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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 （1004）      PDF（pc） （3716KB）（109）       Knowledge map    Save   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.  Reference | Related Articles | Metrics | Comments（0）

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Analysis of the clinical characteristics and postoperative efficacy of fungal sphenoid sinusitis Xie Kaipeng, Kang Yuanchun, Liu Haibin, Zhou Liufeng, Peng Hu, Ji Zhenhua, Cheng Yin, Yang Zixuan, Chen Jinxuan, Zhang Guomin, Wu Xiaoqin Chinese Journal of Clinical Anatomy    2021, 39 (4): 473-476.   DOI: 10.13418/j.issn.1001-165x.2021.04.021 Abstract （940）      PDF（pc） （1645KB）（297）       Knowledge map    Save Objective 　To explore the clinical and imaging characteristics of fungal sphenoid sinusitis and to evaluate the clinical effect of nasal endoscopy surgery.　Methods　The clinical data of 67 patients admitted to the department of Otonolaryngosis Head and Neck Surgery of the following hospitals from January 2008 to January 2018 were retrospectively analyzed (the PLA Joint Service Protection Force 909 Hospital, Longhai City First Hospital and the Affiliated to the Naval Military Medical University). The clinical and imaging characteristics of the 67 patients with fungal sphenoid sinus invasion and sphenoid sinus were summarized. All patients received endoscopic sphenoid sinus opening and lesions removal surgery,  and were followed up for 6 months to 12 months to evaluate the surgical efficacy. Visual analog scale (VAS) was used for subjective disease assessment, while the Lund-Kennedy scoring was used for objective disease. The differences between preoperative and postoperative 3, 6 and 12 months were compared.　Results　All 67 cases were cured by one operation, and none of them had serious complications after surgery. The VAS score was (8.34±1.36) preoperatively, but decreased continuously. The VAS score of 3, 6, 12 months after surgery were (2.45±1.06) points, (1.65±1.24) points, (1.21±0.66), respectively. Lund-Kennedy's score was (8.42±1.16)  before surgery, but decreased to (2.56±0.86), (1.74±1.16), (1.15±0.76) at 3, 6, 12 months after surgery, respectively. There were statistical differences in the VAS score and Lund-Kennedy's score before and after surgery (P<0.001).　Conclusions　The main symptoms of fungal sphenoid sinusitis is headache without any regularity.  Endoscopic examination showed mucosal edema in the sphenoidal crypt, and there are caseous and mucinous secretions at the sinus orifice. CT images are characterized by uneven soft tissue density shadow in the sphenoidal sinus cavity, with high-density plaque-like calcification shadow, and thickening of the bone in sinus wall. According to different ranges of lesions, it is a simple, safe and effective method to treat fungal sphenoid sinusitis with the whole hemp nasal endoscopy and nasal endoscopy-assisted surgical treatment. Reference | Related Articles | Metrics | Comments（0）

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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 （818）      PDF（pc） （3435KB）（171）       Knowledge map    Save 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.  Reference | Related Articles | Metrics | Comments（0）

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Anatomical study and clinical significance of the middle axillary approach in the treatment of T2~T5 vertebral lesions Hou Jun, Shi Dongdong, Pan Qing, Chen Changcheng, Chen Qianfen Chinese Journal of Clinical Anatomy    2021, 39 (4): 384-388.   DOI: 10.13418/j.issn.1001-165x.2021.04.003 Abstract （806）      PDF（pc） （2352KB）（122）       Knowledge map    Save Objective　To study the anatomical relationship between thoracic  vertebral body (T2~T5) and adjacent tissue structure, and to explore the feasibility of treating the T2~T5 vertebral body lesion through the middle axillary approach.　Methods　Ten (20 sides) formalin-treated cadaveric specimens with intact thoracic and upper limbs  were selected to simulate T2~T5 vertebral surgery through the left and right mid-axillary thoracic approaches, respectively, and then dissected layer by layer to the lateral front of the thoracic spine. The length of the skin incision, the longitudinal width of the rib fracture were observed.  The upper and lower ends of the opening, the upper edge of the aortic arch, the highest point of the sacral arch, the position of the vertebral body of the thoracic duct, and the distance between the thoracic sympathetic trunk and the anterior edge of the costal joint were extended to simulate the operation of T3 vertebral body resection + rib bone graft + plate screw internal fixation.　Results　The length of the mid-axillary skin incision was (11.63 ±0.50) cm, and the width of the third rib was (7.04±0.47) cm. The upper and lower ends of the brace were flat on the 2nd and 5th thoracic vertebrae. The upper edge of the aortic arch flat T3 was 70%, the highest point of the venous arch flat T4 was 60%, and the thoracic duct crossing T5 from the front was 70%. The distance from the sympathetic trunk to the leading edge of the first rib joint was (6.84±0.55) mm, (6.99±0.51) mm, (6.98±0.56) mm, (7.07±0.47) mm, respectively. The simulated surgical field can exposed the T2~T5 vertebra. The adjacent structures were relatively fixed, which can safely and effectively complete the surgical operation of removing the bone graft and internal fixation and reconstructing the stability of the thoracic spine. Conclusions　The middle axillary approach is a treatment for T2~T5 vertebral lesions, which has the advantages of good visual field, less trauma, and high safety. Reference | Related Articles | Metrics | Comments（0）

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Anatomical observation of pyramidalis muscle and anterior pubic ligament Yuan Jiajie, Yuan Zhirong, Chen Xiaomei, Su Minghao, Li Zelin, He Shanli, Liu Chang, Li Zeyu, Ouyang Jun, Dai Jingxing Chinese Journal of Clinical Anatomy    2022, 40 (5): 515-518.   DOI: 10.13418/j.issn.1001-165x.2022.5.03 Abstract （771）      PDF（pc） （1715KB）（78）       Knowledge map    Save Objective   To explore the adjacent relationship between pyramidalis muscle and anterior pubic ligament, so as to provide anatomical basis for further understanding the mechanism of maintaining the stability of the pubic symphysis.   Methods   Twenty-four specimens (19 males and 5 females) were selected to observe the length, width, thickness of the pyramidalis muscle and the adjacent relationship between the adjacent rectus abdominis, adductor longus and anterior pubic ligaments.   Results   In the 24 gross specimens, 23 cases of pyramidalis muscle existed bilaterally (accounting for 95.8%, 19 cases in males, 4 cases in females). One case lacked the right muscle (accounting for 4.2%, 1 case in female). The length of pyramidalis muscle was (70.64±13.48) mm in males and (71.81±11.27) mm in females on the right side, (69.60±12.01) mm in males, (64.25±19.79) mm in females on the left side. Width, on the right side: male (20.68±4.12) mm, female (20.65±2.04) mm, on the left side: male (20.02±2.99) mm, female (18.23±4.77) mm. Thickness, right: male (2.50±1.61) mm, female (1.49±0.40) mm, left: male (2.19±1.06) mm, female (1.50±0.56) mm.   There was no statistical difference in the length, width and thickness of the pyramidalis muscle (P>0.05). The width of anterior pubic ligament was (5.96±1.55)mm in males and (6.60±1.10) mm in the females on the right side, (6.35±1.58) mm in males and (6.16±0.69) mm in females on the left side. The pyramidalis muscle originated from the fibrous ligament anterior to the pubic bone and pubic symphysis with tendinous fibers. The origin of rectus abdominis tendon, adductor longus tendon, inguinal ligament and the starting point of the pyramidal muscle were intertwined with adjacent to the pubic crest, forming a distinct anterior pubic ligament.  Conclusions    The pyramidalis muscle originates from the anterior pubic ligament and forms the anterior pubic ligament together with the inguinal ligament and the adductor longus tendon. At the same time, with the anterior pubic ligament as the center, adjacent structures together form a complex, which provides important support for the stability of the pubic symphysis. Reference | Related Articles | Metrics | Comments（0）

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Risk factors and clinical effect of vertebral cavity formation after posterior short-segmental fixation for thoracolumbar and lumbar burst fractures Liang Changxiang, Liang Guoyan, Zheng Xiaoqing, Huang Yongxiong, Yin Dong, Chang Yunbing Chinese Journal of Clinical Anatomy    2022, 40 (6): 714-719.   DOI: 10.13418/j.issn.1001-165x.2022.6.15 Abstract （726）      PDF（pc） （3635KB）（34）       Knowledge map    Save Objective   To observe the vertebral body healing pattern after posterior short-segmental fixation for thoracolumbar and lumbar burst fractures, and to analyze the risk factors and clinical effect of vertebral cavity.    Methods    Fifty-two patients with posterior short-segmental fixation for thoracolumbar burst fracture were followed up for at least 2 years. The CT results of the last follow-up were analyzed to observe the morphological characteristics of the cavity in the vertebral body. The patients with and without obvious cavities in the vertebral body were divided into two groups. The clinical and imaging characteristics of the two groups were compared, and the risk factors leading to the cavities were analyzed to observe whether the vertebral cavity affects the clinical efficacy or not.    Results    There were 12 cases of complete healing of vertebral body (accounting for 23.1%) and 40 cases of cavity (accounting for 76.9%). The shape of the cavity in the vertebral body could be divided into the following types: small cavity in the endplate (n=9, accounting for 22.5%),  large cavity in the vertebral body (n=19, accounting for 47.5%), and  split in the vertebral body (n =12, accounting for 30%). The proportion of males in the vertebral cavity group was higher, and the spinal cord nerve injury was more serious. An average follow-up of 37.8 months after surgery showed that the two groups of patients had good back pain and lumbar function, and there was no statistical difference in the VAS and ODI scores between the two groups.   Conclusions    Vertebral cavities are commonly seen after posterior short-segmental fixation for thoracolumbar and lumbar burst fractures. The higher degree of fracture rupture, the easier to cause the vertebral cavity. The large degree of the vertebral body anterior edge reduction after the operation of screw placement is an important cause of the cavity.  Presence of a cavity in the vertebral body does not affect the patient’s lumbar pain and function in the short term.  Reference | Related Articles | Metrics | Comments（0）

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Clinical anatomical study on the classification of the superior aspect classification of the greater tuberosity Zhang Lei, He Xue, Zhou Xin, Xiong Lujing, Zhang Meng-yao Chinese Journal of Clinical Anatomy    2021, 39 (5): 513-517.   DOI: 10.13418/j.issn.1001-165x.2021.05.003 Abstract （702）      PDF（pc） （1507KB）（173）       Knowledge map    Save  目的    通过对肱骨大结节上面观的形态学分型，探讨其临床意义。  方法    将296例肩关节CT扫描图像根据大结节上面观形态进行分型，分别测量冈上肌、冈下肌和小圆肌肌腱在大结节上的止点长度，肩胛下肌肌腱在小结节上的止点长度，大结节最高点至肱骨头最高点的距离以及结节间沟的宽度和深度。  结果    肱骨大结节上面观形态可分为3型：弧形45.60%（135例），平坦形44.26%（131例），丘形10.14%（30例）。弧形的肱骨大结节，其冈上肌肌腱止点长度短于平坦形和丘形；丘形的肱骨大结节，其冈上肌肌腱在大结节上的止点长度、肩胛下肌肌腱在小结节上的止点长度、结节间沟的宽度和深度均短于弧形和平坦形；丘形的大结节最高点至肱骨头最高点的距离大于弧形和平坦形，差异均有统计学意义（P＜0.05），其他解剖学形态差异无统计学意义（P>0.05）。  结论    不同分型的肱骨大结节上面观对临床肱骨大结节相关疾病诊治有一定的指导意义。 Reference | Related Articles | Metrics | Comments（0）

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The whole-mount intramuscular nerve distribution pattern of intermediate plantar groupand dorsalis pedis muscles and its significance Deng Qun, Luo Linfen, Yang Shengbo Chinese Journal of Clinical Anatomy    2022, 40 (5): 523-529.   DOI: 10.13418/j.issn.1001-165x.2022.5.05 Abstract （663）      PDF（pc） （7242KB）（12）       Knowledge map    Save Objective  To reveal the whole-mount intramuscular never distribution pattern of intermediate plantar group and dorsails pedis muscles and to explore its significance.  Methods  The intermediate plantar group and dorsails pedis muscles from twelve adult cadavers fixed by formalin were removed. Modified Sihler's staining was used to display the whole-mount intramuscular nerve distribution pattern.   Results   The nerve branches of the flexor brevis digitorum, the first and second lunbrical muscles innervated by medial plantar nerve entered from deep and superficial surface respectively. The nerve branches of the quadrates, the third and fourth plantar lunbrical muscles innervated by lateral plantar never coursed from the insertion to the origin of the muscle. While the nerve branches of the interossei plantar muscles and the interossei dorsal muscles coursed from the origin to the insertion of the muscle. The nerve branches of the extensor hallucis brevis and the extensor brevis digitorum muscle shared one nerve trunk. The lumbrical muscles, the first and second interossei plantar muscles, the first interossei dorsal muscle, the extensor hallucis brevis and the extensor brevis digitorum muscle formed only one intramuscular nerve dense region in the middle of the muscle belly. The flexor brevis digitorum, the quadrates plantae, the third interossei plantar muscle and the second to fourth interossei dorsal muscles had two intramuscular nerve dense regions on both sides of the muscle, these muscles can be divided into two neuromuscular subdivisions.   Conclusions   These results may provide morphological guidance for surgical operation to avoid nerve injury and the selection and matching of muscle transplantation and the injection of botulinum toxin A to block the spasticity of these muscles.  Reference | Related Articles | Metrics | Comments（0）

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The variation of superior vena cava and its branches: a case report Yang Jiping, Li Haoxu Chinese Journal of Clinical Anatomy    2021, 39 (4): 501-.   Abstract （653）      PDF（pc） （1724KB）（323）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Anatomical observation of the extraforaminal ligaments of the cervical spine  Gao Qiang, Fan Lei, Li Xiaobin, Cai Teng, Zhao Jianjun, Zhao Qinghao, Liu Tao Chinese Journal of Clinical Anatomy    2021, 39 (4): 375-378.   DOI: 10.13418/j.issn.1001-165x.2021.04.001 Abstract （643）      PDF（pc） （546KB）（82）       Knowledge map    Save Objective　To describe the extraforaminal ligaments in the exit regions of the C2~7 intervertebral foramina and to discuss their possible clinical significance.　Methods　A total of 100 C2~7 intervertebral foramina from 10 adult cadavers were anatomically observed. All the ligaments that appeared were identified. The number, morphology, distribution, starting and ending position of the ligaments were observed and recorded. The length, width and thickness of each ligament were measured by vernier calipers. Results　There were 252 extraforaminal ligaments in the 100 intervertebral foramina. The extraforaminal ligaments could be divided into  radioactive ligaments (236pcs, accounting for 93.7%) and  transforaminal ligaments (16pcs, accounting for 6.3%). Radioactive ligaments, which connected the nerve root to the surrounding structures, could be divided into superior ligaments (accounting for 25.0%), inferior ligaments (accounting for 60.2%), anterior ligaments (accounting for 6.3%) and posterior ligaments (accounting for 8.5%). The transforaminal ligaments were perpendicular to the nerve root and straddled the nerve root. The transforaminal ligaments were the most common in C4~5 ligaments. The average length of the transforaminal ligaments at C4~5 intervertebral foramina was (8.12±1.38) mm (6.28~9.93 mm), and the thickest was 1.04 mm. There was one transforaminal ligament at most per cervical foramina.　Conclusions　The extraforaminal ligaments is a normal physiological structure of intervertebral foramen and may be related to the occurrence of C5 nerve palsy after cervical decompression surgery. After cervical decompression surgery, the transforaminal ligaments may be one of the potential causes of nerve root entrapment and nerve injury. The radioactive ligament could limit the displacement of spinal nerves and may cause nerve injury by traction. Reference | Related Articles | Metrics | Comments（0）

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Morphological variation of coracoid process and the related diseases Hu Jian, Liu Bingli, Yu Baoqing Chinese Journal of Clinical Anatomy    2021, 39 (4): 496-500.   DOI: 10.13418/j.issn.1001-165x.2021.04.026 Abstract （613）      PDF（pc） （1808KB）（371）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Anatomical basis of hypothenar skin flap based on descending branches of supracarpal cutaneous branch of the ulnar artery  Xu Dan, Liu Peng, Zheng Xuefeng, Cao Min, Ding Zihai, Ai Xuguang Chinese Journal of Clinical Anatomy    2021, 39 (4): 396-399.   DOI: 10.13418/j.issn.1001-165x.2021.04.006 Abstract （589）      PDF（pc） （2232KB）（123）       Knowledge map    Save Objective     To provide the clinical anatomical basis for repairing the palm skin defect with the hypothenar skin flap of the descending branches of supracarpal cutaneous branch of the ulnar artery. Methods    From May, 2018 to May, 2019, a total of 42 side upper extremities were used in the research. Twenty-eight side through brachial artery were perfused with red latex for anatomy, 14 side through brachial artery were perfused with ABS and eroded to be vascular cast mold. The branch, course, distribution, communication, outer diameter and anastomosis of the descending supracarpal cutaneous branch of the ulnar artery were anatomically observed and measured.    Results    A line from lentiform bone to the ring, webbing of the little finger was drawn and the line was divided into 3 equal sections. The descending branches of supracarpal cutaneous branch of the ulnar artery arised 14.5 branches, including 6.8 cutaneous branches and 7.7 communicating branches in the distal, middle and proximal 1/3 segments. The cutaneous branches anastomosed with each other to form 1-2 grade cutaneous branch chain in the superficial fascia of hypothenar. The length of cutaneous branches was (1.80±0.60) cm and the diameter of cutaneous branches was (0.23±0.10) mm. The communicating branches was anastomosis with deep branch of ulnar artery, the ulnar margin of superficial palmar arch, the common palmar digital artery or ulnar volar artery of little finger, respectively. The length of communicating branches was (1.60±0.50) cm and the diameter was (0.16±0.06) mm. There was one or two large communicating branches in the proximal and distal 1/3 segments, which can be used as an ideal flap vascular pedicle.   Conclusions     The hypothenar flap is an ideal selection to repair the small tissue defect of palm skin, for it has a constant position of the descending supracarpal cutaneous branch of the ulnar artery in the hypothenar skin flap, with abundant endothelium branch chains, and its skin structure is the homology with the center of the palm. Reference | Related Articles | Metrics | Comments（0）

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Application of three-dimensional CT imaging technology in the determination of the "V" point in posterior cervical approach percutaneous spinal endoscopic surgery   Jian Wei, Xu Cong, Ai Wen, Yin Shengjiang, Bi Zhenyu, Wu Zebin Chinese Journal of Clinical Anatomy    2022, 40 (6): 720-724.   DOI: 10.13418/j.issn.1001-165x.2022.6.16 Abstract （588）      PDF（pc） （1655KB）（187）       Knowledge map    Save Objective    To evaluate the application value of three-dimensional computed tomography (3D-CT) in determining the "V" point in transforaminal decompression and nucleus pulposus enucleation of posterior cervical approach by using percutaneous spinal endoscopy.    Methods    A retrospective analysis was made on 50 patients who underwent transforaminal decompression and nucleus pulposus enucleation of posterior cervical spine approach by using percutaneous spinal endoscopy and followed up from January 2016 to June 2018. They all sufferred from cervical spondylotic radiculopathy with unilateral symptoms, conservative treatment for more than 6 weeks were ineffective for them. The dynamic X-ray film of cervical spine showed no instability of cervical spine. There were 27 males and 23 females, with an average age of 54.2 (40~75) years, 14 cases of C4/5 segment, 25 cases of C5/6 segment and 11 cases of C6/7 segment. Fifty patients were divided into groups A (26 cases) and group B (24 cases). The patients were positioned according to the intraoperative conventional "V" point positioning method using C-arm X-ray machine in group A, and the patients determined the "V" point using the 3D-CT technology method before the operation in group B. The average hospital stay, operation time, number of intraoperative fluoroscopy and surgical efficacy between the two groups were compared and statistically analyzed.   Results   All 50 patients were followed up for an average of (7.20±2.56) months (3-13 months), The average operation time and intraoperative fluoroscopy in group A were more than those in group B (P<0.05). There was no signiant difference in the average hospital stay, postoperative follow-up score, the curvature of the cervical spine, the height of the intervertebral space of the operation segment and the stability of the cervical spine between the two groups (P>0.05).    Conclusions 3D-CT technology plays an important role in determining the "V" point in posterior cervical approach percutaneous spinal endoscopic surgery.  Reference | Related Articles | Metrics | Comments（0）

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Three dimensional CT study of sphenoid sinus in patients with pituitary adenoma Qin Yong, Zhao Lin, Wei Liangfeng, Wang Shousen Chinese Journal of Clinical Anatomy    2021, 39 (4): 410-414.   DOI: 10.13418/j.issn.1001-165x.2021.04.009 Abstract （580）      PDF（pc） （2934KB）（12）       Knowledge map    Save Objective 　To investigate the anatomic changes of sphenoid sinus and the significance in patients with pituitary adenoma in transsphenoidal surgery by 3D CT.　Methods　The imaging data of 51 patients with pituitary adenoma in our hospital from March 2014 to March 2015 were collected. Before the operation, the CT images of the paranasal sinuses were input into the computer, and the separation of the sphenoid sinuses was reconstructed by using the software of mimics15.0. The number, shape and deviation of the sphenoid sinuses were observed and recorded, and they were compared with those of during the operation. The gasification types of the sphenoid sinuses, the internal carotid protrusion and fissuring and the incidence of Onodi cell chamber were observed.　Results　Among the 51 cases, the sphenoid sinus presented anterior sellar type in 3 cases, semi sellar type in 12 cases, sellar type in 18 cases and sella occipital type in 18 cases. The sphenoid sinus had no septum in 1 case, 1 mediastinum in 36 cases, 2 mediastinum in 11 cases, 3 mediastinum in 2 cases. The tumor was filled with the sinus cavity and the number of septum could not be determined in 1 case. There were 2 cases of transverse septum and 1 case of oblique septum. The anterior edge of the septum was the middle in 19 cases left in 14 cases on the, right in 16 cases. The anterior edge of the septum was damaged by tumor and could be judged in 1 case. In 5 cases, the posterior margin of 7 sides of sphenoid sinus was attached to the carina of internal carotid artery. There were 12 cases of bilateral internal carotid artery carina, 2 cases of unilateral internal carotid artery carina and 5 cases of internal carotid protrusion fissure. Onodi cell chamber was found in 9 sides of 5 cases. In all patients, the bony separation in the sphenoid sinus was consistent with the three-dimensional reconstruction image before operation. The localization of the sellar base was realized quickly and accurately under the guidance of the sphenoid sinus separation.　Conclusions　CT three-dimensional reconstruction technique can display the bony separation in the sphenoid sinus and the protrusion of the lateral wall of the sphenoid sinus well, which is helpful for rapid and accurate localization in transsphenoidal surgery. Reference | Related Articles | Metrics | Comments（0）

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The morphological classification and clinical significance of the scapular spine based on CT three-dimensional reconstruction Yu Hao, Deng Wanqiu, Sang Peng, Liu Yi Chinese Journal of Clinical Anatomy    2021, 39 (4): 415-419.   DOI: 10.13418/j.issn.1001-165x.2021.04.010 Abstract （543）      PDF（pc） （1760KB）（96）       Knowledge map    Save 　Objective   To explore morphological classification of scapular spine based on three-dimensional reconstruction of CT and its clinical significance.   Methods   Three hundred and nineteen patients (179 cases of left shoulder and 140 cases of right shoulder) from the department of Radiology in the affiliated Hospital of Zunyi Medical College were scanned by CT, and then the three-dimensional reconstruction and classification of the affected scapular spine were performed. It was assumed that the point of intersection between the medial end of the scapular spine and the medial margin of the scapula was point A. The intersection of the glenoid notch and the superior margin of the scapular spine was point B. The glenoid notch was point C. The medial edge of the acromion was point D. The lateral edge of the acromion was point E. The inner 1/3 point of AB was point F. The inner 1/3 point of AC was point G. The outer 1/3 point of AB was point H, the outer 1/3 point of AC was point I, the midpoint of FG was point J, the midpoint of HI was point K, the midpoint of BC was point L. Research parameters were the following: the distance between  point A and point B, point A and point C, point A and point D, point A and point E, point B and point C, point H and point I, point F and point G, and the thickness of B, H, F, L, K, J, E, I, G.    Results    The shape of the inferior scapular spine reconstructed by CT can be divided into 6 types: large fusiform-type, small fusiform-type, wooden club-type, thick rod-type, S-type and slender rod-type. The length of AE, BC, AC and AD in large fusiform-type, wooden club-type and thick rod-type was longer than that of small fusiform-type, S-type and slender rod-type. The length of AB in large fusiform-type was longer than that of wooden club-type and slender rod-type (P<0.05). The height of FG in large fusiform-type was higher than that in small fusiform-type. The height of HI in large fusiform-type was higher than that of all other types (P<0.05). The thickness of B, C, H, K, I, F, J and Gin large fusiform-type and thick rod-type were thicker than those of slender rod -type and small fusiform-type (P<0.05).   Conclusions    The scapular spine can be divided into 6 types based on the CT three-dimensional reconstruction: large fusiform-type, small fusiform-type, wooden club-type, thick rod-type, S-type and slender rod-type. Different morphological types of scapular spine provide anatomical basis for clinicians to choose internal fixation and operation methods. Reference | Related Articles | Metrics | Comments（0）

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Diffusion tensor tractography imaging observation and clinical application of the anterior cruciate ligament Wang Changqing, Yang Rongli, Fu Shengqi Chinese Journal of Clinical Anatomy    2021, 39 (4): 405-409.   DOI: 10.13418/j.issn.1001-165x.2021.04.008 Abstract （527）      PDF（pc） （1958KB）（23）       Knowledge map    Save Objective　To provide image data for grading diagnosis in the different degree of anterior cruciate ligament injury.   Methods   One hundred normal knee joint and one hundred unilateral anterior cruciate ligament laceration in the Affiliated Hospital of Xinxiang Medical University were selected by diffusion tensor imaging scanning, and divided into I grade, Ⅱ grade, Ⅲ grade and Ⅳ grade according to the damage degree. At the workstation, the regions of interest of the anterior cruciate ligament and its injury were divided, the tractography images were generated and the fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of the regions of interest were measured. The FA values and ADC values were compared in different position and different degree damage position of the anterior cruciate ligament.    Results    There were significant differences in the FA values and ADC values of the anterior cruciate ligament among the upper ends, upper-middle position, middle position, lower-middle position and lower ends (P<0.05), the FA values was negatively correlated with the decreasing of anterior cruciate ligament from top to bottom, while the ADC values was positively correlated with the increasing of anterior cruciate ligament. There was no significant difference in the FA values and ADC values between the upper ends and upper-middle position of the groups (P>0.05), and it was significant difference in the FA values and ADC values between the other position (P<0.05). There were significant differences in the FA values and ADC values of the anterior cruciate ligament injure at I grade, II grade, III grade and IV grade (P<0.05), the FA values decreased with the increasing of damage degree, while the ADC values increased. There was no significant difference in the FA values and ADC values between the I grade and II grade (P>0.05), and it was significant differences in the FA values and ADC values between the other damage grades (P<0.05).    Conclusions    The FA values and ADC values of anterior cruciate ligament are closely related to the damage location and damage degree. Diffusion tensor tractography imaging can provide an objective imaging diagnosis basis for the changes of the microstructure of anterior cruciate ligament injury. Reference | Related Articles | Metrics | Comments（0）

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The surgical treatment strategy for adjacent segment disease after anterior cervical discectomy and fusion of multi-segments Chinese Journal of Clinical Anatomy    2023, 41 (2): 218-223.   DOI: 10.13418/j.issn.1001-165x.2023.2.17 Abstract （524）      PDF（pc） （3631KB）（30）       Knowledge map    Save Objective    To explore the surgical treatment strategy for adjacent segment disease (ASD) after anterior cervical discectomy and fusion of multi-segments.    Methods    From 2015 to 2019, 13 patients with ASD in our hospital were retrospectively analyzed. Eight patients were treated with anterior cervical Zero-P plate and 5 patients were treated with single-door laminoplasty. JOA, VAS, and NDI were noted to evaluate the clinical outcomes, and X-ray, CT, and MRI imaging were recorded and analyzed as well.   Results    All the patients were followed up for an average of 11.6 months (6~24 months). The JOA, VAS and NDI were significantly improved after both surgeries. In the anterior cervical operation group, the position of the internal fixation was good and no loosening of the plate screw was observed during follow-up. The average time of bone fusion was about 7.6 months. In patients who were treated with single-door laminoplasty, there were no complications such as C5 nerve root palsy, lamina re-closing and so on.   Conclusions   The selection of reoperation methods for ASD after multilevel anterior cervical fusion should follow the principle of individualization. For single-level ASD without severe posterior longitudinal ligament ossification, anterior decompression and fusion with the Zero-P system should be selected. For multi-levels ASD, the posterior single-door laminoplasty is preferred. Reference | Related Articles | Metrics | Comments（0）

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The three-dimensional model construction of bronchial tree and the simulation of fiberoptic bronchoscopy surgery based on Chinese Visible Human dataset  Yang Jingyi, Hu Xin, Yao Jie, Xu Zhou, Yang Zhi, Chen Zhi, Wu Yi Chinese Journal of Clinical Anatomy    2023, 41 (1): 1-7.   DOI: 10.13418/j.issn.1001-165x.2023.1.01 Abstract （500）      PDF（pc） （8102KB）（171）       Knowledge map    Save Objective    To construct detailed three-dimensional (3D) digital structures and apply to virtual simulation and 3D printing of the human lung bronchial trees, so as to provide accurate morphological data for the virtual simulation of fiberoptic bronchoscopy surgery.    Methods    The tomographic anatomical images of Chinese Visible Human CVH1,2,5,6 chest were selected. The lungs and bronchial trees were segmented and  reconstructed in 3D by using AMIRA software. Cinema 4D software was used to smooth, construct an interactive 3D-PDF model, and perform 3D printing to create virtual fiberoptic bronchoscopy surgery simulation model.    Results    Detailed 3D digital models of 4 lung bronchial trees were constructed, including 3 adults and 1 child, showing the branches of the human bronchial tree at 3-6 levels, the number of branches at level 4 and level 6 was about twice the number of branches of the upper level. The segment of left lung was 8, the number of bronchial branches at level 6 was (63.8±3.6), the segment of right lung was 10, the number of bronchial branches at level 6 was (63.8±3.6), and the bronchial branches number ratio of the left and right lungs was 0.79. The longest length of the bronchus was located in the left lobe, and the diameter of children’s lumen was smaller than that of three adults.   Conclusions    The 3D digital model, 3D printing model, 3D-PDF and virtual simulation software for surgery of the bronchial trees have improved the understanding of anatomy and developmental biology of bronchial tree. We believe that the B1+2 and B7+8 bronchopulmonary segments of the left lung are separate segmental bronchi, rather than two combined segmental bronchi, which provides morphological basis for clinical anatomy teaching and virtual simulation of fiberoptic bronchoscopy surgery. Reference | Related Articles | Metrics | Comments（0）

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Anatomy of the inferior mesenteric artery evaluated by three-dimensional CT angiography before radical resection of rectal cancer Zhang Peng, Chen Xin, Zhang Lan, Lin Yao, Lv Jianbo, Zeng Xinyu, Wang Zheng, Li Xin, Jin Yao, Tao Kaixiong Chinese Journal of Clinical Anatomy    2022, 40 (5): 530-535.   DOI: 10.13418/j.issn.1001-165x.2022.5.06 Abstract （500）      PDF（pc） （4182KB）（82）       Knowledge map    Save  Objective   To evaluate and analyze the classification and anatomical characteristics of the inferior mesenteric artery (IMA) of patients with rectal cancer by three-dimensional CT angiography (CTA) in order to provide reference for the surgical management of rectal cancer.    Methods    A retrospective analysis was performed on the clinical and image data of rectal cancer patients received IMA CTA examinations in Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019. IMA images were reconstructed by three-dimensional CT angiography. Branch types of IMA were classified, and anatomical parameters of the inferior mesenteric vessel were measured and analyzed.    Results    Among the 266 cases, 187 were males and 79 were females. The left colon artery (LCA) arose independently from the common trunk in 111 cases (accounting for 41.7%). In 112 cases (accounting for 42.1%), the LCA and sigmoid colon artery (SA) had a common trunk, and in 33 cases (accounting for 12.4%), LCA, SA and superior rectal artery (SRA) forked at same point, whereas LCA disappeared in 10 cases (accounting for 3.8%). The length of the IMA (LIMA) was (39.1±10.1) mm, and the distance between the IMA root and iliac aortic bifurcation (DIMA) was (44.1±7.4) mm. The distance from the IMA root to the inferior mesenteric vein (IMV) and the IMA branch point to the IMV were (24.6±8.9) mm, (13.0±5.3) mm, respectively. In 122 cases (accounting for 47.6%), LCA ascended medial to the lateral border of left kidney, while in 46 patients (accounting for 18.0%), LCA arranged below the inferior border of left kidney. LCA located medial to IMV at the level of IMA root in 65 cases (accounting for 25.4%), just lateral to IMV in 136 cases (accounting for 53.1%), and lateral away from IMV in 55 cases (accounting for 21.5%).   Conclusions Three-dimensional CT angiography before surgery can accurately assess the IMA branch types and anatomical parameters of the inferior mesenteric vessel, which can provide reference for vascular management in rectal cancer surgery. Reference | Related Articles | Metrics | Comments（0）

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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 Abstract （490）      PDF（pc） （3229KB）（422）       Knowledge map    Save 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. Reference | Related Articles | Metrics | Comments（0）