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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

Table of Content

    25 November 2010 Volume 28 Issue 6
      
    The clinical anatomy of the facial nerve correlated with the temporal bone surgery
    TIAN Guang-Yong, DUAN Yong-Chang, SHI Xiao-Tian, HUANG Mei-Xian, XU Da-Chuan
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  593. 
    Abstract ( 1795 )  
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    Objective To study the anatomy features and the location of the facial nerve during the temporal approaches. Methods The mastoidotympanectomy, the facial recess approaches, the facial nerve decompression, the middle cranial fossa approach and the infrelabyrine approach were simulated on 15 adult cadaveric specimens (30 sides). The topographical features and the relationship of facial nerve with the surrounding structures were explored. 30 dry temporal bones were cut along the facial canal, for exploring the relationship of the facial canal and the surrounding structures. Results (1) The distance from the vertical part of the facial nerve to the glomus was about (3.58±1.33)mm, and to the sigmoid sinus (6.42±2.65)mm. (2) The air cells of lateral facial recess was found in 26 cases (86.67%),which is helpful for locating the facial recess and the facial nerve. (3) The lateral lap of the facial nerve was under the point between the posterior and middle 1/3 of the lateral semicircular canal about(1.70±0.33)mm. The vertical line connected this point to the anterior extremity of the conker's crista represented the vertical part of the facial nerve. (4) Geniculate ganglion located anteriorly to the cochleariform process about(2.48±0.23)mm. (5) The fundus of internal acoustic meatus was in the anterior aspect of the lateral point of the eminence of superior semicircular. The ramus lacrimales nervi petrosi superficialis majoris was the convenient signal for locating the labyrinthine segment of the facial nerve. Conclusions It is valuable for locating the facial nerve through its relationship with the surrounding structures, the topography and the features of substantia ossea surrounding the facial nerve, during the temporal approach.

    Double teams right coronary artery anomalies :one case report
    CHEN Liu-Yi, MA Jian-Jun, ZHANG  Bei, LI  Hui, GENG E-Chen, WANG Dan-Dan, ZHANG La-Fang, LI Hai-Na, GUO Zhi-Kun
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  597. 
    Abstract ( 1324 )  
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    Microanatomy and imageology of the posterior segment of basal vein and its clinical significance
    CHEN  Dan, DENG Xue-Fei, WANG  Na, LIU  Bin, CHEN Fang-Hong, HAN  Hui
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  598. 
    Abstract ( 1707 )  
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    Objective To correlate microanatomy of posterior segment of basal vein with its venograms, in order to provide a basis for the preservation of basal vein during the posterior incisural space route.  Methods  A total of 20 human cadavers (40 sides) and 42 patients (80 sides) were examined in this study. Each head of the cadavers was injected with blue gelatin via the superior sagittal sinus and internal jugular veins. The venograms of each patient was obtained from the venous phases of digital subtraction angiography (DSA) (40 sides out of 22 patients) or computed tomographic venography (CTV) (40 sides out of 20 patients). Results Compared to the cadaver dissection, DSA and CTV revealed 89.79% and 94.89% of basal vein respectively, because the diameter of the veins depicted by the imageology were larger than that of anatomic dissection about 37.28% and 36.72% respectively. In this study, the dural entrence of basal vein were clustered along the medial segment of Galen's vein,the initiative segment of Galen's vein and the end of internal cerebral vein. DSA, CTV can reflect the regulation of the dural entrence of basal vein. Conclusions The preoperative venogram is useful for designing the individualized surgical approach for the preservation of basal vein.

    Variation of the biceps femoris: one case report
    DAN Jing-Bao, MA Jian-Jun, WANG Jian-Xue, ZHANG  Bei, WANG Dan-Dan, YAN Zhong-Wei, ZHANG La-Fang, YANG Zhi-Kui
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  602. 
    Abstract ( 1368 )  
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    Digital anatomy of the submental artery perforator flap
    DING Mao-Chao, MAO Si-Hua, CHEN Shi-Xin, JU Tian-Le, WANG Jian-Gong, TANG Mao-Lin
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  603. 
    Abstract ( 2262 )  
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    Objective To provide algorithmic morphological data that enables safe elevation of the submental artery perforator flap. Methods Two fresh unfixed corpses underwent whole body latex injection; eight fresh cadavers were injected with a modified lead oxide-gelatin mixture. Two of them were selected for three-dimensional reconstruction using a spiral computed tomography scanner and specialized volume-rendering software. Ten specimens were dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the submental region. The surface areas of cutaneous territories and perforator zones were measured and calculate with Photoshop and Scion Image. Results The skin and muscles on the anterior neck and mandible are nourished by several arterial perforators: lingual artery, the superior thyroid artery, the submental artery, mental artery, and the facial artery. The diameter of the submental artery was (1.7±0.4)mm at its origin from the facial artery. It sends(1.8± 0.6) perforators to the skin on its course toward the chin. The average size of the territory supplied was(45± 10.2 )cm2. Its largest perforating branch arised behind the medial border of the anterior belly of the digastrics muscle. There were multiple anastomosis between perforators from the submental artery, facial artery, and sublingual artery. Conclusions This study clarifies the anatomy of the submental flap and provides a three dimensional understanding to this important head and neck donor site.

    Applied anatomy of maxillofacial region's blood vessel
    WANG Ai-Beng, BANG Tian-Gong, ZHOU Xiao-Bing, XIE  Wei, LV Yun-Cheng, HONG  Li, LI Yan-Bing
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  606. 
    Abstract ( 1987 )  
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    Objective To provide the reference of applied anatomy for flap design of maxillofacial region, by adopting macromicrodissection and blood vessel cast skill. Methods ①Antisepsis fixation and by way of common carotid artery filling emulsion stuffing dealt with 3 specimens of healthy adult cephal-neck region. Dissection was performed bit by bit from the surface to the deep, for observing and recording the origin diameter, courses, branches, distribution of maxillofacial region's blood vessels; ②Three fresh healthy adult cephal-neck region's specimen were filled with red perchloroethylene stuffing through the common carotid artery. After the corrosion, the origin, courses, branches, distribution and anastomosis of maxillofacial region's blood vessels were explored. Results Maxillofacial region's blood supply was mainly from the branches of facial artery, ophthalmic and maxillary artery, and superficial temporal artery, while that of cheek, lips, nose and chin area were from the branches of facial artery, that of eyeball, extraocular muscles, lacrimal gland and dorsumand palpebrae were from the branches of ophthalmic artery, that of teeth, gingiva, cheek, mandibular joint, nasal cavity, palate and muscles of mastication were from the branches of maxillary artery, and that of parotid gland, orbicularis oculi, soft tissue of temporal and branch of facial nerve were from the branches of superficial temporal artery, respectively. Conclusions  It is a beneficial reference for the approach of plastic operation in maxillofacial region, by investigating systematic anatomic features of maxillofacial region's blood supply.

    Anatomy and significance of the nasal endoscopic lamina erbitalis approach
    CHEN Ge-Xin, ZHANG  Wei, WANG Zhang-Feng, WEN Wei-Beng, ZUO Ge-Jun, SHI Jian-Bei, HU  Geng
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  611. 
    Abstract ( 1550 )  
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    Objective To provide anatomic basis for the nasal endoscopic orbital interior operative approach.  Methods According to the reported approach, the range and thickness of lamina erbitalis excised during the process, and the thickness of fasciae and fossae ischiorectalisadipose body of orbit were measured. Results Excisional range of lamina erbitalis was about 22.15±6.06 mm(20.16~14.68 mm) in length, and 13.45±2.08 mm(12.66~14.44 mm) in height. The thickness of orbital paper plate was 0.38±0.06 mm(0.30~0.46mm), the thickness of the fasciae of orbit was(0.32±0.02 mm(0.30~0.38 mm), and that of fossae ischiorectalisadipose body of orbit (fixed specimens) was about 1.40±0.34 mm(1.18~1.76 mm).   Conclusions  It is feasible to perform orbital interior operation under the guiding of nasal endoscope, and our result provide anatomic basis for clinical application of nasal endoscope.

    A case report of the sciatic nerve
    SUN Xian-Ding, TANG Cheng-Dun, LIN  Yuan, CHEN Wei-Jun
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  613. 
    Abstract ( 1018 )  
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    Applied anatomy of intermediate femoral neurocutaneous flap pedicled with the vastus medialis perforators
    LIN Jia-Fu, ZHENG He-Beng, LIN  Jian
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  614. 
    Abstract ( 1611 )  
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    Objective To provide anatomic basis for the intermediate femoral neurocutaneous flap pedicled with the vastus medialis perforators. Methods 30 embalmed lower limb specimens from adult cadavers perfused with red latex were used for this anatomical study. The midpoint of patella and adductor tubercle were used as observation points, for the following exploration: ①The course and distribution of the intermediate femoral cutaneous nerve;②Anastomosis between the vastus medialis perforators and the nutrient vessels of the intermediate femoral cutaneous nerve. Simulated operation was performed on one side of fresh specimen. Results ①The line between the midpoint of inguinal ligament and the midpoint of the patella-adductor tubercle line which between the midpoint of the patella and adductor tubercle can be considered as the projection on body surface of the anterior branch of intermedial femoral cutaneous nerve. ②The location of vastus medialis perforators was nearly at the midpoint of the line between the midpoint of patella and the one thirds of the line between the midpoint of inguinal ligament and the adductor tendon, about (9.4±2.4)cm above the adductor tendon and (4.1±1.0)cm interiorly of the inner of the vertical line of the middle patella. The vastus medials perforators pierced through the deep fascia and gave off large number of small blood vessels, which closely aligned with the nutrient vessels of intermediate cutaneous nerve, and then formed vascular plexus in the anteromedial part of thigh along the intermediate femoral cutaneous nerve. Conclusions The intermediate femoral neurocutaneous flap pedicled with vastus medialis perforators can be developed to repair soft tissue defects around knee joint.

    Applied anatomy of minimum skin flap supplied with the dorsal artery of great toe 
    MAO  Yong, HUANG  Dong, TUN Wei-Chi, ZHANG Hui-Ru
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  618. 
    Abstract ( 1363 )  
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    Objective  To investigate anatomic basis of minimum skin flap supplied with the dorsal artery of great toe. Methods 20 sides of adult foot specimen, including 18 sides perfused with red emulsion and 2 sides with Chinese ink, were dissected for observing the courses and distribution of dorsal artery of great toe. Results The dorsal artery of great toe originated from the first dorsal metatarsal artery, with 4 to 7 cutaneous branches, and the diameter of (0.9±0.2)mm. The diameter of the dorsal artery of great toe originated from the first dorsal metatarsal artery was more wide than that of from the first plantar metatarsal artery, despite that the diameter of the latter was always exceeded about 0.5mm. Conclusions The dorsal artery of great toe is a favorable choice for being taken as nutrient artery of fibular, dorsal skin flaps or great toe skin-nail flaps, for its stable course and distribution.

    Ankle part of small saphenous vein and its tributaries: anatomy and clinical significance
    CHA Shua-Beng, LEI Lin-Zhong, ZHOU Chi-Long, LI  Chen, TANG Qing-Hua, ZHANG Cai-Meng, LIN  Yong, HUANG De-Biao
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  620. 
    Abstract ( 1606 )  
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    Objective  To provide anatomic basis for more effectively handling small saphenous vein in the distally based sural neurocutaneous flap in order to alleviate the venous blood regurgitation. Methods The small saphenous veins and their tributaries were dissected at the malleolar region of 40 lower extremities of adult cadavers. The line was served as ankle reference line, which passed the tip of the external ankle. The origin patterns of small saphenous vein were observed. The vertical distance between the point of the highest branch jointing small saphenous vein trunck and the ankle reference line was measured. Results According to the infusion points and the courses of tributeries, small saphenous veins could be divided into four types: the single trunk type 47.5%(19 cases), the double trunks type 27.5%(11), the three trunks type 10.0%(4), and the four trunks type 15.0%(6). However, there were three types according to the highest jointing point: the low origin type 10.0%(4), the average origin type 35.0%(14), and the high origin type 55.0%(22). Conclusions The origin of small saphenous vein is variable, which implicate that, during the procedure of preparing the distally based sural neurocutaneous flap, not only the small saphenous vein trunks must be ligated, but also the tributeries, which maybe entry the base of flap, need to be handled.

    The variant of left facial artery: one case report
    XIE  Meng, YANG Xin-Wen, XUE E-Zhong, SHU Wei-Cai
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  624. 
    Abstract ( 960 )  
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    Applied anatomy of the hepatic portal vein
    ZHANG  Hui, ZHOU Ting-Yong, JIAN Hua-Hua, LIU Ben-Ju, XU  Wei, LI Lin-Hong, LV Fa-Jin
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  625. 
    Abstract ( 1980 )  
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    Objective To provide morphologic data for diagnosis and treatment of the liver diseases by observation of the anatomic properties and embranchment of the hepatic portal vein. Methods 50 adult liver specimens without visual pathological changes were used in this study. The embranchment of the hepatic portal vein were dissected and observed, as well the features of main trunk of portal vein were measured and analyzed statistically. Results For 54.0% specimens, the main portal vein bifurcated outside liver parenchyma, with the vertical distance from the bifurcation site to porta hepatis of(8.94±3.17)mm, however, for 34.0%specimens, bifurcation of porta hepatis was in the liver. The lengths of the left main trunk of hepatic portal vein and its pars transverse were(47.44±7.23)mm and (23.90±5.29)mm, and the external diameter of the left main trunk was about(7.43±1.09)mm respectively. The length of pars sagitalis and its external diameter were (24.02±4.97)mm and (7.07±1.36) mm respectively. The angle of the pars angularis was about(114.18±22.59)°. The length and external diameter of the right main trunk of hepatic portal vein were(20.63±6.59)mm and (9.26±1.77)mm respectively. According to the distribution features, 8 types of portal vein could be established.  Conclusions  Hepatic portal veins are variable, especially for its distribution and bifurcation site, which should be remarked during the liver operation.

    The variation of heart and multiple organs: a case report
    LI Xuan-Long, SHU Wen-Cha, XIANG Yu-Juan, LIU  Ying, WANG  Yan, SUN Xiao-Meng, ZHANG  Feng, DIAO Ru-Xing, MA Shen-Zhou, DING  Chuan
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  628. 
    Abstract ( 1063 )  
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    Facet tropism and the severity of degeneration of facet joints: relationship and clinical significance
    ZHANG Ji-Ye, SHU Jing-An, JIANG Huan-Chang, WANG Ji-Xin
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  629. 
    Abstract ( 1343 )  
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    Objective To investigate the relationship between the facet tropism and the severity of degeneration of facet joints in degenerative lumbar spondylolisthesis(DLS), and explore its clinical significance. Methods 60 from 102 patients with DLS,treated in our hospital during May 2004 to August 2009,were randomly selected. 60 age- and sex- matched people free from spinal diseases were selected as control group from a group of 300 coming for routine physical examination. The facet angles at L3/4, L4/5 and L5/S1 level on axial MRI were measured,then facet tropism was calculated. The severity of degeneration of facet joints was evaluated by using a 4-grade scale. The relativity analysis of obtained parameters was performed. Results The left facet joints were sagittally oriented than the right facet joints, but the difference was statistically significant only at L3/4 (P=0.003) and L4/5 (P=0.000) in the DLS group. The facet tropism at L4/5 was more significant than that at L3/4 and L5/S1 in both groups. The facet tropism, the degeneration of facet joints in the DLS group were more significant than those in the control group. The facet tropism increased with the severity of degeneration of facet joints in both groups. Conclusions (1)Facet tropism is quite common in lower lumbar level. (2)There is a positive correlation between the facet tropism and the severity of degeneration of facet joints. (3)Facet tropism is not simply due to secondary osteoarthritic remodeling but also part of the pre-existing morphologic abnormality. (4)The facet tropism increases the risk in the development of DLS. The facet tropism and the severity of degeneration of facet joints have an important etiologic meaning in the occurrence of DLS.

    Applied anatomy of extra-lateral minimally invasive approach at the level of T5 to T11 spine
    TUN Ceng-Hui, DAN  Yi, HU Xiao-Xiao
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  634. 
    Abstract ( 1559 )  
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    Objective To provide anatomic basis for extra-lateral minimally invasive approach on T5 to T11 spinal level. Methods 12 adult cadavers were dissected to observe the course, distribution and adjacent relations of vessels and nerves around lateral T5 to T11 vertebral body. Results Vessels around T5-T11 passed through the lower part of corresponding vertebral body constantly, with the upper segmental veins, and lower segmental artery. Both sympathetic trunk of gave off the great splanchnic nerves at the level of T6-T9,  and the small visceral nerves at the level of T10-T12. Azygos vein located at the right and anterior of T5 to T11 spine, and closed to the left side of the upper spine. Thoracic aorta travelled through the left and anterior of the spine,  and turned to the right side gradually. The distance between the right sympathetic trunk and the azygos vein was wider compared to that between the left sympathetic trunk and the thoracic aorta. Conclusions Extra-lateral minimally invasive approach around T5-T11 thoracic spine is operable, however, vessels and nerves at the antero-lateral side of vertebral body have to be protected during the operation.

    Applied anatomy of the anterior transposition of ulnar nerve in children elbow
    SHU E-Zhong, ZHOU  Rong, TUN Shui-Pei, DONG De-Qing, LING Shu-Cai, ZHANG Fa-Hui
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  637. 
    Abstract ( 1492 )  
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    Objective  To provide anatomical basis for the treatment of humeral supracondylar fracture of children with the anterior transposition of ulnar nerve. Methods 20 elbow specimens from 10 children cadaveric upper limbs (aged from 6 to 8) were used in this study. Anatomic features of ulnar nerve and its accompanying vessels, and ulnar groove were explored, while, anatomic position of the nerve after anterior transposition were analyzed. Results Ulnar nerve was supplied mainly by superior ulnar collteral artery, however, this nerve was nourished mainly by ulnar artery when it passed through the foream. Ulnar nerve was always accompanied by superior and inferior ulnar collteral arteries, and the posterior branch of ulnar recurrent artery during its course, which would not be interfered during the approach of anterior transposition of ulnar nerve. Transferred ulnar nerve located on the soft tissue bed, easy to be slided, and escaped from the drag injury caused by flexion movement of elbow joint. Conclusions Anterior transpostion of the ulnar nerve is favorable for blood supply of the nerve, and the slide movement.

    Localization of arytenoid cartilage and its significance
    HONG  Chao, WANG Bin-Quan, HUANG Fu-Hui
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  640. 
    Abstract ( 1459 )  
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    Objective To provide anatomic data for the localization of arytenoid cartilage during clinical operation of arytenoid cartilage. Methods After dissecting larynx, the locating relationship between arytenoid and thyroid lamina and the morphological features of the projective point of the muscular process in thyroid lamina and vocal process were observed and measured on 30 normal laryngeal specimens (60 sides). Results (1)10 parameters of arytenoid were measured, including the distance from the top to bottom of arytenoid. Except for the depth of thyroarytenoid attachment in vocal process, the other parameters were gender significant (P<0.05).  (2)The distance from the muscular process to the lower point of the inferior cornu of thyroid was about (13.05±1.92) mm in male and (11.76±1.79) mm in female and to the posterior edge of thyroid lamina was (8.11±1.17) mm in male and (6.95±1.26) mm in female, and to the medial surface of thyroid lamina was 3.71 mm±1.31 in male and (3.65±1.23) mm in female. (3) The projective point of the muscular processes located in the inferior part of posterior oblique line region of thyroid lamina. The point was far from the posterior edge of larynx with the distance of (7.27±1.52)mm in male and (5.81±1.47) mm in female, from the inferior edge of thyroid lamina with the distance of (7.12±1.43)mm in male and (5.92±1.26) mm in female. Conclusions  Operation about arytenoids may approach along posterior, inferior edge of thyroid cartilage and inferior edge of cricothyroid joint to locate the muscluar process of arytenoid. As shortest is the distance from muscular process of arytenoid to endosteum of thyroid lamina,if we approach from the posterior oblique line region of thyroid lamina to locate the arytenoid in thyroid cartilage windowing operation, the distance of operation should be shortened..

    Three-dimensional sectional anatomy of paraprostatic fascia and its adjacent structures
    WANG Shi-Dong, DENG Xue-Fei, WANG  Na, CHEN  Dan, ZHANG  Ming, HAN  Hui
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  643. 
    Abstract ( 1568 )  
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    Objective To illustrate anatomical configration of periprostatic tissues for radical rebropubic prostatectomy. Methods The pelvics from 6 male adult cadavers were serially sectioned transversely, sagittally and coronally respectively, with the thickness of 3mm. Identical levels on three plane were selected to observe the configuration of the periprostatic fascia and its adjacent structures. Results ① Puboprostatic ligament was formed by the end of parietal fascia which fixed the prostate to the pubis; Dorsal vein complex was on the pubourethral ligament between bilateral puboprostatic ligaments, with closely adhering to prostatic fascia anteriorly and to  prostate posteriorly. ② Lateral part of prostatic capsule, venous plexus and prostatic fascia were interlaced each other, which were closely adhered to prostate and loosened to parietal fascia. ③ Rectovesical septum was composed of Denonvillier's fascia and fascia propria in which a potential fascia space was found between them. The former coursed laterally stretching to prostatic fascia and the latter the lateral part of the fascia propria. Denonvillier's fascia, fascia propria and parietal fascia constituted the triangle of neurovascular bundle. Conclusions Dissecting along the prostatic fascia and Denonvillier's fascia, with less bleeding and nerve damage, is the key in radical rebropubic prostatectomy.

    Application of CT virtual endoscopy in analysis of variations of hepatic portal vein
    PANG Guo-Dong, LIU  Cheng, LIU Hua-Jing, DIAO  Fang, WANG Ti-Meng, RUI  Jun
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  647. 
    Abstract ( 1798 )  
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    Objective To analyze and evaluate the value of CT virtual endoscopy(CTVE) in accurately distinguishing the variation type of the portal vein(PV). Methods The study included retrospectively evaluated 32 patients (20 males, 12 females) who had undergone routine abdominal MSCT. 15 patients with trifurcation variation of the main PV(MPV)verified by VR and MIP, and 17 patients with the trifurcation variations of the right PV(RPV)were emphatically analyze the lumen structures at the point of trifurcation,such as the short PAPV-LPV trunk or the  short RAPV-RPPV trunk, and then the CTVE was adopted to identify the short common trunk from trifurcation, and compared the results with that of classical techniques. Results Trifurcation of MPV was observed in nine of fifteen patients (60%), which were verified by CTVE as the short RAPV-LPV trunk or short RAPV-RPPV trunk; Trifurcation of RPV appeared in six from 17 patients(35%), with the VII segmental branch(right posterior portal vein) arising from the main portal vein, the right anterior segmental branch and the left portal vein sharing a common trunk. In addition, we found that 2 patients were normal(12%). With the analysis of CTVE, only 15 cases, were truly trifurcation, with the positive rate of 47%. Conclusions CTVE is valuable for demonstrating the sequence of intracavity bifurcation, and clearly distinguishing the trifurcation from the short common trunk, which can be used to analyze anatomic features of portal vein more accurarely.

    A reclassification of the right anterior lobe of liver based on the anatomy of portal vein
    XIE  Xu, CA Shou-Wang, DONG Jia-Hong, ZHOU Ding-Hua, ZHOU Ning-Xin
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  651. 
    Abstract ( 2346 )  
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    Objective To evaluate anatomic features of intrahepatic portal and hepatic veins of right anterior lobe of liver, and provide a new concept of the classification of hepatic segment for imaging diagnosis and liver surgery. Methods The data from successive section MRI of the upper abdomen from 60 living donors for liver transplantation and three-dimensional images of 10 patients were used in this study. The course and division pattern of the intrahepatic portal and hepatic veins, and their relationships were investigated. Results The intrahepatic portal veins of eight hepatic segments can be mainly divided into ventral and dorsal branches, despite four branches could be found in some cases. About 90% dorsal branches supplied the dorsocranial area of the right lobe posterior to the right hepatic vein. Most branches of P5 gave off the right anterior trunk of P8v, and most drainage veins of S5 joined MHV. Therefore, the right anterior lobe could be divided into S8v+S5 (ventral segment) and S8d (dorsal segment).  Conclusions  This new concept of hepatic segment division will be helpful for the accurate allocation of lesion in the liver, as well for the development of the new and safe surgical procedures.

    Assessment of myocardial performance in fetuses by velocity vector imaging
    XIA Xun, TU Yan-Gong, LI Qing-Li, GUO Fei-Yan, WANG Chen-Gong, LIAO Yu-Mei
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  655. 
    Abstract ( 1601 )  
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    Objective To investigate the application and the influencing factors of velocity vector imaging for evaluating of myocardial mechanics in the normal fetal ventricles. Methods Two-dimensional 4-chamber images of the heart (n=147) were interrogated offline using Syngo US Workplace VVI software. Measurements of global and segmental longitudinal velocity, strain, and strain rate were performed on the right and left ventricle. Comparison was made between each segmental and global measurement respectively. The correlation of above measurements with gestational weeks and fetal heart rate was analyzed. Results (1) The left and right ventricular velocities decreased from the base to the apex segment (P<0.05). The strain and strain rate showed no significant difference among global and each segmental measurement (P>0.05). (2) The global velocities had significant positive correlation with increasing gestational week (left ventricle r=0.662,P<0.05;right ventricle r=0.732,P<0.05). The strain and strain rate had no significant correlation with gestational age (P>0.05). (3) There was significant correlation between the global strain rate and fetal heart rate (left ventricle r=0.454,P<0.05;right ventricle r=0.465,P<0.05). The strain and velocity had no significant correlation with the fetal heart rate (P>0.05).  Conclusions VVI is a newly technique for quantitating global and segmental fetal cardiac function.

    The characteristics and significance of area and fractional anisotropy change in cerebral peduncles among patients with silent lacunar infarct in pyramidal tract
    SONG Zhi-Ban, BO Su-Ti, ZHOU Yan-Ling, DONG Yan-Jiang, LIANG Hai-Mao
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  659. 
    Abstract ( 1537 )  
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    Objective To research the change rules and clinical significance of area and fractional anisotropy (FA) in cerebral peduncles among patients with silent lacunar infarct in pyramidal tract  Methods: 54 patients with silent lacunar infarct in pyramidal tract diagnosed by MRI and 105 healthy adults were selected as study subjects. The cerebral peduncle area and FA of 54 patients were divided into two groups according to injured side of cerebral peduncle: injured side group and uninjured side group, the area and FA of two groups were compared with the control group, as well, the cerebral peduncle area and FA asymmentry ratio of lacunar infarct group was compared with that of the control group. Results The cerebral peduncle areas of 54 patients with silent lacunar infarct in pyramidal tract were smaller than that of control group(Left F=17.104 ,P=0.000,Right F=12.581,P=0.000). There was no difference of cerebral peduncle FA between lacunar infarct group and control group (Left P=0.894, Right P=0.968), and there was no difference of area and FA between left and right cerebral peduncle in lacunar infarct group (t=0.254 P=0.800,t=0.268 P=0.790). There was no difference of cerebral peduncle area and FA asymmentry ratio between observed group and control group (t=0.114 P=0.267,t=1.463 P=0.175. Conclusions The lesion of silent lucunar infarct in pyramidal tract can't lead to area and FA changes of cerebral peduncle in all, there is no affect on area and FA changes of cerebral peduncle caused by Wallerian degeneration after cerebral infarction.

    Distribution variation of lumbar nerve roots in patients with transitional lumbosacral vertebrae
    HOU Li-Sheng, CUI Hong-Feng, RUAN Di-Ke, BAI Xue-Dong, WANG Yi-Zhou, HE  Qing, DIAO  Cheng, LI Hai-Feng, LI  Wei, XU  Cheng-
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  663. 
    Abstract ( 1686 )  
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    Objective  To detect the distribution variation patterns of lumbar nerve roots in patients with lumbosacral transitional vertebrae (LSTV).  Methods From May 2008 to March 2010, lumbosacral disc herniation was confirmed by CT and/or MRI scanning on LSTV patients verified by conventional whole spinal radiographs. For those SZ cases, physical examination was performed to detect distribution variation of lumbosacral nerves, including false LSTV cases of C-I sacralization(SZ) or C -IIIB lumbarization(LZ).  Results 12 SZ and 12 LZ cases were enrolled in the study. Among SZ cases, 5 C-IIIB, 3 non-squaring well-configured and 1 IIIA cases existed the disturbances caused by lumbar nerve compression(s) resembled those by the same and /or one level distal nerve(s) in non-LSTV ones. The disturbances caused by lumbar nerve compressions in 3 C-IIB ones resembled that in non-LSTV ones. Among 12 LZ ones, the distributions caused by lumbosacral nerve compression(s) in 10 total-lumbarization ones resembled that by the same and/or the lower proximal nerve(s) in non-LSTV ones, and the disturbances caused by S1~2 nerve root in one total-lumbarization resembled that by L4~S1 nerve root compression in non-LSTV one. The disturbance caused by lumbar nerve compressions in one case of C-IV LZ resembled that in non-LSTV one. Conclusions In patients with sacralization, lumbosacral nerve roots tend to act as the usual function of nerves at the same level and/or lower level in non-LSTV ones, especially in those with decreased mobile segment ones. In patients with lumbarization, the lumbosacral nerve roots tend to act as the usual function of nerves at the same level and/or upper level in non-LSTV ones, especially with increased mobile ones.

    Pancreaticobiliary junction and acute pancreatitis: MR cholangiopancreatography analysis
    LI Dong-Xuan, SHANG Li-Jun, HUANG  Zhu, JU  Shu, MA Li-Gong, LI Yong-Ji, XIANG Ke
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  668. 
    Abstract ( 1542 )  
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    Objective To provide anatomic basis for the onset of acute pancreatitis by explore morphologic features of pancreaticobiliary junction. Methods MR cholangiopancreatography (MRCP) of 83 patients with acute pancreatitis (acute pancreatitis group, AP group) were analyzed retrospectively, and their pancreaticobiliary junctions were measured and compared. PRCP of other 139 patients with non-acute pancreatitis was analyzed in the same way as control (control group). Results For acute pancreatitis group, the length of common channel was significantly longer than that in control group (P<0.01), and the angle between common bile duct(CBD) and pancreatic duct in the former was significantly larger than that of the latter (P<0.01). However, there was no significant difference between the diameters of common bile duct or pancreatic duct in two groups (P>0.05). Conclusions Pancreaticobiliay junction plays a significant role at the onset of acute pancreatitis,meanwhile,long common channel and large angle of pancreaticobiliay ducts are important factors causing acute pancreatitis.

    The abnormity of anterior communicating artery: one case report
    LIU Meng-Shen, JIA Chun-Bei, LI Guang-Biao, SU Guo-Jun, CHEN Ze-Wen, TU  Liu
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  670. 
    Abstract ( 938 )  
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    The determination of optimal depth of the insertion of central venous catheter in infants through transesophageal echocardiography
    LI  Zhen, WANG  Cheng, WANG Zhi-Feng, DIAO Guo-Dong
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  671. 
    Abstract ( 1218 )  
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    Objective  To explore the values of transesophageal echocardiography in determining optimal depth of insertion of CVP catheter in infants undergoing cardiovascular surgery. Methods 100 infants underwent cardiovascular surgery were selected in this study. The CVP catheterization was performed under the guide of TEE. The position of the catheter tip determined by AP chest x-ray, was identified by the level of thoracic vertebra(T) corresponding to the position of the catheter tip. Results The position of tip normally distributed from T4-T6 which anatomically corresponded to SVC under the guide of TEE. Conclusions TEE is a simple and accurate guide for positioning the catheter tip at the level of T4-T6 in infants.

    Diagnosis of congenital coronary anomalies in adults by dual source CT
    AN  Yu, LIU Han-Lin, CHEN Shao-Yuan, FANG Gong-Cheng, SU You-Su
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  674. 
    Abstract ( 1564 )  
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    Objective To evaluate the diagnosis value of dual source computed tomography on congenital coronary anomalies (CCA) in adults. Methods Retrospective analysis was performed on 1824 cases underwent the dual source CT coronary angiography, and the data of patients suffered from CCA were statistically analyzed, for evaluating clinical value of dual source computed tomography. Results A total of 43 cases of CCA were found from 1824 cases who undergoing DSCT, giving the detect rate of 2.3% (43/1824), including anomalies of origin of 24 cases (1.3%, 24/1824), myocardial bridge(MB)of 18 cases (0.99%, 18/1824), and abnormal termination of 1 cases. Conclusions DSCT can be used to display of anomalous coronary arteries accurately, especially for the diagnosis and prognosis of CCA for outpatients.

    Involvement of nerve innervation on the expression of Ki67 and α-SM-actin in new formed collateral vessels induced by ischemia
    LUO Meng-Yang, WU Jiao-Qiong, YANG Bao-Lin, SHU  Wu, LUO  Hua, LUO Hua-Gang, CA Wei-Jun
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  677. 
    Abstract ( 1573 )  
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    Objective To investigate the effects of nerve innervation on the expression of Ki67 and α-SM-actin in new formed collaterl vessel. Methods Both left and right femoral arteries of ten rabbits were ligated seperately. For the right side, additional sciatic and femoral nerves incision were followed. All animals survived about 7 days. The expression of Ki67 and α-SM-actin was detected by confocal immunofluorescence with special antibodies against Ki67 and α-SM-actin. Results In normal small arteries,the expression of Ki67 was absent,while α-SM-actin evenly expressed in SMC;For the left side specimens,ki67 positive cells significantly increased and distributed in all layers of the vascular wall. α-SM-actin expressed in the neointima, however, the expression was more weak compared to that in the media;For right side(ligation plus dennervation), Ki67 positive staining was rarely found,occasionaly in endothelial cells, as well α-SM-actin expressed weakly. Statistic analysis showed the significant difference of ki67 and α-SM-actin expression in collateral vessels between simply ligated-side and femoral artery ligation plus dennervation side (P<0.05). Conclusions  This data suggests that the nerves of the vascular wall involve in mediating expression of Ki67 and α-SM-actin during the growth of the collaterl vessel. 

    Effects of laminar shear stress on expression of MT1-MMP in rat bone marrow-derived mesenchymal stem cells
    TANG  Jie, SUN Xiao-Dong, YUAN Ya-Gong, LI Rui-Meng, BANG Xin-Chun, WANG Han-Qin
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  680. 
    Abstract ( 1572 )  
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    Objective To investigate the effect of laminar shear stress on the expression of membrane type-1 matrix metalloproteinase(MT1-MMP)in rat bone marrow-derived mesenchymal stem cells (rMSCs). Methods rMSCs were isolated from SD rat lower extremities and loaded by laminar shear stress with the parallel-plate flow chamber system, then the expression of MT1-MMP mRNA of rMSCs was examined by real-time PCR. Results Shear stress with different magnitude of 5, 15, 30 dynes/cm2 all induced MT1-MMP mRNA expression, especially high shear stress, 30 dynes/cm2, which was time-dependent. The expression of MT1-MMP mRNA was inhibited by SB202190, an inhibitor of p38, but enhanced by wortmannin, an inhibitor of PI3K/Akt. Conclusion Shear stress can activate the expression of MT1-MMP. The amount of MT1-MMP expression is closely related to stimulating time and the strengths of shear stress, and p38MAPK and PI3K/Akt signal pathway may play a critical role during the process.

    Three dimensional finite element analysis of the pelvis under extorsion loading
    XIAO  Jin, YIN Qiang-Shui, ZHANG Mei-Chao, DIAO Wei-Dong, LI Jian-Die
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  683. 
    Abstract ( 1552 )  
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    Objective    To study the mechanics of pelvis under extorsion loading using three-dimensional finite element model (FEM). Methods A healthy adult male volunteer was chosen to undergo PET-CT scanning. The initial images of pelvis were output to PC. Next a three-dimensional reconstruction and a finite element model were made. An extorsion loading was put to the model. The horizontal loading reached to the left anterosuperior iliac spine posteriorly. Then the stress, strain and displacement nephograms were obtained and the biomechanical features were analyzed. Results The stress conducted through the two ways. Firstly, it was rearwards to the superior part of the sacrum passed the sacroilial joint at the same side. Secondly, the stress passed forward to the pubis at the opposite side. The loading of the anterior ring of pelvis was relatively greater than that of other parts. The peak value of stain appeared at the antero-inferior part of the sacroilial joint at the same side. The peak value of displacement was at the loading point. The displacement at ilium, ischium and ramus of pubis at the same side were relatively greater. Conclusions The extorsion stress easily cause the fractures of pubic branch fracture, the damage of sacroilial joint, or the compressed fracture of sacrum.

    Relationship between the elastic modulus of the hepatic artery and gender
    LI  Jing, LI Wen-Chun, SONG  Jie, WANG Meng-Hua, WANG  Lei, WANG Han-Qin, HUANG Tie-Zhu
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  686. 
    Abstract ( 1691 )  
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    Objective To explore the relationship between the gender and the elastic modulus of the hepatic artery of pigs and to provide theoretical basis for pig-to-human transplantation. Methods The hepatic artery of female, male and gonadectomized 23 Hubei white pigs aged between 4 and 7 months were obtained, and then, the arteries were divided into the upper, middle and lower segments, kept at 4℃. The pressure-diameter relationship of the middle segment was measured on the biomechanical testing system for soft tissues, and the elastic modulus was calculated, including press strain elastic modulus (Ep), incremental elastic modulus (Einc), and volume elastic modulus (Ev). Results The difference of hepatic arterial elastic modulus among female, male and gonadectomized groups was significant (P<0.01), with the lowest of female group, the highest of gonadectomized group and the middle of male group. The hepatic arterial elastic modulus in all groups aged 7 months was lower than that in all groups aged 4 months, and the difference was significant (P<0.05). Conclusions There is the sex difference of the hepatic arterial elastic modulus in all pigs aged 7 months, which suggests that gender mathching pig liver should be selected as the donor organs, for keeping the same elastic modulus between the donor and receptor and reduce the hepatic arterial complications after liver xenotransplantation.

    Repair of hand and foot soft tissue defect with dissociative saphenous arteria flap
    JU Ji-Hui, JIN Guang-Zhe, DIAO  Jiang, LIU Ti-Fei, WEI  Cheng, LI  Lei, LI Jian-Ning, LIU Xin-Yi, JU Guo-Beng, HOU Rui-Xin
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  690. 
    Abstract ( 1878 )  
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    Objective To report the clinical effects of the dissociative saphenous arteria flap on repairing hand and foot soft tissue defect. Methods From Feb. 2003 to Feb. 2009, 8 cases of hand skin soft tissue defect and 5 cases of foot skin soft tissue defect were treated with dissociative saphenous arteria flaps. All the 13 cases were accompanied with exposed tendons,bones and nerves, and the flap area was about 7cm×6cm~12cm×9cm,while achilles tendon defect appeared in one child patient. Donor areas of 2 cases were stitched up directly, however, donor areas of 11 cases were replanted with total pachydermia of hypogastrium.  Results The flaps of all 13 cases survived after surgery, and the wound of donor area healed primarily. Our follow-up lasted for 6~36 months, averagely 9 months. It showed that, the flaps survived well, with no swelling and distension. The sensory recovery reached about S2~S4. The loss of the function of hand and foot did not appeared for all cases. Linear scars on donor area can be found for 2 cases with direct stitches, with no hyperplasia or contracture, while, donor areas of 11 cases were soft and neat, without scar or contracture. Conclusions The application of dissociative saphenous arteria flap in repairing and reconstructing of hand and foot soft tissue defect were with anatomical invariableness, with safe and convenient operation, and with the need of recovering the wound surface of hand and foot.

    The tympanoplasty under modified endaural incision without accessory incision
    FAN Yun-Beng, LV Meng-Hui, CHEN Ge-Xin, JIA Wen-Tong, FENG Shao-Yan, HONG Hai-Yu
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  694. 
    Abstract ( 1177 )  
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    A comparative study of the two kinds of anterior decompression and reconstruction for treating two-level cervical myelopathy
    CHEN Ying-Dong, LONG Hou-Qing, ZHANG Bing-Zhi, KONG Lian-Tong, LI An-Cheng, DIAO Hong-Sheng, DONG Yan-De, HU San-En, DIAO Ji-Nan, YIN Ke-Jiang, ZHANG Zhi-Zhi, LUO Yan-Ping
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  698. 
    Abstract ( 1538 )  
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    Experimental research on the combination of the Astra blue staining of brain slices with plastination-embedding
    HAN  Lei, QIN Rong-Rong
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  702. 
    Abstract ( 941 )  
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    The Natural etching combined with Lye corrosion
    XIAO Zhao-Meng, LI Ze-Yu, LIU  Chang, TUN Kun-Cheng, HONG Hui-Wen, ZHONG Guang-Meng, JIA Cheng-En, HU An-Wei, LI Zhong-Hua
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  704. 
    Abstract ( 918 )  
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    Nonrecurrent and recurrent laryngeal nerve coexistence: a surgical pitfall in cervical operation
    DU Xin-Ru, JIA  Hui, LIU  Duan
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  705. 
    Abstract ( 889 )  
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    Four cases of variations of common carotid artery and its branches as well as subclavicula artery
    LV Yang-Bei, DIAO Li-Wu, JING  Xiang, YANG  Rui, TUN  Yue
    Chinese Journal Of Clinical Anatomy. 2010, 28(6):  707. 
    Abstract ( 1062 )  
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