis of the human body and the line M formed by connecting the midpoint of the upper and lower edges of the sacral vertebra, was acute angle. The pubic symphysis was located at the lower position of the anterior middle of the sacral vertebra. The angle B, between the vertical line of the long axis of the human body and the line N formed by connecting the upper edge of the pubic symphysis and the lower edge of the lower sacral vertebra, was positive (that was, the position of the upper edge of the pubic symphysis was lower than the lower edge of the sacral vertebra) accounting for 89.7% of cases (897/1000). The measurement value of angle A in the adolescent group (14~45 years old) was (35.86±6.88)°, which was significantly lower than that in the middle-aged group (46~69 years old) (37.82±6.34)° and the elderly group (>69 years old) (37.60±6.65)° （P<0.05）. The value of angle B in the adolescent group was (10.27±7.02)°, which was significantly higher than that in the middle-age group (8.88±7.23)° and the elderly group (7.83±6.93)° (P<0.05), and there was no significant difference between the middle-age group and the elderly group. The value of angle A (36.12±0.27)° and angle B (6.27±0.25)° in males were significantly lower than those in females (38.03±0.33)° and (12.79±0.33)° (P<0.05).    Conclusions    The CT image reconstruction technique can be used to observe and analyze the anatomical morphology of the sacral vertebra and its relative position with the pubic symphysis. The positional relationship of the sacral vertebra and pubic symphysis were significantly different in different ages and genders, which can provide a reliable anatomic basis for the optimal design of the radiography position of anteroposterior sacral vertebra. 

CT anatomic study of normal left posterior pararenal space

Li Yubiao, Ren Anli, Ding Ning, Zhao Zhe, Dong Xiaohan, Li Zhimin, Dong Peng

Chinese Journal of Clinical Anatomy. 2022, 40(4):  414-417.  doi:10.13418/j.issn.1001-165x.2022.4.08

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Objective    To study the computed tomography (CT) manifestations of normal left posterior pararenal space (LPPrS).    Methods    (1) One cadaver was perfused with latex into the left anterior pararenal space. The anatomical characteristics of the bilateral posterior pararenal space was observed  and the diffusion of perfusion agent in the LPPrS was recorded. (2) The abdominal CT data of 50 normal adult were analyzed to observe the morphology and fat thickness of LPPrS, the vascular display of LPPrS and its relationship with the left posterior renal fascia. The maximal fat thickness of LPPrS at the level of left renal vein and the subcutaneous fat area at the level of the second lumbar vertebra were measured, and their correlation was analyzed.    Results     (1) After entering into the interfacial planes of the left posterior renal fascia, the axial tomography perfusion agent spread along the fiber separation of LPPrS. The posterior pararenal space was menisus in shape with multiple vessels. (2) On the axial CT images, multiple vascular shadows were detected in the LPPrS and mainly located in the lateral and posterior left kidney. The blood vessels passed through the left posterior renal fascia. CT images showed slender separation in the LPPrS. The average maximal fat thickness at the left renal vein level and the subcutaneous fat area at the second lumbar vertebra level were 0.77 cm and 112.37 cm2. The relationship of them was positive (r=0.283, P<0.05). Conclusions     The LPPrS has its own anatomical features. Paying attention to the CT manifestation of the LPPrS is helpful to the imaging diagnosis and treatment of LPPrS lesions and adjacent organs.

Correlation between intestinal ischemia time and GRP78 expression in rats and its significance

Zang Chenghao, Yang Jinwei, Ma Wei, Liang Yu, Liu Kuangpin, Liu Wei, Liu Jie, Wang Guodong, Zhang Sijia, Wu Hongjie, Zhu Kewei, Guo Jianhui, Li Liyan

Chinese Journal of Clinical Anatomy. 2022, 40(4):  418-424.  doi:10.13418/j.issn.1001-165x.2022.4.09

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 Objective    To study the relationship between the degree of apoptosis of small intestinal tissue cells and the expression of GRP78 under different ischemic times.    Methods    Four-week-old female SD rats were randomly divided into a control group and injury groups (20, 40, 60, 80, and 100 minutes of ischemia). They were sacrificed 6 hours after reperfusion. The expression level of DAO in the serum was detected. Small intestine tissue was used to detect cell apoptosis and GRP78 expression, and the survival of rats within one week was observed.    Results    Compared with the control group, with the increasing of ischemia time, the expression of GRP78 in the injury group gradually increased, reached a peak at 80 min. Compared with the injury group at 80 min of ischemia, the expression level of GRP78 mRNA at 100 min decreased significantly. Compared with the injury group at 80 min of ischemia, the GRP78 protein expression level decreased slightly at 100 min. Compared with the control group, with the increasing of ischemia time, the degree of apoptosis in the injury group gradually increased.  Compared with the control group, the longer the ischemic time, the lower the two-week survival rate of the rats.    Conclusions    With the increasing of ischemia time, the degree of apoptosis of rat small intestinal tissue cells in the villous layer and mucosal layer gradually increased. Before 80 min, with the prolongation of rat small intestine ischemia time, the expression level of GRP78 gradually increased. Although the injury degree of small intestine tissue increased at 100 min compared with that at 80 min,  the expression level of GRP78 decreased than that at 80 min. The expression level of GRP78 was closely related to the degree of apoptosis of small intestine tissue cells at different ischemic times.

Effect of Urantide on the expression of ERK1/2 and P38 in the spleen of atherosclerotic rats

Xu Yuhang, Li Ying, Xie Yunpeng, Wang Tu, Cui Haipeng, Zhao Juan

Chinese Journal of Clinical Anatomy. 2022, 40(4):  425-431.  doi:10.13418/j.issn.1001-165x.2022.4.10

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Objective   To observe the effect of Urantide on the expression of ERK1/2 and  P38 in MAPK signaling pathway  in  spleen of  atherosclerotic rats, and to explore the effect and mechanism  of  Urantide  on  ERK1/2 and P38 MAPK signaling pathway in spleen.    Methods    A total of 180 wistar rats were randomly divided into a normal group, an AS group, a Simvastatin group, a Urantide 3 days, 7 days and 14 days group. The thoracic aorta and spleen of rats were observed by HE staining. Immunofluorescence, Western blotting were used to detect the expression of ERK1/2 and P38 in the spleen of rats.    Results    Compared with control group, the HE staining of AS group showed typical AS pathological changes in thoracic aorta, and hyaline degeneration in the central artery of spleen, the positive expression of  p-ERK1/2 and p-P38 protein in the spleen of rats significantly increased (P<0.05). Compared with AS group, the hyaline degeneration in spleen significantly reduced in Urantide groups and Simvastatin group, the positive expression of p-ERK1/2 and p-P38 protein in spleen significantly decreased, especially in the Urantide 14 days group (P<0.05).    Conclusions    Urantide can improve the degree of pathological changes in spleen of AS rats by inhibiting the expression of ERK1/2 and P38.

Effects of Caffeine and Sodium Benzoate on learning and memory ability in rats and its mechanism

Li Jianzhong, Hao Xinghua, Wu Haiping, Wu Zhibing, Zhang Lifang

Chinese Journal of Clinical Anatomy. 2022, 40(4):  432-437.  doi:10.13418/j.issn.1001-165x.2022.4.11

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Objective   To investigate the effects of Caffeine and Sodium Benzoate on learning and memory ability and hippocampal synaptic plasticity in rats.  Methods  Thirty-three SD rats were randomly divided into a control (C), a low-dose Caffeine and Sodium Benzoate (A-LD) and a high-dose Caffeine and Sodium Benzoate group (A-HD), with 11 rats in each group. They were administered by gavage once a day (C: 1 ml of normal saline; A-LD: 60 mg/kg of Caffeine and Sodium Benzoate; A-HD: 120 mg/kg of Caffeine and Sodium Benzoate) for 60 days. The learning and memory ability was detected by Morris water maze test.The expression of synaptophysin (SYN) and postsynaptic density 95 (PSD95) in hippocampus of rats in each group were detected by immunohistochemical staining and Western blot. The dendritic spine density in hippocampal CA1 region was detected by Golgi staining, and the synaptic numerical density (Nv) and surface density (Sv) were detected by transmission electron microscopy and stereological methods.   Results    Morris water maze test showed that there was no significant difference in escape latency between C group and A-LD group (P>0.05). While the escape latency significantly prolonged and the time spent in target quadrant and number of platform crossings significantly reduced in A-HD group compared with C group (P<0.01). Immunohistochemical staining and Western blot showed that there was no significant difference in the expression of SYN and PSD95 in hippocampus between C group and A-LD group (P>0.05), while the expression of SYN and PSD95 in hippocampus of A-HD group significantly reduced compared with C group (P<0.01). Golgi staining and transmission electron microscopy showed that there was no significant difference in the dendritic spine density, Nv and Sv between C group and A-LD group (P>0.05), while the dendritic spine density, Nv and Sv of A-HD group significantly reduced compared with C group (P<0.01).   Conclusions   The high-dose Caffeine and Sodium Benzoate can reduce the hippocampal synaptic plasticity of rats, resulting in the impairment of learning and memory ability.

Research on the permeability of small molecule compound Kartogenin delivery by using cartilage explants

Wen Caining, Ouyang Kan, Zhou Xiaoying, Qin Zhuan, Wang Daping, Duan Li

Chinese Journal of Clinical Anatomy. 2022, 40(4):  438-441.  doi:10.13418/j.issn.1001-165x.2022.4.12

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Objective    To establish a pig articular cartilage explant model and explore its role in drug delivery evaluation to repair osteoarthritis articular cartilage lesion, thus providing a simple and economical strategy for ex vivo study.   Methods   The pig knee joint cartilage was aseptically dissected ex vivo. The cylindric cartilage in diameter of 40 mm was taken using a biopsy tissue puncher. Then, the explants were cultured in a serum-free medium. The penetration study of small molecule compounds was performed using the Rhodamine B labeled- Kartogenin(KGN). After penetration for 12 h, 24 h, and 48 h, each time point was set up for three repeat groups , the explants were obtained for frozen section. The structure of the explants and the penetration process of small molecule drugs in the cartilage of explants were observed by laser confocal microscope, and the fluorescence intensity was analyzed by Image J.   Results   The cartilage explants can maintain the normal morphology and structure in the serum-free culture for 12 h, 24 h, and 48 h ex vivo. The small molecule drug Rhodamine B-KGN emitted red fluorescence under laser confocal microscope. The fluorescence signal in the 48 h group significantly enhanced (P<0.01). The amount and depth of drugs entrance into the explants were gradually increasing.   Conclusions    An evaluation model is successfully established to trace the penetration and distribution of the small molecule compound KGN in the cartilage explant. This study can provide a simple and economical model to evaluate the effect of drug delivery on osteoarthritis cartilage repair.

Protective effects of Ginkgolide B on model rats with Parkinson’ s disease

Ding Xu, Yin Zi, Deng Xiangmin, Zhang Yanjun, Song Xiaoli

Chinese Journal of Clinical Anatomy. 2022, 40(4):  442-446.  doi:10.13418/j.issn.1001-165x.2022.4.13

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Objective    To explore the protective effects of ginkgolide B (GB) on model rats with Parkinson's disease (PD).     Methods     PD rat models were established by intracerebral injection of 6-OHDA, and they were randomly divided into a sham group, a model group, a Madopar group (20 mg/kg) and low-, middle- and high-dose GB groups (15, 30, 60 mg/kg). The rats were randomly divided into a Sham group, a Model group, a GB 60 mg/kg group, a LY294002 group and a GB 60 mg/kg+ LY294002 group, and rotating experiment was used to detect the behaviors of rats. Kit test was used to detect the levels of MDA, SOD and GSH, and ELISA was applied to measure the levels of IL-6, IL-1β and TNF-α. Western blot was applied to detect the expressions of PI3K/Akt signaling pathway proteins in rat substantia nigra and striatal tissue.    Results     After treatment, the number of rotations of rats in Madopar group and middle- and high-dose GB groups was significantly less than that in model group (P<0.05). The levels of MDA, IL-6, IL-1β and TNF-α were significantly lower than those in model group (P<0.05), while the levels of SOD, GSH and protein expressions of p-PI3K, p-Akt were significantly higher than those in model group (P<0.05). Compared with the LY294002 group, the protein expressions of p-PI3K and p-Akt significantly increased (P<0.05), and the levels of MDA and IL-6, IL-1β and TNF-α significantly reduced (P<0.05) while the levels of SOD and GSH significantly increased (P<0.05) in the GB 60 mg/kg+ LY294002 group.   Conclusions    High-dose GB can improve the behaviors of PD rats, enhance the ability of anti-oxidative stress, relieve inflammatory injury, and play a certain protective effect. In addition, its role mechanism may be related to the regulation of PI3K/Akt signaling pathway.

Impact of extent of ischemia and length of delay on the efficacy of flap delay surgery 

Chen Shaofeng , Jing Xing , Fang Fang , Fan Yingjuan, You Xiuhua, Zhuang Yuehong

Chinese Journal of Clinical Anatomy. 2022, 40(4):  447-453.  doi:10.13418/j.issn.1001-165x.2022.4.14

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Objective    To investigate the effect of delayed surgery with different length and various degrees of ischemia on flap survival.    Methods    125 adult ICR mice were randomly divided into 5 groups. In the control group, flaps based on iliolumbar vessels with a size of 4.5 cm×1.5 cm were established. The four delayed groups were divided into vessels-preserved 1- and 2-week delay groups and vessels-transected 1-and 2-week delay groups. After the delay, the same flap model as the control group was established. Then, the necrosis rate of the flap was calculated, the arterial diameter and blood perfusion of the flap were measured by a laser speckle imaging device, and the blood vessels in the flap were marked by a CD31 antibody. The data of each group were statistically compared by one-way ANOVA.    Results    7 days after operation, the flap necrosis rate in each delayed group was lower than that in the control group (P<0.001). The diameter and perfusion intensity of the pedicle and the choke area in the four delayed groups were significantly higher than those in the control group (P<0.05). The survival rate of the flap, the diameter of the pedicle and choke arteries, and the blood perfusion intensity in the two vessels-transected groups were significantly higher than those in the two vessels-preserved groups (P<0.05); There was no significant difference in the various parameters between the 1-week delay group and the 2-week delay group (P>0.05). At 0 days after surgery, the vascular density in the four delayed groups was significantly higher than that in the control group (P<0.001), but there was no significant difference at 7 days after surgery (P=0.883).     Conclusion    The best efficacy can be achieved by delaying only one week. In addition, during the delay period, the flap should be in the state of the most serious ischemia without tissue necrosis.

Finite element analysis and comparison of the models of patellar transverse fracture fixed with hollow screw combined with “8” and “0” tension band wire internal fixation

Cai Hao, Zhou Haibo, Yu Jiahuan, Hu Kai, Meng Hongming, Shou Zeyu, Chen Chun, Bai Zhibiao

Chinese Journal of Clinical Anatomy. 2022, 40(4):  454-459.  doi:10.13418/j.issn.1001-165x.2022.4.15

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Objective    To compare the stability of patellar transverse fracture model fixed by hollow screw combined with “8” and “0” tension band wire fixation systems by finite element analysis (FEA). Methods    Computerized tomography (CT) images were acquired from a 48-year-old healthy male volunteer. A geometric model of patella was firstly built in the computer-aided design (CAD) system, and then imported into the Ansys system. The finite element model of patellar was built without the soft tissue and cartilage. Patellar transverse fracture model was created by intersecting the patella on the median transverse section. The proximal end of the patella was fixed and tractive force was loaded on the distal end of the patella. The models were set in the condition of 90° knee flexion during non-weight-bearing extension with the middle part of the patellar articular surface contacting to a cartilage-covered distal femur.    Results    When the patella transverse fracture was fixed with “8” or “0” tension band wire fixation system, under distraction force of 200 N, the maximum relative displacement of screws were 0.32 mm and 0.20 mm, that of wires were 0.36 mm and 0.21mm and that of patella were 0.35 mm and 0.22 mm, respectively. The maximum equivalent stress of screws were 778.01 Mpa and 941.88 Mpa, that of wires were 311.51 Mpa and 336.24 Mpa, and that of patella was 3.81 Mpa and 3.66 MPa, respectively. Stress concentration was observed in screws and wires in both groups.    Conclusions    When combined with hollow screw in the treatment of patellar transverse fracture, the “0” tension band wire fixation system is more stable than the “8” fixation system based on FEA.

Clinical study of degenerative lumbar spinal stenosis with percutaneous endoscopic guided by electromagnetic navigation

Chen Botao, Fan Xiaohong, Chen Rigao, Yu Yang, Jiang Leiming, Li Qianchun

Chinese Journal of Clinical Anatomy. 2022, 40(4):  460-465.  doi:10.13418/j.issn.1001-165x.2022.4.16

Abstract ( 139 )   PDF (3462KB) ( 58 )  

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Objective    To explore the clinical application value of degenerative lumbar spinal stenosis through the intervertebral foramen with percutaneous endoscopic guided by electromagnetic navigation. Methods   A retrospective cohort study was performed. From Sep 2018 to Sep 2019, 63 patients with degenerative lumbar spinal stenosis were treated with percutaneous endoscopic, who were divided into a navigation group (n=27) and a conventional group (n=36). The demographic characteristics and operation-related indexes of the two groups were recorded. Visual analog scale (VAS) and Japanese Orthopedic Association scores (JOA) were used to evaluate and analyze the clinical efficacy.    Results    There was no significant difference in the demographic characteristics and preoperative clinical features between the two groups (P>0.05). There were significant differences in fluoroscopy times, puncture and operation time, postoperative hospital stays between the two group (P<0.05), and there were significant differences in VAS score and JOA score of leg pain preoperative and postoperative in each group (P<0.05). There was no significant difference in the recurrence rate between the two groups (P>0.05).   Conclusions   Percutaneous endoscopic treatment of lumbar spinal stenosis guided by electromagnetic navigation can reduce the fluoroscopy times, puncture and operation time, postoperative hospital stays, thus reducing the radiation exposure during operation and improving the efficiency of positioning and punctruing.

Clinical effect analysis of reconstruction of posterior cruciate ligament from personal tendon under  arthroscopy

Li Bingkun, Zhang Lei, Xia Zhangrong, Zhou Xin, Tang Xiaogao, Fu Shijie, Wang Guoyou, Huang Wenhua

Chinese Journal of Clinical Anatomy. 2022, 40(4):  466-470.  doi: 10.13418/j.issn.1001-165x.2022.4.17

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Objective   To investigate the clinical effect and prognosis of reconstruction of posterior cruciate ligament (PCL) with peroneal longus tendon and semitendinosus tendon autografts under  arthroscopy.    Methods   The clinical data of 33 patients who met the inclusion criteria and treated with PCL rupture in the Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University from June 2018 to May 2019 were retrospectively analyzed. Posterior cruciate ligament reconstruction with autologous peroneus longus tendon and tendon of semitendinosus under arthroscopy were performed. The IKDC score, Lysholm score, Tegner score and the backwards distance of tibial plateau were compared before operation, 3 months, 6 months and 12 months after operation to evaluate comprehensive function of the knee joint.   Results    The X-ray and MRI of the patient 12 months after operation showed that the screw position was securely fixed without rupture or release, union of bone canal, and the PDT turned negative. The backwards distance of tibial plateau 12 months after operation was obviously shorter than that  before operation, (11.33±1.45) cm VS(3.27±0.80) cm, P<0.05. after operation of 3 months, 6 months, and 12 months, The backwards distance of tibial plateau increased slowly at 3, 6, 12 months postoperatively (2.94±0.90), (3.18±0.84) and (3.27±0.80) cm, respectively, without statistical difference. At 3, 6, and 12 months after operation, the IKDC scores were (70.97±2.59), (86.18±1.78), (92.67±2.13), respectively, compared with (50.33±3.31) before operation, P<0.05.  Lysholm scores were (73.52±2.59), (87.12±1.93), (93.94±1.98), respectively, compared with (51.82±3.95) before operation, P<0.05.  Tegner scores were (5.21±0.74), (7.67±0.85), (8.52±0.57), respectively, compared with (1.97±1.10) before operation, P<0.05 The function was improved significantly, the comparison between scores was gradually increased, with significant difference.   Conclusions   The clinical effect of posterior cruciate ligament reconstruction with autologous peroneus longus and semitendinosus tendon under arthroscopy is definite with fewer complications. Besides, the surgery can significantly improve knee joint function, pain and stability, which is worthy of recommendation.

Efficacy comparison of fibular strut combined with hollow screw versus via the trans-fibular approach locking plating for tibial pitch and calcaneal arthrodesis 

Zheng Jiafa, Li Rongjun, Song Xiufeng

Chinese Journal of Clinical Anatomy. 2022, 40(4):  471-475.  doi:10.13418/j.issn.1001-165x.2022.4.18

Abstract ( 200 )   PDF (3470KB) ( 63 )  

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Objective　To compare the clinical efficacy of the trans-fibular approach locking plating versus fibular strut combined with hollow screw for tibial pitch and calcaneal arthrodesis.　Methods　A retrospective study was performed on the 87 patients who had undergone tibial pitch and calcaneal arthrodesis from June 2016 to June 2019 in our department. 41 were treated by fibular strut combined with hollow screw (fibular flap group) and 46 by locking plating (locking plate group). The operation time, drainage volume, fusion rate, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Scale, visual analogue scale(VAS) and complications were compared between the two groups.　Results　All patients received successful operation. There was no statistical difference in the operation time between the two groups (P>0.05). Postoperative drainage volume of fibular flap group was (253.6±34.7) mL and locking plate group (212.8±20.1) mL, there were statistical differences in the postoperative drainage volume between the two groups (P<0.05). The fusion rate at 10 weeks after operation of the locking plating group was (73.9 %) significantly lower than that of the fibular strut combined with hollow screw group (95.1 %) (P<0.05). There was no statistical difference in the fusion rate at 6 months after operation, AOFAS score, VAS score at 12 months after operation (P>0.05). All incisions were healed in the first stage and the fibula osteotomy site irritation appeared in 3 patients in the locking plate group.　Conclusions　Both open lateral ankle locking plating and fibular strut combined with hollow screw are effective procedure to tibial pitch and calcaneal arthrodesis. The fibular strut combined with hollow screw preserves part of the blood supply of the fibula and can achieve faster fusion. In addition, the irritation symptoms of the fibula osteotomy site is not obvious, and the shape of the ankle joint after fusionalso has advantages. 

The effect of suture Nice knot tension band combined with lag screw fixation for simple transverse olecranon fracture

Wang Tianfang, Cai Li, Shi Haifeng, Yin Qudong, Wu Yongwei

Chinese Journal of Clinical Anatomy. 2022, 40(4):  476-479.  doi:10.13418/j.issn.1001-165x.2022.4.19

Abstract ( 254 )   PDF (1705KB) ( 13 )  

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Objective    To investigate the effect of the suture Nice knot tension band combined with lag screw fixation for simple transverse olecranon fracture.    Methods    From January 2016 to December 2020, 23 cases of simple transverse olecranon fracture were fixed with suture Nice knot tension band and lag screw. There were 14 cases of Mayo type IIA and Mayo 3 cases of type IIIA , as well as 6 cases of olecranon transverse osteotomy for comminuted fracture of intercondylar humerus. Elbow flexion and extension motion were started on the second day after operation. The fracture healing, limb function recovery and complications were recorded.   Results  All patients were followed up for 12 to 28 months, with an average follow-up of (17.5±2.7) months. There were no screw breakage and obvious discomfort caused by screw withdrawal stimulation. All the fractures healed, the average healing time was (2.3±0.5) months. At 3 months and 1 year postoperatively, the average flexion and extension range of elbow joint were (103.5±22.0) ° and (127.1±34.0) °, respectively. The average pronation range were (72.2±7.0) ° and (80.8±7.5) °, respectively. The average supination range were (70.9±6.7) °and (78.2±8.0) °,There were statistical difference between before operation and 3 months and 1 year  after operation (P<0.05). At the last follow-up, the Mayo elbow performance score averaged was (87.7±8.3), the excellent and good rate was 91.3%, the removal rate of internal fixation was 26.1%, of which, the required removal rate of internal fixation was 4.35%.    Conclusions    Suture Nice knot tension band and lag screw fixation for simple transverse olecranon fracture has the advantages of simple performance, rapid and satisfactory functional recovery of elbow joint, lest complications and lower removal rate of internal fixation.

Comparison of clinical efficacy of cystic plate approach and traditional approach in laparoscopic cholecystectomy for gallstone patients

Xiao Le, Jiang Zongxing, Luo Hao, Wang Tao, Tan Zhen, Wang Tao

Chinese Journal of Clinical Anatomy. 2022, 40(4):  480-484.  doi:10.13418/j.issn.1001-165x.2022.4.20

Abstract ( 388 )   PDF (3039KB) ( 190 )  

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Objective   To explore the safety, feasibility and advantages of cystic plate approach in laparoscopic cholecystectomy.    Methods    The clinical data of 110 cases of laparoscopic cholecystectomy via cystic plate approach (experimental group) and 170 cases of traditional laparoscopic cholecystectomy (control group) who went to our center from July 2016 to December 2019 was retrospectively analyzed. The gender, age, size and number of stones, operation time, conversion rate, intraoperative blood loss, the number of clips used, postoperative hospital stay, complication rate, the amount of postoperative drainage fluid were compared between the two groups to evaluate the therapeutic effect and clinical value of different techniques. Results   There was no statistical difference in general conditions, operation time, conversion rate, postoperative hospital stay, and complication rate between the two groups (P>0.05). The intraoperative blood loss (P=0.004), the number of clips used (P=0.000), the amount of postoperative drainage fluid (P=0.005), the postoperative pain (P=0.015) in the experimental group were less than those in the control group.  Conclusions   Laparoscopic cholecystectomy via the gallbladder plate approach is safe and feasible, and theoretically has the advantage of avoiding the risk of intraoperative biliary tract injury.

Correlation between preoperative hypoalbuminemia and prevalence of adverse events after posterior lumbar interbody fusion

Li Xin, Zhang Guowei, Wan Jiangtao, Qiu Xianshuai, Zhang Fu, Dai Jingxing, Min Shaoxiong

Chinese Journal of Clinical Anatomy. 2022, 40(4):  485-490.  doi:10.13418/j.issn.1001-165x.2022.4.21

Abstract ( 201 )   PDF (2388KB) ( 23 )  

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Objective  To investigate the correlation between preoperative hypoalbuminemia and prevalence of adverse events after posterior lumbar interbody fusion (PLIF).    Methods     Patients diagnosed with lumbar degeneration disease (LDD) who underwent PLIF in our hospital from January 2017 to December 2019 were selected and categorized based on preoperative serum albumin concentration: a low albumin group (n=91, ALB<35g/L); a normal albumin group (n=1281, ALB≧35g/L). The adverse events within 3 months after operation were recorded and compared, including: transfer to the intensive care unit (ICU) for monitoring transition, postoperative specific complications, readmission, incision infection, and poor healing. Multivariable logistic regression analysis model adjusting confounders was used to assess the relationship between preoperative serum albumin levels and adverse postoperative outcomes, and the relationships between preoperative hypoalbuminemia and rates of adverse postoperative outcomes.    Results    A total of 1372 patients, including 597 males and 775 females, with the average age (58.11±12.56) years old data study showed that preoperative albumin levels were closely related to the occurrence of adverse postoperative outcomes (OR=0.94; 95%CI: 0.90~0.98; P<0.05). Compared with patients in the preoperative normal albumin group, the risk of adverse postoperative outcomes in the preoperative low albumin group was 2.15 times that of the normal albumin group (OR=2.15; 95% CI: 1.21~3.79; P<0.05).   Conclusions    Patients with preoperative hypoalbuminemia will significantly increase the incidence of adverse outcomes after PLIF. The preoperative serum albumin level can be used as an important reference index for predicting adverse outcomes after PLIF.

Effect and prognosis of oblique lateral interbody fusion in the treatment of degenerative lumbar spinal stenosis and its influence on oxidative stress index levels

Li Rui, Xu Caiyuan, Sun He, Zhang Yilong

Chinese Journal of Clinical Anatomy. 2022, 40(4):  491-496.  doi:10.13418/j.issn.1001-165x.2022.4.22

Abstract ( 147 )   PDF (1700KB) ( 28 )  

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Objective   To investigate the effect of oblique lateral interbody fusion (OLIF) in the treatment of degenerative lumbar spinal stenosis (DLSS).    Methods    A total of 103 DLSS patients in our hospital were selected. According to the treatment method, they were divided into an OLIF group (n=51, OLIF operation), a posterior lumbar intervertebral fusion (PLIF) group (n=52, PLIF operation). The curative effect, surgical conditions and perioperative serum inflammatory factors, oxidative stress indicators, spinal cord function, the Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) were compared between the two groups.    Results    The perioperative index and the effect of 1 year after operation in the OLIF group were better than those in the PLIF group (P<0.05). The levels of serum inflammatory factors in the OLIF group were lower than those in the PLIF group at 1 day and 3 days after operation (P<0.05). The levels of serum advanced oxidation protein products (AOPP) and malondialdehyde (MDA) in the OLIF group were lower than those in the PLIF group at 1 and 3 days after the operation, and the superoxide dismutase (SOD) level was higher than that in the PLIF group (P<0.05). The nerve conduction velocity (NCV) level and JOA score of the tibial nerve and common peroneal nerve in the OLIF group were higher than those in the PLIF group at 6 months and 1 year after the operation, while the latency (DL) and the VAS scores of waist and leg pain were lower than those of the PLIF group (P<0.05).    Conclusions    OLIF is effective in the treatment of DLSS, with less trauma. 

The influence of the main nucleus of hypothalamus on blood glucose

Zhou Li, Ran Xuerui, Wang Zhiyong

Chinese Journal of Clinical Anatomy. 2022, 40(4):  497-499.  doi:10.13418/j.issn.1001-165x.2022.4.23

Abstract ( 166 )   PDF (493KB) ( 21 )  

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Research progress on the mechanism of metformin inhibiting medulloblastoma through Sonic Hedgehog pathway

Zhang Zhongding, Fang Huangyi, Sheng Hansong

Chinese Journal of Clinical Anatomy. 2022, 40(4):  500-502.  doi:10.13418/j.issn.1001-165x.2022.4.24

Abstract ( 186 )   PDF (495KB) ( 96 )  

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Bilateral hilum position variation

Deng Rudong, Li Hui, Wang Yisan, Chen Yiran, Huang Junting

Chinese Journal of Clinical Anatomy. 2022, 40(4):  459.  doi:10.13418/j.issn.1001-165x.2022.4.25

Abstract ( 132 )   PDF (636KB) ( 46 )  

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A case of carpal tunnel syndrome caused by two bundle variation of median nerve

Chen Buguo, Wu Zhenzhi , Dong Ziqaing, Wu Yao, Zheng Dawei, Zhu Hui

Chinese Journal of Clinical Anatomy. 2022, 40(4):  503.  doi:10.13418/j.issn.1001-165x.2022.4.26

Abstract ( 288 )   PDF (1156KB) ( 212 )  

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