Information
Chinese Journal of Clinical Anatomy
(Founded in July 1983 Bimonthly)
Responsible Institution: China Association for Science and Technology
Sponsor: Chinese Society of Anatomical Sciences
Editing and Publishing: Editorial Board of Chinese Journal of Clinical Anatomy
Advisor: ZHONG Shi-zhen
Editor-in-chief: OUYANG Jun
Former Editor-in-chief: XU Da-chuan
Overseas Distributor: China International Book Trading Corporation (P.O. Box 399, Beijing, China, Code No. BM5961)
Address: 1023 Shatainan Road, Guangzhou, 510515, China
Tel: (020)61648203
E-mail: journal@chjcana.com
CN: 44-1153/R
ISSN: 1001-165X
25 September 2024, Volume 42 Issue 5
  • Expert consensus on the anatomical characteristics and localization methods of perforators of anterolateral thigh flap (2024 edition)
    Xu Yongqing, Tang Juyu, Liu Yuanbo, Zhou Zhengbing...
    2024, 42(5):  489-499.  doi:10.13418/j.issn.1001-165x.2024.5.01
    Abstract ( 55 )   PDF (4807KB) ( 64 )  
    The anterolateral thigh flap (ALTF), often referred to as a "versatile flap" due to its versatility, is extensively utilized in clinical repair and reconstructive surgery. This surgical flap involves using the anterolateral thigh as the donor site, primarily depending on the perforating branches of the lateral circumflex femoral artery (LCFA) for its blood supply. To comprehensively review and summarize the research findings regarding the anatomical characteristics and location of the perforators of the ALTF, the Microsurgery Branch of the Chinese Medical Association, the Clinical Anatomy Branch of the Chinese Society for Anatomical Sciences, and the Editorial Board of the Chinese Journal of Clinical Anatomy have taken the initiative to organize numerous domestic experts specializing in microsurgical repair and reconstruction. These experts convened to deliberate and formulate the "Expert Consensus on the Anatomical Characteristics and Localization Methods of Perforators of the Anterolateral Thigh Flap (2024 Edition)". The consensus aims to further advance the clinical application of the ALTF and to acknowledge the contributions of Chinese scholars to the advancement of ALTF techniques.
    The anterolateral thigh flap continue to discover new world 
    Tang Maolin, Cui Huairui
    2024, 42(5):  500-503.  doi:10.13418/j.issn.1001-165x.2024.5.02
    Abstract ( 2335 )   PDF (586KB) ( 32 )  
    Anterolateral thigh flap: omnipotent flap and implement of reconstruction-Experience of more than 1,000 clinical applications for 38 years
    Zhang Chun
    2024, 42(5):  504-509.  doi:10.13418/j.issn.1001-165x.2024.5.03
    Abstract ( 1663 )   PDF (10362KB) ( 32 )  
    Anterolateral thigh flap is known as "omnipotent flap" because of its excellent anatomical characteristics and wide applicability. This article is a summary of the clinical application of more than 1,000 cases of anterolateral femoral flap in 38 years. We share the author's experience of learning, researching and applying the anterolateral thigh flap, introduce the process of expanding the application range of the flap and discovering the high perforating branch, and summarize the operative indications and skills. It is hoped to make a modest contribution to the research, development and promotion of anterolateral thigh flap.
    Individualized precision design of anterolateral thigh perforator flaps: a clinical effectiveness analysis of 1079 cases over ten years
    Tang Juyu, Sun Nianzhe, Wu Panfeng, Yu Fang, Zeng ...
    2024, 42(5):  510-516.  doi:10.13418/j.issn.1001-165x.2024.5.04
    Abstract ( 1853 )   PDF (2704KB) ( 32 )  
    Objectives   To investigate the clinical efficacy of individualized precision design using anterolateral thigh perforator flaps for reconstructing various complex tissue defects.    Methods   A retrospective analysis was conducted on 1079 patients who underwent reconstruction using individualized precision-designed anterolateral thigh perforator flaps at our department from January 2013 to January 2023. The descending branches of the lateral circumflex femoral artery were utilized as the vascular pedicle (including 65 pediatric cases) in 1013 cases, transverse branches in 40 cases, oblique branches (including 1 pediatric case) in 26 cases, and descending branch of the medial circumflex femoral artery or femoral artery perforators as the pedicle in 9 cases. Procedures included 441 cases of free flap transplantation, 27 cases of pedicle transfer, 511 cases of basic types of special form perforator flaps, and 100 cases of derivatives. Defects repaired included 787 cases in the lower limbs, 264 cases in upper limbs, 17 cases in trunk, 4 cases in head-neck region and 7 cases in multiple sites. Postoperative clinical outcomes and complication rates of various individualized precision designs of anterolateral thigh perforator flaps were statistically analyzed and compared.   Results   Among the 1079 cases of anterolateral thigh perforator flaps, 1063 cases survived postoperatively, with 14 cases undergoing vascular exploration due to vascular crisis, yielding an overall success rate of 98.52%. Comparison of success rates among free anterolateral thigh perforator flaps, pedicled flaps, basic types and derivatives of special form perforator flaps revealed no significant differences in success rates (P>0.05). Complications included venous crisis in 35 cases (3.24%), arterial crisis in 22 cases (2.04%), infection in 19 cases (1.76%), delayed wound healing in 6 cases (0.56%), complete necrosis in 16 cases (1.48%), and partial necrosis in 35 cases (3.24%). In terms of venous crisis, the incidence rate of perforator flaps in basic types group was lower than that in derivatives group (P<0.001). Regarding wound infection, the incidence rate in pedicled flap group was higher than that of basic types group (P = 0.007). For delayed wound healing, the incidence rate of perforator flaps in traditional free flaps group was higher than that in basic types group (P = 0.04). In terms of partial flap necrosis, the incidence rate in pedicled flap group was higher than that of basic types group (P=0.008).    Conclusions   Individualized precision design of anterolateral thigh perforator flaps could achieve favorable clinical outcomes and merit further clinical application and promotion.
    Analysis of related factors of postoperative necrosis in 1260 cases of free anterolateral thigh flap transplantation
    Tao Xianyao, Xue Mingyu, Mi Jingyi, Shi Haifeng, L...
    2024, 42(5):  517-522.  doi:10.13418/j.issn.1001-165x.2024.5.05
    Abstract ( 1832 )   PDF (574KB) ( 24 )  
     Objective    To summarize the influencing factors of free anterolateral thigh flap necrosis in our hospital, and to discuss and analyze the related influencing factors.   Methods   A total of 1260 free anterolateral femoral flaps operated in our hospital from June 2014 to June 2024 were collected, and 23 related influencing factors were analyzed, including patient characteristics, preoperative factors, intraoperative factors, postoperative factors. Univariate analysis and multivariate logistic regression analysis were performed on these influencing factors and the results of flap necrosis.   Results    1260 free anterolateral thigh flaps survived in 1167 cases (92.6%) and necrotic in 93 cases (7.4%). Statistical analysis showed that the number of venous anastomosis, flap infection, subflap hematoma, vascular crisis were closely related to the necrosis of the free anterolateral femoral flap.   Conclusions   Venous vascular anastomosis (≥2) can increase blood return and make the flap more viable, and thorough debridement, precise hemostasis and adequate drainage during surgery can reduce the occurrence of flap infection and hematoma, reduce flap necrosis, and timely detection and treatment of arteriovenous crisis after surgery can improve the survival rate of flap.
    Localization of perforating branch  and optimal design of anterolateral thigh flap
    Wei Zairong
    2024, 42(5):  523-528.  doi:10.13418/j.issn.1001-165x.2024.5.06
    Abstract ( 1913 )   PDF (1579KB) ( 29 )  
    Anterolateral thigh flap (ALTF) was first reported by Chinese scholars, and after 40 years of in-depth research by domestic and foreign scholars, it has been continuously innovated, and is known as "universal flap". Up to now, there were nearly 20 perforator mapping methods to assist ALTF localization of perforating branch, and there were nearly 20 flap design and incision schemes. Based on the applied anatomy of ALTF, perforator mapping methods and optimal design, this paper summarized the selection of perforator mapping methods and various flap optimization design of ALTF engaged in by the author for more than 10 years in order to further improve its clinical application value.
    Personalized reconstruction of maxillofacial defects using anterolateral thigh flap
    Jiang Canhua, Fu Xinyao, Zhu Feiya
    2024, 42(5):  529-534.  doi:10.13418/j.issn.1001-165x.2024.5.07
    Abstract ( 1904 )   PDF (3135KB) ( 12 )  
    Digital anatomical study of the lateral circumflex femoral artery and its branching patterns
    Zhang Xing, Wu Panfeng, Li Cheng, Zhou Xiaobing, T...
    2024, 42(5):  535-542.  doi:10.13418/j.issn.1001-165x.2024.5.08
    Abstract ( 1825 )   PDF (7597KB) ( 20 )  
    Objective To provide vascular anatomical evidence for the design and harvesting of anterolateral thigh perforator flaps. Methods Thirty-four fresh adult cadavers underwent whole-body vascular angiography, CT scanning, 3D reconstruction, and specimen dissection for comprehensive analysis. The branches, course, and distribution areas of the lateral circumflex femoral artery were observed. Anatomical validation was then performed in accordance with the design and harvesting steps of the flap surgery, using 3D reconstructed images. Results A total of 408 anterolateral thigh skin perforators were observed in 65 effective specimens (an average of 6.3 per side), of which 391 originated from the lateral circumflex femoral artery system, accounting for 95.8% (391/408). The distribution among the branches of the lateral circumflex femoral artery was as follows: ascending branch 9.1% (37/408), transverse branch 16.4% (67/408), descending branch 60.8% (248/408), and oblique branch 9.6% (39/408). The external diameters of the perforator origin were (0.7±0.3) mm, (0.9±0.4) mm, (1.1±0.5) mm, and (0.8±0.3) mm, respectively. Seventeen perforators originated from the deep femoral artery, medial circumflex femoral artery, femoral artery, or superficial circumflex iliac artery, accounting for 4.2%, with an external diameter of (0.7±0.3) mm at the origin. Conclusions (1)The descending branch of the lateral circumflex femoral artery remains the primary source vessel for anterolateral thigh perforator flaps. (2)High-level skin perforators mainly originate from the transverse and ascending branches of the lateral circumflex femoral artery. (3)Oblique branches often originate from the common trunk of the ascending and transverse branches, possess a certain external diameter and pedicle length, and can be used as the pedicle for flap harvesting. (4)In cases where the perforators originating from the lateral circumflex femoral artery are thin or absent, flaps can be harvested from high-level skin perforators originating from the medial circumflex femoral artery, femoral artery, or other source vessels.
    Clinical application of anterolateral thigh perforator propeller flaps and alternative solutions
    Du Qingyan, Zang Mengqing, Zhu Shan, Li Shanshan, ...
    2024, 42(5):  543-548.  doi:10.13418/j.issn.1001-165x.2024.5.09
    Abstract ( 1705 )   PDF (2449KB) ( 8 )  
    Objective    To explore the clinical applications of the anterolateral thigh (ALT) perforator propeller flap and its alternatives in repairing different regions.   Methods   Between November 2009 and December 2023, a total of 45 patients were prepared for the harvest of the ALT propeller flap and reviewed. The clinical application and alternatives of the ALT perforator propeller flap were summarized.   Results    Of the 45 patients, 39 cases of (86.7%) ALT perforator propeller flap were harvested as planned; six (13.3%) were converted to other perforator propeller flap due to lack of suitable perforators in the ALT region. Among them, the source blood vessels of other perforating branch of propeller flap included femoral rectus branch in 2 cases.  one case from the transverse branch of the lateral circumflex femoral artery, one case of the femoral artery, one case of the profunda femoris artery, and one case of the superior lateral genicular artery, respectively. Two flaps developed obstruction of venous congestion, one survived after conservative treatment, and one had distal flap necrosis, which was salvaged with a peroneal artery perforator propeller flap. Conclusions    The ALT perforator propeller flap can be used to reconstruct defects located from the groin to the knee. When the perforators in the ALT region are not available, perforators from the rectus femoris branch, femoral artery, superior lateral genicular artery, or profunda femoris artery can be used as the pedicle for harvesting a perforator propeller flap which can be used for defect reconstruction.
    A retrospective clinical study of 41 cases of distally based anterolateral thigh flaps based on a new classification
    Du Qingyan, Zang Mengqing, Zhu Shan, Tong Dedi, Li...
    2024, 42(5):  549-554.  doi:10.13418/j.issn.1001-165x.2024.5.10
    Abstract ( 1692 )   PDF (4969KB) ( 9 )  
    Objective   To investigate the characteristics and surgical attentions of the distally-based anterolateral thigh (dALT) flap in order to improve the success rate of operation.   Methods   A retrospective analysis of 41 patients treated from November 2010 to February 2023 to repair soft tissue defects around the knee joint with dALT flaps. The dALT flap was classified into type I, type II, or type III based on the origin (the descending, oblique, or transverse branch) of the chosen perforator. The vascular pedicle length, repaired defect location, and flap outcome of different types were compared.    Results    The type Ⅰ flap had a shorter vascular pedicle that primarily reached closer regions (distal third of the thigh and anterior/lateral knee) (62.5%,15/24). Type Ⅱ and type Ⅲ flaps had longer pedicles that mostly reached more distal regions (medial/posterior knee and proximal third of the leg) (84.7%, 11/13; 100.0%, 4/4). However, the type Ⅲ flaps had higher complication rate (50.0%) and flap necrosis rate (25.0%).   Conclusions   To achieve more desirable outcomes using the dALT flap, preoperative assessment of vascular pedicle length and proper intraoperative maneuvers that avoid compromising the reverse blood circulation are necessary. 
    Bilateral femoral anterolateral free myocutaneous flap transplantation for the repair of large chest wall defect
    Yu Junyi, Song Dajiang, Li Zan, Zhou Bo, Lv Chunli...
    2024, 42(5):  555-559.  doi:10.13418/j.issn.1001-165x.2024.5.11
    Abstract ( 1656 )   PDF (3487KB) ( 7 )  
    Objective    To summarize the clinical results and experience of combined transplantation of bilateral free anterolateral thigh myocutaneous flaps to repair large full-thickness chest wall defects after radical resection of tumor.    Methods    From January 2011 to December 2018, 22 patients who needed full-thickness chest wall reconstruction by using using bilateral femoral anterolateral free myocutaneous flap combined with titanium alloy scaffold or bone cement were admitted to our unit. The area of chest wall defect ranged from 300 cm2 to 700 cm2 (median area was 360 cm2). A total of 44 myocutaneous flaps were designed and harvested, with skin area of (173.55±67.78) cm2 and muscle area of (158.68±94.93) cm2. The flaps were transferred to the chest wall defect, and the arteries were anastomosed in end-to-end manner. According to the number of available arteries in the recipient area, the arterial blood supply of the two musculocutaneous flaps was reconstructed by outer-supercharging or inner-supercharging. During venous anastomosis, different anastomosis strategies were adopted according to the number and pattern of different veins in the vascular pedicle and recipient area.  Results   All 44 myocutaneous flaps from 22 patients survived, while 1 myocutaneous flap had partial necrosis at the distal end, and the wound healed after debridement. All 44 wounds at the donor sites of bilateral thighs healed smoothly, leaving only linear scars. Patients were followed up for 6 to 36 months (18.27±8.62 months), and no local recurrence was found. Bone metastasis was found in one breast cancer patient. The texture of the reconstructed chest wall was good, the patient's breathing was normal, the muscle strength and joint activity of both lower limbs were not affected, and the patient's satisfaction was high.   Conclusions   The combined transplantation of bilateral free anterolateral thigh myocutaneous flaps can cover the chest wall defects well. At the same time, according to the different vascular anatomy, the myocutaneous flaps can protect the function of the donor site to the greatest extent, which is a reliable method for chest wall reconstruction.
    Clinical application of lateral femoral musculocutaneous flap free transplantation in treatment of chronic intractable empyema 
    Liu Yiyang, Zhang Chun, Guo Qiaofeng, Shen Lifeng,...
    2024, 42(5):  560-563.  doi:10.13418/j.issn.1001-165x.2024.5.12
    Abstract ( 1618 )   PDF (3699KB) ( 9 )  
     Objective    To investigate the efficacy, advantages, disadvantages and application value of lateral femoral musculocutaneous flap free transplantation in the treatment of chronic refractory empyema.   Methods    From May 2015 to June 2021, 16 cases (including 13 males and 3 females) aged (51.19±17.42) years of chronic refractory empyema were treated with lateral femoral musculocutaneous flap free transplantation. The lateral femoral musculocutaneous flap was transplanted after full debridement of pus cavity. In 1 case, the lateral femoral muscle was transplanted in two sides, and the rest were transplanted in one side.    Results    During the follow-up of (20.94±8.27) months, 1 case died of tumor recurrence 6 months after operation, all the muscle flaps survived, and 2 cases of partial skin-flap necrosis were sutured directly after debridement. The abscess cavity was well filled in all cases. Postoperative pulmonary infection occurred in 1 case, which was cured after bronchoscopic closure of pleural fistula. None of the patients had symptoms such as chest tightness. The donor areas of the lower limb muscle flap were sutured directly and healed well. Walking function and knee joint activity were not significantly affected.    Conclusions    The  lateral femoral muscle has constant blood vessels, clear anatomy,  long and wide muscle shape and large volume, which can effectively fill the cavity formed by empyema and close the wound. This operation not only broadens the application range of lateral femoral musculocutaneous flap, but also provides a new choice for the treatment of intractable empyema.
    Application of lobulated  anterolateral thigh perforator flap in repair of soft tissue defect of limbs
    Zhan Jie, Sun Peng, Wu Jinsheng, Wang Sixia, Ma Ju...
    2024, 42(5):  564-569.  doi:10.13418/j.issn.1001-165x.2024.5.13
    Abstract ( 1598 )   PDF (6231KB) ( 7 )  
     Objective     To investigate the clinical effect of repairing large limbs soft tissue defect by using the lobulated anterolateral thigh perforator flap.    Methods   F168 cases of the lobulated  anterolateral thigh perforator flap was used to repair large soft tissue defect of limbs were collected from November 2014 to April 2024.  The area of the flap was 24 cm×7 cm -37 cm×10 cm. The arteriovenous and cutaneous nerves of the perforator flap were anastomosed with those of the recipient area. The patients were followed-up by the way of outpatient service and wechat for 5 months-7 years, including flap survival, color and texture, appearance, sensory recovery, donor site healing.   Results   165 cases of flap survived without infection. Necrosis occurred in 1 case of perforator flap and 2 cases of the whole flap. The clean wound through debridement operation was healed with free skin transplantation. There was no osteofascial compartment syndrome after cosmetic suture in the donor area. 3 cases of the skin flap appearance was slightly bloated, after the second stage of the skin flap plastic surgery, the appearance was satisfactory. After operation, the donor area of the flap showed linear scar with concealed location and no obvious hyperplasia.     Conclusions   The anterolateral femoral perforator flap is nourished by the lateral circumflex femoral artery, which has relatively stable anatomic branches and many perforating branches, and is suitable for the design of lobed flap. The lobular design and incision method can repair multiple wounds in similar locations. In addition, the width of the recipient area can be converted into the length of the donor area, so that the donor area can close the wound in the first stage. At the same time, the anatomical boundary of the hands and feet can show a good physiological fold line through the segmentation design. Lobulated anterolateral thigh perforator flap is an ideal method to repair complex soft tissue defects of limbs.
    Application of free anterolateral thigh perforator flap for diabetic foot ulcer reconstruction
    Sun Xiangdong, Abudusaimijiang Aximu, Qiao Weilong...
    2024, 42(5):  570-574.  doi:10.13418/j.issn.1001-165x.2024.5.14
    Abstract ( 1662 )   PDF (3119KB) ( 9 )  
    Objectives To investigate the clinical application effect of the anterolateral thigh perforator flap for diabetic foot ulcer reconstruction. Methods A retrospective analysis was performed for the medical records of 35 patients from March 2020 to March 2024 who were treated with free anterolateral thigh perforator flap for diabetic foot ulcer reconstruction, the average age of the patients was 62 years old (45 to70 years), wound size was 5.0cm×6.5cm~24.0 cm×8.0cm. Wound location: 11 cases of forefoot, 9 cases of dorsum of feet, 9 cases of soles of feet, and 6 cases of heels. In all patients, infection was controlled by first-stage debridement and VSD negative pressure drainage.  The wound was repaired by free transplantation of anterolateral thigh perforator flap in the second stage. Results All patients had varying degrees of arteriosclerosis in the donor site, 3 cases had arterial occluded with flap, 1 case was salvaged, and 2 cases had failed and amputation. One case had venous crisis, effusion under the flap, partial necrosis, wound healing after dressing change, and the rest of the flaps survived completely, with a survival rate of 91.4% (32/35) and the limb salvage rate of 94.3% (33/35). Six months after operation, all patients were able to walk independently, and the AOFAS score of foot and ankle function was 73-95 points, with a median average of 87 points. After  6-18 months follow-up, no recurrence was observed. Conclusions The anterolateral thigh perforator flap is used to repair diabetic foot ulcers, which can reduce the recurrence and amputation rates, and obtain satisfactory function and appearance. 
    Hierarchical anatomy and 3D localization of perforator branch morphology
    Zhou Xiaobing, Zhang Xing, Yao Jie, Wang Qian, Xio...
    2024, 42(5):  575-580.  doi:10.13418/j.issn.1001-165x.2024.5.15
    Abstract ( 1860 )   PDF (7686KB) ( 11 )  
    Objective   To construct a standard method of hierarchical anatomy and localization of perforating vessels based on digital anatomy technology, so as to provide reference for morphological research of perforating vessels.    Methods   Five donated adult fresh specimens were performed via systemic arterial: two of them with red latex-carboxymethyl cellulose suspension and the left three with lead oxide-red latex-carboxymethyl cellulose suspension. After specimen perfusion, the former was used for gross level anatomy, while the latter was scanned by multiple row spiral CT (MDCT), and then the image workstation (MIMICS, Materialise, Belgium) was used to establish a digital anatomical model of the flap, followed by gross hierarchical dissection.   Results   The blood vessels of the specimen are well filled, with continuous and smooth edges, and no cavitation or interruption. The subdermal vascular network, cutaneous nerves and their nutrient vascular chains were clearly visible. The main trunk of blood vessels, large and small branches of the three-dimensional image were clear, with stunning 3D effect and without tooth-like artifacts.   Conclusions   ① The three elements of digital early treatment are  alkalization, temperature control and suspension ratio.   ② The digital anatomical model of the flap established by Mimics can provide precise hierarchical anatomy and 3D tracking and positioning of the perforator.  
    Metrological analysis of the differences in Chinese and Western expressions of common terms for anterolateral thigh flap
    Mao Yihua, Zhao Lina, Zhang Xinxin, Dai Jingyu, Di...
    2024, 42(5):  586-588.  doi:10.13418/j.issn.1001-165x.2024.5.17
    Abstract ( 20 )   PDF (443KB) ( 6 )  
    Objective    To explore the differences in the Chinese and Western expressions of commonly used terms of ALT based on the background of the global promotion of the anterolateral thigh flap (ALT), so as to provide clear conceptual distinctions and theoretical support for accurate communication in the medical field and the wider application of ALT technology.    Methods    ALT-related keywords through retrieval platforms such as CNKI, Chinese Academy of Sciences-Term Online, PubMed, Gray's Anatomy, Wikipedia, and Research gate were searched, and metrological analysis was performed on the retrieval results.  Results    In the field of ALT research, there were significant differences in the number of literatures retrieved by different keywords.    Conclusions   Due to the differences in medical education systems, clinical practice traditions, and language and cultural backgrounds of different countries and regions, there is diversity in the expressions of commonly used terms of ALT. When Chinese people submit manuscripts to the outside world, they should use characteristic terms in this field as much as possible, so that the ALT technology can be better promoted and applied.
    Angiographic anatomical study of middle meningeal artery based on endovascular treatment of chronic subdural hematoma
    Zhou Fujia, Wei Tingfeng, Sun Yong, Kuang Xiongwei...
    2024, 42(5):  589-594.  doi:10.13418/j.issn.1001-165x.2024.5.18
    Abstract ( 22 )   PDF (4524KB) ( 7 )  
    Objective   To observe and analyze the angiographic anatomy of middle meningeal artery (MMA) in patients with chronic subdural hematoma (CSDH) and explore its value of guiding MMAE strategy.  Methods   102 MMA angiographic anatomic images of 80 CSDH patients from March 2019 to March 2023 were collected. Independent evaluation was performed by two senior neurointerventional physicians, MMA classification was performed by reference to Adachi classification. The MMA classification, origin and variation, dangerous anastomosis, embolization strategy, operation-related complications and postoperative recurrence were recorded.    Results    A total of 101 MMAs (79 cases) were classified. Type I were observed in 44/101 (43.6%) MMAs, and the results were moderately consistent (Kappa=0.54, 95% CI: 0.39-0.69). Type A were observed in 32/101 (31.7%) MMAs, and the results showed strong consistency (Kappa=0.84, 95% CI: 0.72-0.96). Out of 102 MMAs, only 1 (1.0%) MMA variously originated from the ophthalmic artery (OA). In 2 of these 102 (2.0%) MMAs, OA originated from MMA. The anastomosis with OA via collateral branch was observed in 5/102 (4.9%) MMAs and the anastomosis with the contralateral MMA branches was observed in 8/102 (7.8%) MMAs. Radiographic recurrence occurred in 2 cases during postoperative follow-up.    Conclusions    It is of great clinical significance to be familiar with MMA angiographic anatomy, especially the classification of MMA and the possible dangerous anastomosis, to guide the selection of embolic agents and the formulation of embolic strategies for MMAE treatment of CSDH, and to improve the efficacy and safety of endovascular embolization treatment of CSDH.  
    CT anatomical study of  influential factors on the distance between abdominal aorta and left psoas major muscle
    Gao Jun, Li Yuwei, Wu Hang, Li Sashuang, Yang Kail...
    2024, 42(5):  595-600.  doi:10.13418/j.issn.1001-165x.2024.5.19
    Abstract ( 24 )   PDF (2991KB) ( 5 )  
    Objective To measure the distance between the abdominal aorta and the left psoas major (DALP) at different levels based on CT images and analyzed its influential factors. Methods The CT and clinical data of 116 normal adults were retrospectively analyzed. The following measurements were taken: DALP, diameter of the left psoas major, cross-sectional area (CSA) of the psoas major, aortic diameter, transverse diameter and area of the L2 vertebral body, thickness of anterior abdominal wall fat at L2 and navel level, subcutaneous fat area (SFA), visceral fat area (VFA) at L2 and navel level. Additionally, VFA/SFA ratios were calculated at both L2 and navel levels. The radiographic density, density standard deviation and radiographic density ratio (RDR) of the left psoas major muscle at three intervertebral disc levels of L2-L5 were measured in 82 patients. The correlation between the DALP and other data at three intervertebral disc levels of L2-L5 was analyzed, and the regression equation was calculated. Results The DALP decreased from level L2 toL5. Age was positively correlated with DALP at L2-L5 disc level (all  P<0.01).The DALP at the L2-L3 disc level was negatively correlated with the CSA of the psoas major at the L2-L3 disc level (P<0.01), and positively correlated with the VFA/SFA at L2 level (P<0.05). The DALP was negatively correlated with the CSA of the psoas major at the L3-L4 disc level (P<0.01), and positively correlated with the VFA/SFA at L2 level (P<0.01).  The DALP was negatively correlated with the CSA of the psoas major at L4-L5 disc level (P<0.01), and positively correlated with the VFA/SFA at L2 level (P<0.05). Conclusions On CT images, the distance between the abdominal aorta and the left psoas major was influenced by age, CSA of the psoas major and the VFA/SFA at L2 level. Preoperative CT examination is of great significance in guiding the OLIF operation.
    The effect of lumbar spondylolisthesis on lumbar segmental vessels and the safety zone of OLIF approach
    Gao Fei, Duan Hongkai, Wang Hongwei, Li Xian, Jian...
    2024, 42(5):  601-606.  doi:10.13418/j.issn.1001-165x.2024.5.20
    Abstract ( 30 )   PDF (5136KB) ( 14 )  
    Objective    To study the effects of Ⅰ~Ⅱ degree lumbar spondylolisthesis on the left lumbar segmental vessels  and the safety zone of OLIF surgical access by MRI.    Methods    The MRI data of lumbar spine of 221 patients with low back and leg pain who met the selection criteria from October 2019 to November 2022 were retrospectively analyzed, and patients with lumbar disc herniation, discogenic low back pain, and degenerative lumbar spinal stenosis without significant collapse of the intervertebral space height and without intervertebral displacement were divided into the control groups (n=107). Patients with I~II degree lumbar spondylolisthesis  were divided into the observation group (n=114). The angles of vascular emanation from the lateral segments of the left vertebral , the angles of vascular travel, the length of the vessels, the spacing of the vessels in the segments of different Moro regions of the vertebral and their distance from the adjacent disc edges were measured and compared between the two groups. The differences in the area between segmental vessels and the proportion of vessels present in the simulated channels were also analyzed.     Results     ① Compared with the control group, the angle of L4 vessel emanation, the angle of L1/L3/L4/L5 vessel travel, and the length of L2/L4 vessels were reduced in the observation group, and the distance between the vessels of L1,2 and L3,4 segments was decreased at the junction of II-III and III -IV zones, and the intervascular area was reduced accordingly. ②The area between the L4,5 vertebral segmental vessels was<22mm at the junction of the III-IV region in  both groups .The distance between the segmental vessels and the edge of the same sequence of vertebral bodies is<10 mm in the two groups,except the distance between the L3-5 vessels with the same sequence of lower edge in the I-II region. In addition, the results of the same sequence of vertebral artery distances from the lower edge of the vertebral suggested that the distances at the junction of L1 II - IV zones decreased, but the distances at the junction of L4 II - IV zones increased, while the results of the same sequence of vertebral vein distances from the upper edge of the vertebral suggested that the distances at the junction of L2 I - II zones, L2-5 II - III zones, and L2/L4 III - IV zones decreased. ③ The proportion of lumbar segmental vessels in the simulated channels was greater in the observation group than in the control group, with the most significant differences found in the L5 vessels in zones I and II.    Conclusions    Ⅰ~Ⅱ degree lumbar spondylolisthesis affect the travel of the left lumbar segmental vessels, reduce the distance between segmental vessels in L1,2 and L3,4 , narrow the distance from the L2-5 segmental vessels at the junction of zones II-III to the upper edge of the vertebral in the same sequence, increase the difficulty and risk of OLIF channel establishment. In particular, when operating in the L4,5 interval, it is necessary to avoid placing OLIF expansion channels at 10 mm from the disc edge and at the junction of zone III-IV. The channels can be adjusted to the cephalic side of zone II as appropriate, and close attention should be paid to the alignment and distribution of the vessels of the L5 segment in zones I and II to avoid injury.
    Effect of total knee arthroplasty on isokinetic muscle strength curve in knee joint of the aged
    Zeng Fanling, Jia Rui, Huang Yilin, Gao Weibang, Z...
    2024, 42(5):  607-611.  doi:10.13418/j.issn.1001-165x.2024.5.21
    Abstract ( 30 )   PDF (1427KB) ( 6 )  
    Objective To explore the influence of total knee arthroplasty (TKA) on the isokinetic muscle strength curve of knee joints in the aged. Methods Patients underwent TKA one year after surgery and healthy people who matched in age and sex were selected. Isometric and isokinetic strength of knee flexion and extension at velocity of 180°/s and 60°/s was tested by isokinetic dynamometer. The peak moment and hamstring/quadriceps ratio (H/Q) of flexion and extension muscles were collected, normalized torque-angle curves (torque/body mass) were generated in steps of 1°. Results At 180°/s for patients after TKA, the flexion moment of the affected side was lower than that of the healthy side in the range of 16° to 64° and lower than that of the same side of the healthy subjects in the range of 10° to 83° (P<0.05); at 60°/s, the flexion moment of the affected side was lower than that of the healthy side in the range of 72° to 76° and lower than that of the healthy subjects in the range of 59° to 87° (P<0.05). There were also no significant differences in knee extension moment, the peak moment and H/Q between the affected side of patients and healthy subjects at 180°/s (P>0.05); at 60°/s, the knee extension moment on the affected side was lower than that on the healthy side in the range of 68° to 85°, and lower than that of the healthy subjects in the range of 18° to 37° and 72° to 81°, the H/Q on the affected side was higher than that of the healthy subjects (P<0.05). There was no significant difference in the peak moment and extension moment of isometric test between the affected side and the healthy subjects (P>0.05). Conclusions After total knee arthroplasty, the hamstring strength of the affected side decreased during high-speed and low-speed within the end range of joint movement, and the quadriceps strength of the affected side decreased during low-speed within the starting range of joint movement. 
    Research progress on the function of reticularspinal tract and changes after central nervous system injury 
    Jia Fangfang, Chen Peng, Wang Zhihang, Yang Shengb...
    2024, 42(5):  612-615.  doi:10.13418/j.issn.1001-165x.2024.5.22
    Abstract ( 19 )   PDF (535KB) ( 2 )  
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LFPEMFs effects on the proliferation and chondrocyte-like differentiation of BMSCs labeled with SPIO
Chinese Journal Of Clinical Anatomy. 2015 Vol. 33 (6): 662-666 doi: 10.13418/j.issn.1001-165x.2015.06.010
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