Table of Content

25 July 2011 Volume 29 Issue 4

  

Applied anatomy of mastoidectomy through the posterior transpetrosal approach

WANG Jun-Yu, L??Yi-Cheng, DANG Rui-Shan, LIAO Jian-Chun

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  363-366. 

Abstract ( 874 )  

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Objectives　To provide anatomic data for mastoidectomy through the posterior transpetrosal approach.    Methods　The mastoidectomy was simulated in 25 cadaveric specimens. Electric drill was used to move the superficial bone of the mastoid to expose the underlying structures. The sigmoid sinus, superior petrosal sinus, dura mater of middle cranial fossa, posterior cranial fossa, bony semicircular canals and mastoid segment of the facial nerve were exposed and skeletonized. Variations of the structures in the mastoid were observed and important data were collected.　Results　Mastoid bone can be divided into three layers including the superficial cortical bone, the mastoid air cell and the Ivory bone encasing the sigmoid sinus, the facial nerve and the labyrinth. The minimal distances from the superficial mastoid to the sigmoid sinus, the junction of the transverse sinus, sigmoid sinus and the superior petrosal sinus, the top point of the eminence of the horizontal semicircular canal，the middle part of the mastoid segment, the digastric ridge was  （7.28±2.14）mm,（14.22±2.74）mm,（16.56±2.10）mm,（13.31±1.87）mm,（11.58±1.60）mm separately. The variations of the sigmoid sinus included the enlargement of the sinus, the far-advanced sigmoid sinus and high jugular bulb. No variations of the mastoid segment of facial nerve and the bony semicircular canals were observed.　Conclusions　Be familiar with the anatomic characteristics of the mastoid can make the mastoidectomy more safe and efficient.

Anatomy and clinical application of the improved extended transbasal approach

CHEN Xiao-Lei, LIU 　Ning

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  367-370. 

Abstract ( 212 )  

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Objective　To explore microsurgical anatomy and clinical effects of the improved extended transbasal approach with preservation of olfaction.　Methods　The anatomic features were observed and measured in 20 dry skulls and 15 wet cadaveric heads. From March 2005 to June 2010, thirteen patients with tumors in midline of skull base were surgically treated through the extended transbasal approach with the preservation of olfaction function.　Results　The extended transbasal approach provided a significant increased operating field compared to that of the standard transbasal approach. Nasal mucosa attached to the cribriform plate could be remained by removing the nasal bone and orbital plate during the osteotomy. The optic nerves，carotid arteries，vidian canals，hypoglossal canals and other structures would be the perturbation for the further extension of operating field. 9 among 13 patients were totally removed the tumors. Five patients occurred postoperative complications. No surgical mortality occurred.　Conclusions　The main apparent advantages of the improved approach are the quality of surgical exposure, a low risk of brain damage, and the effective preservation of olfaction, which is an optimal selection for resecting the tumors in the midline part of skull base involving the orbit, paranasal sinus, ethmoid sinus, sphenoid sinus and clivus regions.

Measurement of orbital volume in zygomaticomaxillary complex fractures and its clinical significance

YIN Xue-Min, REN Xiao-Xu, LIU 　Chi, LI 　Yan

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  371-374. 

Abstract ( 752 )  

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Objective　To calibrate the variations of orbital volume of zygomaticomaxillary complex fracture patients, and get the accordance to recover the normal orbital volume and shape, based on three-dimensional reconstruction and computer software technique.　Methods　18 patients with the zygomaticomaxillary complex fractures and endophthalmos were scanned by multiple spiral CT, and then, the Simplant analytic software was used to calibrate and compare statistically the intact and traumatized orbital volume.　Results　Traumatized orbital volume significantly enlarged in all patients, with a mean volume of (1.83±0.75) cm3 compared with the opposite intact orbit (P=0.000). For the males, the intact orbit volume was about (28.50±1.15) cm3, which was significant different with that of the females (23.57±1.31) cm3 (P=0.000). Conclusions　The promptly measurement of orbital volume is helpful for making optimal operation plan, recovering accurately the original orbital volume, and avoiding the development of endophthalmos.

A case of multi-belly triceps brachii with supernumerary head

JING 　Xiang, CHE Jia-Dong, YANG 　Rui, TUN 　Yue

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  374. 

Abstract ( 157 )  

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Three-dimensional reconstruction of the mandibular canal and its clinical significance

FU Sheng-Qi, FAN Ti-Yi, MIAO Ying-Ying, HU 　Wei, DAO 　Jing, DENG Xiao-Hui

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  375-377. 

Abstract ( 746 )  

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Objective　To provide anatomic basis for the mandibular dental implantation.　Methods　20 volunteers with healthy teeth were selected and scanned in series by spiral CT from the orbitomeatal line (OML). The mandibular canal was reconstructed by the curve-planar reconstruction(CPR) under the ADW 4.2 software. The position and composition of mandibular canal were observed, followed by the measurement of the distance from the dental root of mandibular posterior teeth to the superior wall of mandibular canal. The visual model of mandible and mandibular canal were reconstructed by the Amira 3D software. The course of mandibular canal in the diaphanous mandible and the relationship of mandibular posterior teeth with it were detected.　Results　The mandibular canal was composed of a thin compact bone and traveled through the bottom of lingual side of the molar and buccal side of the premolar. The lingual side of the madibular canal was thicker than that of other sides. In the diaphanous mandible, the mandibular canal could be clearly displayed, including its position, shape and course, and the distances from the mandibular canal to the inferior edge of mandibular body, alveolar crest and the medial, lateral plates of mandible respectively. The distance from the dental root of second molar to the mandibular canal was the nearest than that of the others, and the followed was the second molar, first molar, third molar, second premolar and first premolar by the near and far. The distance was nearer from the distal root of mandibular molar to the mandibular canal than that of the mesial root. The nearest distance from the dental root of first premolar, second premolar, first molar, second molar, third molar to the superior wall of mandibular canal were (8.38±1.04) mm(left) and (8.44±1.05) mm(right), (7.51±0.85) mm, (3.40±0.65) mm, (2.93±0.61) mm, (3.92±0.63) mm(left) and (3.97±0.63) mm(right) separately.　Conclusions　Three-dimensional reconstruction and analysis of mandibular canal is valuable for choosing appropriate length of dental implantation and avoiding to injury the inferior alveolar nerve during the operation.

Applied anatomy of the superficial inferior epigastric artery flap and its clinical significance in repairing head and neck defect

WANG Xiao-Min, MA Shi-Yin, ZHANG 　Kai, MENG Zhong-Hua

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  378-381. 

Abstract ( 480 )  

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Objective　To study anatomic features of the superficial inferior epigastric artery(SIEA) flap and explore its clinical application in the repair of head and neck defects.　Methods　The origin, course, branch, distribution, diameter, pedicle length and neighbours of superficial inferior epigastric artery and vein were dissected and measured in 10 adult corpses perfused with red latex through artery system.　Results　In our series of 20 cadaveric dissections, the SIEA was identified in 18(90%) and the SIEV in 20(100%). The external diameter of SIEA was 1.48±0.44mm(0.85~2.43）, The length of SIEA was 4.8±1.18 cm (2.56~7.02), averagely. The external diameter of SIEV ranged from 1.46 to 4.05mm, with the average value of 2.33±0.71mm. The length of SIEV ranged from 4.03 to 8.42cm, with the average value of 5.45±1.2cm. For those with absence or hypogenesis of SIEA, the longer and larger ascending branches of the superficial circumflex iliac artery system could be identified.　Conclusions　Considering its reliable blood supply, sufficient transfer area, and the slight donor site damage, the superficial inferior epigastric artery flap can be applied to reconstruct head and neck defects.

Applied anatomy of peroneal artery perforator flap

LI Kuang-Wen, TANG Ju-Yu, LIU Chang-Xiong, XIE Song-Lin, LIU Ming-Jiang, DAO Ke-Ai

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  382-385. 

Abstract ( 1215 )  

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Objective　To provide anatomic basis for the application of the peroneal artery perforator flap.　Methods　Fifteen fresh adult leg specimens injected with red latex were dissected. The number, distribution, and the courses of the peroneal artery perforators were explored, as well,  the pedicle length and external diameter of the artery used for the flap were measured and analyzed.　Results　68 perforators were identified in 15 leg specimens (averagely 4.5 perforators for each leg). The perforators in the proximally lateral leg originated from different arteries. Peroneal artery perforator gathered in the region under the fibular head about 10 to 15 cm, with the  longest perforator of (5.23±0.75)cm. Under the fibular head about 5 to 20 cm, the larger perforator could be identified. The perforators in the proximal lateral leg were mainly soleus perforators, and the most septocutaneous perforators and the flexor hallucis longus muscle perforators gathered in the lateral mid-distal region.　Conclusions　With the stable course, enough size and length, peroneal artery perforators originated from the region under the fibular head about 10 to 15cm are ideal nutrient vessel for supplying free peroneal perforator flap.

A case of multi-belly biceps brachii with supernumerary muscle

CHE Jia-Dong, JING 　Xiang, YANG 　Rui, TUN 　Yue

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  385. 

Abstract ( 320 )  

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Morphological study and clinical significance of popliteofibular ligament

CENG Shu-Xiong, DONG Chi-Le, WU Guo-Qing, HUANG Hui-Long, GUO Xiao-Dan, WANG 　Dong, DANG Rui-Shan

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  386-388. 

Abstract ( 1135 )  

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Objective    To provide anatomic basis of the popliteofibular ligament (PFL) for clinical diagnosis and surgical treatment on its injury.    Methods    We performed this anatomical study on the PFL and its surrounding structures using 61 formalin-fixed knees, observing and measuring its length, width, thickness, and relationship with surrounding structures.   Results    The PFL consistently existed, it originated from popliteal tendon and inserted into styloid process of the fibular. It was fan-like shaped. PFL presented as ligament (89.5%) or fascia (11.5%). It was on an average (10.47±2.38)mm in posterior margin length, (6.24±1.71)mm in anterior margin length, (8.90±3.12)mm in width, 1.23±0.48mm in thickness. The angle between PFL and popliteal tendon was(120.2±15.2)°, the distance between anterior margin of PFL and posterior margin of lateral collateral ligament was (9.67±3.87) mm.    Conclusions    The PFL was one of posterolateral structure of knee, and it constantly existed but variable. So, with a good knowledge of its anatomic characteristics can be useful for the diagnosis and treatment for the PFL injuries.

Anatomy and clinical significance of the tissues separating the deep infrapatellar bursa and knee joint cavity

YONG Liu-Jun, ZHONG He-Qing, DU Xin-Yu, LUO 　Ying, TUN Shao-Beng

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  389-391. 

Abstract ( 1255 )  

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Objective　To investigate structural features of the soft tissues separating the deep infrapatellar bursa and knee joint cavity, and provide anatomic basis for imaging diagnosis of knee joint diseases.　Methods　20 specimens of antiseptic knee joint were dissected. Synovial membrane of knee joint cavity and deep infrapatellar bursa, and the related connective tissue were observed and analyzed. Meanwhile, 20 knee cast samples were used to explore the origin, branches, and distribution of the blood vessels in knee joint cavity and deep infrapatellar bursa.　Results　Synovial tissues covered the internal surface of knee joint cavity and deep infrapatellar bursa, however, synovial membrane of deep infrapatellar bursa was separated from that of knee joint cavity by infrapatellar adipose tissue. Different arteries, including descending genicular artery, inferior-internal arteries of knee, superior-external artery of knee, inferior-external arteries of knee and its branches passed through knee joint cavity and deep infrapatellar bursa.　Conclusions　The synovial tissue of knee joint cavity is divided from that of deep infrapatellar bursa, however, arterial connection occurs between them. Different pathological and imaging changes maybe appear in knee joint cavity and deep infrapatellar bursa for different kinds of diseases.

Morphological characteristics of the lumbar segment above the lumbosacral transitional vertebrae and its clinical significance

YANG Li-Hui, LIU 　Wei, WANG 　Rui, ZHANG Ji-Zong, KONG Xiao-Chuan, AN Li-Kun, DU Xin-Ru

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  392-395. 

Abstract ( 1020 )  

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Objective　To study morphological characteristics of the lumbar segment above the lumbosacral transitional vertebrae, and provide anatomic basis for the clinical treatment in the spondylolisthesis, lumbar disc herniation and pedicle screw fixation.　Methods　59 specimens of dry lumbar segment above the lumbosacral transitional vertebrae were anatomically evaluated. The anteroposterior diameter, the transverse diameter, the thickness and height of the vertebral isthmus, the longitudinal diameter and transverse diameter of the vertebral pedicle, the height and thickness of the vertebral lamina, the spine index, and the degeneration state were measured with the caliper and the protractor in all specimens.　Results　The anteroposterior diameter and transverse diameter of vertebral isthmus were（34.1±2.7）mm and（47.5±4.6）mm respectively. The height of vertebral isthmus was（12.9±1.6）mm, and the thickness (9.0±1.2）mm. The longitudinal and transverse diameters of vertebral pedicle were（10.6±2.4）mm and (14.0±2.4）mm respectively. The height of the lamina was（18.2±2.6）mm, and the thickness （5.7±1.2）mm. The spine index was （1：4.35）. The hyperplasia of upper vertebra appeared in 48 specimens. Spondylolysis was not found in all specimens.　Conclusions　The vertebral body of lumbar segment above the lumbosacral transitional vertebrae and the transverse diameters of the vertebral pedicle are larger than that of the fourth lumbar vertebrae，which is the support for selecting the larger screws for pedicle fixation. The isthmus thickness of lumbar segment above the lumbosacral transitional vertebrae is larger than that of the fourth lumbar vertebrae，however,  congenital developmental defects and weak are not found.

Anterior approach for treating fracture dislocation of iliosacral articulation: applied anatomic study

WU Xin-Guo, CHEN Ye-Guang, HUANG 　Jian, XIE Wei-Wen, WANG 　Jun, ZHENG 　Feng, LIN Gao-Dong

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  396-398. 

Abstract ( 1127 )  

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Objective　To provide anatomic evidence for treating fracture dislocation of iliosacral articulation through the anterior approach.　Methods　The study was performed in 20 adult antiseptic pelvic specimen（from 40 corpses）. The relationship of the internal iliac vessels and the lumbar vessels with acroiliac articulation were explored. The distances from the anterior branches of L4,5 spinal nerves to the lumbosacral trunk and sacroiliac joint were measured.　Results　The external diameters of the left and right internal iliac arteries were (5.92±0.7)mm and (5.38±0.7)mm respectively, at the crossing point of the artery with sacroiliac joint. The distances from the arterial origin to pelvic wall were (11.91±2.4)mm and (12.52±2.9)mm for left and right sides respectively. The external diameters of iliolumbal artery when it passed through sacroiliac articulation was about (2.54±0.39)mm, with the distance from the origin to pelvic wall of (2.50±0.41)mm. The distance from the different sacroiliac articulation planes extended posterosuperiorly to anteroinferiorly to anterior branches of L4,5 spinal nerves and the lumbosacral trunk decreased gradually, as well the distances from anterior branch of L4 nerve root to ala sacralis. L5 nerve root closed to ala sacralis during it's course after leaving corresponding intervertebral foramen.　Conclusions　Iatrogenic injury to vessels and nerves during anterior operation for treating fracture dislocation of iliosacral articulation should be avoided．For avoiding the damage of L5 nerve root, the middle and superior parts of ala sacri, which is far away from the border of ala sacri about 20mm, are safe position for steel plate fixation.

Anatomy of median and medial umbilical ligaments and its significance for laparoscopic herniorrhaphy

LIU Jia-Lin, BI Jian-Gang, TIAN Heng-Yu, CHEN 　Yang, BAO Shi-Yun

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  399-403. 

Abstract ( 744 )  

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Objective　To explore the morphologic features of the umbilical ring (MU), the median umbilical ligament (MnU) and the medial umbilical ligament (MdU) under laparoscope.　Methods　463 patients undergone laparoscopic herniorrhaphy from 2006 to 2009 were collected. The various shapes of MnU and MdU terminated by MU were identified, and followed by the measurement and comparison of the width of MnU and MdU arising from the pelvis.　Results　Four types of umbilical ligaments could be identified as the follows: type I (22.2%, 103 cases), with independent convergence of MnU and MdU to MU; type II (43.6%, 202 cases), with the convergence of MnU and unilateral MdU before reaching MU which receiving another MdU independently; type III (20.7%, 96 cases), bilateral MdUs and MnU converged together before their reaching to MU; and type Ⅳ (13.5%, 6 cases), with no MnU. There was no age and sex difference of the width of MnU, however, the percentage of older aged patients with the MdU width of 2.0cm (46.6%) was lower than that of children patients (73.9%), and the percentage of male patients with the MdU width of 2.0cm (61.6%) was higher than that of female patients(41.4%).　Conclusions　Under the laparoscope, 4 convergence types of MnU and MdU can be identified. There are age and sex difference of the width of MdU, which is notable during the process of laparoscopic herniorrhaphy.

The abnormity of four left renal arteries: one case report

DAO 　Wei, XUE Xian-Biao, GAO 　Jie, ZHONG 　Cha

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  403. 

Abstract ( 200 )  

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Investigation of the lower abdominal wall thickness in adult and its significance for the micturition alert device on the principle of a compass

WANG Jian-Huo, HOU Chun-Lin, WEI Chun-Qin

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  404-406. 

Abstract ( 573 )  

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Objective　To measure the lower abdominal wall thickness in adults，explore its correlation factors，and its significance for the micturition alert device on the principle of a compass.　Methods　The thickness of the lower abdominal wall, including its superficial and deep layers, the maximal anteroposterior, laterolateral and craniocaudal diameters of the bladder were measured respectively using ultrasound skill in 100 adults. As well, the weight, height and body mass index (BMI) was measured and determined, followed by the calculation of the bladder  volume. The correlation factors contributing to the lower abdominal wall thickness were analyzed.　Results　The thickness of the lower abdominal wall was about (23.4±6.6)mm, with 95% confidence interval of 22.1～24.7mm. The thickness was positively correlated with the thickness of superficial and deep layers of the lower abdominal wall, the weight, BMI and the distance from the measuring point to umbilicus, and was negatively correlated with the volume, laterolateral and craniocaudal diameters of the bladder. There was no correlation of the lower abdominal wall thickness with gender, age, height and anteroposterior diameters of the bladder.　Conclusions　For the adults, the thickness of the lower abdominal wall is about (23.4±6.6)mm under ultrasound machine. Nutritional status is the most important correlation factor of the lower abdominal wall thickness. The results provide a new evidence for the usage and improve of the micturition alert device on the principle of a compass

The design of the aliform memory alloy intrasegmental fixation instrument for lumbar spondylolysis: applied anatomic study

ZHANG Xi-Bing, SHU Li-Xin, WANG 　Jian, SHI Ben-Chao, XIE Wen-Meng

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  407-410. 

Abstract ( 909 )  

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Objective　To explore anatomic features of L1～5 and S1 vertebrae, and provide parameters for the development of the aliform memory alloy intrasegmental fixation instrument（AMAIFI）.　Methods　20 sets of antiseptic lumbar specimens (L1~5,S1) of Chinese normal adults were used. The distance from the intersection of the lateral margin of the inferior surface of the lumbar spinous process and lamina of vertebra to the superior border of the root segment of transverse process (DITR), the angle between the anterior and posterior sides sitting at the superior border of the root segment of transverse process (AFR), the width of the root segment of transverse process (WRT), the distance from one side of the junction of the transverse process, superior articular process and pedicle of vertebral arch to the another (DTAP), the thickness of the spinous process (TSP), the distance between adjacent spinous process (DAP), the angle between two lines [(ATL), one is the line between the intersection of the lateral margin of the inferior surface of the lumbar spinous process and lamina of vertebra and the junction of the transverse process, superior articular process and pedicle of vertebral arch, another was the lateral margin of the inferior surface of the spinous process], the length of the spinous process (LSP) were measured and analyzed respectively.　Results　Taken L4/L5 as the example: DITR was about (35.30±2.38)mm, AFR (30.47±6.38)°, WRT (11.43±1.76)mm, DTAP (46.44±2.55)mm, TSP (9.04±1.12)mm, DAP (7.10±1.83)mm, ATL (58.31±7.02)°, and LSP (20.40±2.80)mm respectively.     Conclusions　The design of AMAIFI is feasible, which is a safe and convenient device, for mixing together the advantage of the shape memory effects, hyperelasticity and anticorrosion characters of the nickel-titanium shape memory alloy.

Anatomy and clinical significance of post-pancreas trunk of superior mesenteric vein

LI Tie-Sheng, TIAN Zhi-Feng

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  411-412. 

Abstract ( 324 )  

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Objective　To provide anatomic basis for the resection of post-pancreas trunk of superior mesenteric vein (SMV) and the sequencing vessel anastomosis during the surgical treatment of pancreas uncinate process carcinoma.　Methods　For presumpting the resectable greatest length of the veins during the surgical process of pancreas uncinate process carcinomam, the abdominal specimens (50 male, and 50 female) were used in this study. The length of the SMV behind the uncinate process, and the longitudinal flexure of the SMV were measured after removing the pancreas and duodenum.　Results　The length of the post-pancreas trunk of SMV was about（3.5±0.8）cm and（3.3±0.6）cm for male and female respectively. For 40 male specimens (80%) and 38 female specimens (76%), the length of the post-pancreas trunk exceeded 3.0cm, respectively. The average length of longitudinal flexure of the SMV ranged from 4.0cm to 5.1cm after resecting the pancreas and duodenum.　Conclusions　This study provides a clinical anatomic evidence for the direct end-to-end anastomosis of SMV during the duodenopancreatectomy.

Comparative study of the sectional slice of the prostate zone with its MRI images

GAO 　Wei, YUAN 　Wu, HAN 　Yue, DI Li-Dong, LI Yun-Sheng

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  413-417. 

Abstract ( 1009 )  

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Objective　To compare morphological features of the prostate zones with its corresponding MRI images, and provide anatomical basis for MRI diagnosis of prostate zone diseases.　Methods　Prostate area of 576 normal persons and 6 cadaveric specimens were performed MRI scan and image analysis. And then, series sections of cadaveric prostate zone were prepared by using celloidin embedding method, for the comparative studying of MRI images and morphologic features.　Results　On the sectional specimens, periphery zone, central zone, transitional zone, paraurethral gland zone and fibrous muscle zone of prostate can be roughly identified according to the anatomic location of urethra, seminal crest and ejaculatory duct. On MRI images, outline of prostate presented clearly on T1WI condition, and periphery zone of prostate showed higher signal than that of central zone. The sectional data could be corresponded to MRI data completely.　Conclusions　To scan and analyze prostate zones through transversal, coronal and sagittal scan is helpful for accurate diagnosis and allocation of intraprostatic diseases.

3D-image fusion research of cross CT+MR modality based on localization registration approach of"9-point & 3-plane"

BANG Jian-Jiao, JU Xiang-Yang, BAI 　Bei, LIU 　Qi, CHEN 　Yi, MO Jian-Wen, SHU Qiao-Hong, LI Xin-Chun

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  418-422. 

Abstract ( 299 )  

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Objective　To attempt a localization registration approach of 2-Dimension (2D) images based on somatotopic localization to realize accurate fusion from cross modality of 3-Dimension (3D) CT & MR images.　Methods　To fix digital format after original data of CT/MR input, design cubic localization solution of"9-point & 3-plane"for registration, complete fusion at real-time workstation Mimics based on auto-fusing style of information exchanged by signal overlaid technique.　Results　The fused cubic images of cross [CT+MR] modality were mutually practiced by patients' cranium and knee samples, while complementary images of distinguishing soft and hard tissue in cranium and knee were created, which carrying signal characteristic and medical information respectively from CT & MR individually, and were helpful not only to learn specific location of abnormal organs found out by MR, but also to identify focal nature of abnormal lesions found out by CT.　Conclusions　This cross modality fusion scheme is a supplement for the technique vacant at present, meanwhile, this experiment will also provide experience drawn on invention of [CT+MR] single modality equipment of 3D imaging in advance.

The imaging and clinical significance of persistent carotid-basilar artery anastomoses

YUAN 　Fei, CUI 　Xiang, LIU Yin-She, DIAO 　Jun, GU 　Xin

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  423-427. 

Abstract ( 757 )  

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Objective　To explore the imaging characteristics of persistent carotid-basilar artery anastomoses in an effort to improve our understanding of this anomaly.　Methods　9 craniocervical CT angiography(CTA)，3 cranial and/or cervical MR angiography (MRA) in 12 patients of persistent carotid-basilar artery anastomoses were retrospectively reviewed.　Results　These 12 patients had 9 persistent trigeminal arteries and 3 persistent hypoglossal arteries. Based on the position of the persistent trigeminal artery, 8 patients were the lateral type, 1 was the medial type. According to the configuration of the ipsilateral posterior cerebral artery, 3 cases were Saltzman typeⅠpersistent trigeminal arteries，2 cases were Saltzman typeⅡ，4 were Saltzman type Ⅲ. The veretral artery and basilar artery caudal to the anastomosis with the trigeminal artery were hypoplastic in 4 cases. And 1 case showed the basilar artery completely artopied. 1 case associated with an aneurysm of the persistent trigeminal artery, 2 cases associated with fenestration of contralateral middle cerebral artery. 2 of 3 persistent hypoglossal arteries showed ipsilateral vertebral arteries completely artopied and 1 associated with hypoplasia of the contralateral vertebral artery, 1 associated with hypoplasia and fenestration of the contralateral vertebral artery.　Conclusions　CTA and MRA could rapid, intuitive, and accurate demonstrate the course of persistent carotid-basilar artery including the trigeminal and hypoglossal arteries, adjacent structure and the coexisting abnormalities. Diagnosis these variants prior to surgery and intervention may be helpful for procedures choice and decreasing the risk.

The effect of the self-assemble peptide nanofiber scaffold on the proliferation and differentiation of MCSCs in vitro

CUI Xiao-Jun, TAN Yu-Zhen, LI Shao-Hua, GUO Hai-Dong, WANG 　Cun, ZHANG Jian-Kai

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  428-432. 

Abstract ( 171 )  

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Objective　 To explore the effect of the self-assemble peptide nanofiber scaffold (NFS) on the proliferation and differentiation of marrow-derived cardiac stem cells (MCSCs).　Methods　The self-assemble peptides were designed and synthesized. The self-assemble state was viewed by AFM and SEM. The compatibility of MCSCs with self-assembling peptide nanofiber scarffolds was viewed by SEM. The effect of NFS on the growth of MCSCs was detected by CCK-8. Through cardiac-specific troponin cTnT staining, the effect of NFS was evaluated on myocardial cell differentiation of MCSCs.　Results　SEM showed the self-assembly of the peptides into the retiform interwoven nanofiber scaffold structure, with the stent diameter of 50 ~ 200 nm. MCSCs were seeded into the self-assemble peptide nanofibers 1 day later. Cells were detected in the network-like nanofiber, which closely linked with the nano-fibers under SEM. The viability of cells in NFS was significantly higher than that of control group. The cells in NFS contacted closely with each other, and demonstrated the same direction and arrangement. After 4 weeks' induction, all of cells expressed cTnT. Conclusions　NFS and MCSCs have good biocompatibility. The three-dimensional micro-environment of NFS is valuable for the growth and differentiation of MCSCs in vitro.

Lipid infiltration in pacemaker cells and cell matrix of sinus node induced by atherosclerosis in rabbits

LI Na-Na, WANG Qiang-Zhi, ZHOU Li, ZHANG Gong-Qi

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  433-435. 

Abstract ( 345 )  

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Objective　To explore the effects of atherosclerosis on the morphological changes of rat sinoatrial node (SAN), especially the features of pacemaker cells and transitional cells under light microscopy and transmission electron microscopy.　Methods　20 New Zealand white rabbits were randomly allocated to control group and hyperlipidemia group, with 10 animals in each group. The control animals were fed with routine forage, but animals of the hyperlipidemia group was fed with high lipid forage about 3 months. Histologic changes of SAN were studied through serial sections and transmission electron.　Results　Atherosclerotic plaques and extensive lipid infiltration appeared in myocardium tissue and cell matrix of hyperlipidemia animals separately. Transmission electron microscope revealed that a large number of lipid droplets aggregated in pacemaker cells, transitional cells, interstitial cells and interstitial matrix.　Conclusions　 Atherosclerosis causes fat deposition in SAN. Lipid infiltration in SAN may damage impulse generation, transmission and distribution and thereby provide morphological basis for spontaneous activity.

Karnovsky-Roots' stain of peripheral nerve based on image analysis

CU 　Jian, LUO 　Feng, CHENG Sai-Gong, LI Ceng-Hong, ZHANG 　Yi, LIU Xiao-Lin

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  436-441. 

Abstract ( 548 )  

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Objective　To explore the feasibility of image analysis on the result of acetylcholinesterase stain (Karnovsky-Roots'method) of peripheral nerve, and provide the reference for the standard incubational conditions of the three-dimensional reconstruction of functional fascicles groups of peripheral nerves.　Methods　The samples came from fresh adult common peroneal nerve, which were serially horizontally sliced into 56 slices with the thickness of 10μm. All slices were randomly divided into seven groups with 8 slices in each group, including 1h, 2h, 4h, 8h, 12h, 24h and negative control group. After AChE histochemical staining, the stain characteristics of different nerve fiber in various stain phrases were observed under optic-microscope. The average area, density and integrated optical density (IOD) of AChE positive region of various stain period were analyzed by an image analytical software (Image-Pro Plus 6.0). T-test was adopted to distinguish the group differences through SPSS13.0.　Results　For the mean optical density value, there was notable diversity between 8h and 12h groups, but not for the 12h and 24h groups. The significant differences also appeared among 8h, 12h, and 24h groups for stain area and IOD. Furthermore, overstain was observed on slices of 24h group.　Conclusions　The staining results from 12h to 24h were stable and reliable, moreover, it is possible to identify different functional fascicles surrounding by perineurium. For three-dimensional reconstruction of functional fascicles groups of peripheral nerves, it can be taken as the standard stain incubational condition.

The remodeling evaluation of osteopsathyrosis congenita adopting osteoclast-calvaria co-culture system in vitro

ZHANG 　Gao, ZHONG Qiao-Meng, YUAN 　Kai, CHEN Guo-Xian, LI Ji-Han, CHEN Jian-Ting

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  442-445. 

Abstract ( 841 )  

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Objective　To evaluate the effects of osteoblast (OB) and osteoclast (OC) on the bone remodeling of osteogenesis imperfecta (OI) adopting osteoclast-calvaria co-culture system in vitro on oim/oim (OI) mouse model.　Methods　Wild (WT) and OI mice were used and compared in this study. OC cells were cultured in calvaria (CAL) in vitro for WT (WTCAL-WTOC group) and OI mice (OICAL-OIOC group) respectively. Tartrate-resistant acid phosphatase (TRAP) staining and alkaline phosphatase (ALP) staining were used to identify OCs and OBs respectively. Bone resorption of OCs was assessed by the area percentage of absorption lacunam, which is the rate of OCs number to the whole calvarial surfaces.　Results　At the culturing time of d7, the number of OCs and OC/OB rate of group OICAL-OIOC were significantly lower than that of group WTCAL-WTOC. However, the OCs number normalized to resorption pit number was significantly greater in group OICAl-OIOC compared to that of WTCAl-WTOC group.　Conclusions　The mechanism of the increased OCs function is partially due to the increased bone turnover in OI mice model for the compensation of decreased OBs function.

Establishment of the rat model of traumatic systemic inflammatory response syndrome

LIN 　Kai, SHAO Yu-Feng, YANG Xin-Jian, LIU Li-Jun, WANG Da-Beng

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  446-449. 

Abstract ( 1599 )  

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Objective　To establish a reproducible experimental rat model of traumatic systemic inflammatory response syndrome.　Methods　Thirty healthy Wistar rats were randomly assigned to the control group (group A), the LPS injury group (group B) and the surgical treatment group (group C). For preparing trauma model, the rats of group B were performed intravenous infusion of lipopolysaccharide (LPS, 12mg/kg), and the rats of group C were cut the liver (1/3) and hammered right femur three times. 2 hours later after the treatment, the alanine aminot ransferase (ALT), aspartete aminot ransferase (AST), urea nit rogen (UN) and creatinine (Cr) in serum were surveyed. At the 12 hours, the rats were killed and the liver and lung were taken for HE staining and comparision.　Results　The concentration of serous ALT, AST, UN and Cr in group B and C were significantly higher than that of group A ( P<0.01). Compared to that of group B, Serous UN and Cr in group C were significantly higher (P<0.05). For inflammatory reaction and infiltration in liver and lung, there was no significant difference between group B and C.　Conclusions　The rat model of traumatic systemic inflammatory response syndrome can be established successfully using this surgical process.

The variation of lateral circumflex femoral artery, superficial circumflex iliac artery and deep circumflex artery:one case report

SUN Feng-Gang, DU Ai-She, AN Chu-Gong, LV Ba-Shi

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  449. 

Abstract ( 280 )  

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Anatomy of the extracranial facial nerve of rabbit

DUAN Yong-Chang, TIAN An-Yong, XU Qiao-Lian, ZHENG 　Wei

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  450-451. 

Abstract ( 423 )  

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Objective　To investigate anatomic features of the extracranial facial nerve of rabbits. Methods　15 healthy rabbits were used in this study. The facial nerve and it's extracranial branches were dissected and measured under the surgery microscope.　Results　After leaving stylomastoid foramen, the facial nerve trunk ramified the post aurem branch, the digastric branch and the stylohyoid branch, and then, the main trunk passed through the surface of jugomaxillary muscle, and further divided into temporal branch, zygomatic branch, buccal branch, marginal mandibular branch and cervical branch. The zygomatic branch closed to the buccal branch initially and combined into the latter, but separated from the latter again at the posterior border of angle oris.　Conclusions　For rabbit, the zygomatic and the buccal branches of the facia l nerve origining from the antero-inferior border of the auricle and reaching the posterior border of angle oris are stable and identifiable, which is feasible for repairing damaged facial nerve.

The influence of restoring femoral offset on the function of hip after total hip arthroplasty

LI Li-Cuan, ZHOU 　Bing, WEI 　Zhen, DING Zi-Hai

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  452-455. 

Abstract ( 376 )  

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Objective　 To analyze the influence of restoring femoral offset on the function of hip after total hip arthroplasty (THA).　Methods　68 patients underwent the primary and unilateral total hip arthroplasty were studied from January 2005 to January 2008. The mean follow-up period was 19.2 months, ranged from 9 to 24 months. A anterolateral approach was applied in all the procedures. Preoperative and postoperative femoral offset, the abductor lever arm and the leg length were compared through radiographic measurements, while, the ROM of hip and the Harris scores were recorded respectively. Statistical analysis were performed by SPSS13.0 software.　Results　Femoral offset correlated positively with the length of the abductor lever arm (r=0.534, P<0.001). Femoral offset was significantly positive related to the ROM of hip (r=0.403, P<0.001). Femoral offset was significantly positive related to the Harris scores (r=0.344, P<0.001). Restoration of femoral offset influenced the leg length (x2=4.23，P<0.05).　Conclusions　It is very important to restore femoral offset in THA, on the basis of improving the abductor strength, ROM and stability of hip.

Treatment of fracture of distal humerus with AO distal humeral plate in the aged

CHEN Wei-Meng, LIU 　Fei, CHEN Gui-Quan, ZHONG Zi-Min, HUANG 　Ban, XIE 　Jin

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  456-457. 

Abstract ( 358 )  

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Objective　 To summarize surgical techniques and effects of AO distal humeral plate used as a treatment alternative for fracture of distal humerus.　Methods　From July 2007 to Feb. 2010, 30 cases of fracture of distal humerus were treated with open reduction and internal fixation with AO distal humeral plate (DHP). They were 12 males and 18 females. Their ages ranged from 60 to 80 years (average, 72 years). According to AO classification, 1 case was Type A, 7 were Type B, 5 were Type C1, 10 were Type C2, 7 were Type C3. Functional exercises began on the third day after operation. Functional results were evaluated according to the Mayo elbow performance score (MEPS).　Results　24 patients were followed up for 11 to 30 months (average, 18 months). All fractures achieved complete union. The average ulnohumeral motion was (78±17.08）° (range, 10° to 135°), flexion （102±11.35）°(range, 90° to 135°), extension （20±8.20）°(range, 0° to 60°). The average MEPS was 85.3 points (range, 60 to 100 points). 11 cases were graded as excellent, 10 as good, 2 as fair, 1 as poor. 87.5% of the patients had an excellent or good functional result. 3 cases reported transient ulnar nerve paralysis, 3 slight symptoms of traumatic arthritis, 1 delayed union and elbow stiffness, 2 heterotopic ossification, 3 slight malformation.　Conclusions　AO distal humeral plate is a preferred treatment for fracture of distal humerus in the aged because of satisfactory bone healing, early mobilization, union of fracture and recovery of joint function.

Classified surgical treatment in the insertion injury of digital extensor tendon

HU Hong-Chong, DIAO Xiao-Wei, DOU Qiang-Yin, LIU Guo-Long

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  458-460. 

Abstract ( 835 )  

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Objective　To examine the methods of surgical repairs and clinical efficacy in the treatment of the extensor tendon insertion injury.　Methods　Twenty eight patients with finger extensor tendon insertion injury was categorized into 3 groups: fractures with large blocks, avulsion fracture of bone slices or small bone pieces without bone-crushing which can not be fixed, and tendinous injury at the insertion near the distal dorsal phalanx. The treatments were bone-fix, drilling-fix at the basement of distal phalanx, and direct suture, respectively.　Results　No re-avulsion or re-fraction occurred in these 28 patients. Stiffness of distal interphalangeal joint was observed in 3 patients. The remaining 25 patients had a limitation of initiative extension for the distal interphalangeal point 0°~10°, and initiative inflextion 30°~70°. Conclusions　Targeted selections of bone-fix, drilling-fix at the basement of distal phalanx, and direct suture according to the types of injury are simple and effective in the treatment of insertion injury of digital extensor tendon.

Preservation of parathyroid gland during the resection of thyroid neoplasms: anatomy and operative procedure

HONG Gao-Bei, HUANG Yang-Kai, LIN Ren-Ju, HUANG Han-Min

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  461-463. 

Abstract ( 213 )  

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Objective　To explore operational points for preserving parathyroid glands during the thyroid neoplasms surgery.　Methods　From Jan. 2004 to Dec. 2010, 145 cases of thyroid diffuse nodules and thyroid cancer underwent surgical therapy. Among them, 65 cases only preserved posterior capsule, but not presented parathyroid glands during the operation. However, another 80 cases were performed the liberation and preservation of parathyroid glands and its blood supply during the operation. Postoperative serum calcium level was monitored dynamicly, for evaluating the function of parathyroid glands.　Results　Postoperative incidence of hypoparathyroidism in patients exposing and preserving of parathyroid glands during the operation was significantly lower than that in patients with no special preserving of parathyroid glands（P<0.05）.　Conclusions　During the thyroidectomy procedure, exposing and protecting the parathyroid gland can effectively decrease the incidence of postoperative hypoparathyroidism.

Applied anatomy of posterior Calot's triangle and its clinical significance in laparoscopic cholecystectomy

ZHANG Guo-Wei-

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  464-466. 

Abstract ( 283 )  

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Objective　To explore anatomic features of posterior Calot's triangle and its clinical significance in laparoscopic cholecystectomy（LC）.　Methods　The clinical data of 217 patients with acute cholecystitis underwent LC by using three trocars in our hospital from Aug. 2004 to Oct. 2010 were retrospectively analyzed.　Results　Of the patients，LC was successfully completed in 202 cases (93.2% )，however, 10 cases (4.6%) were converted to open surgery， 5 cases complicated with common duct stones were cured by ERCP.  No biliary injury，bile leak or hemorrhage occurred in this series. Postoperative surgical drainage was performed according to the operating conditions. The patients were discharged from hospital in 2-12 days (averagely 4.5 days). No complication was found during a 6-month follow-up in 193 cases. Conclusions　It is safe and feasible to perform LC by using three trocars for treating acute cholecystitis, especially for those with severe tissue adhesion in posterior Calot's triangle.

The technique of combined thoracic and abdominal multiple organ procurement

LIU Xiao-You, XU 　Jian, DU Chuan-Fu, DENG Wen-Feng, WANG Yi-Bin, FU Chao-Jie, TU Yu-Meng, WEI 　Jiang, MIAO 　Yun, LI Chuan-Jiang, XIE Dun-Sheng, XU Li-Xin

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  467-469. 

Abstract ( 1113 )  

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Objective　To explore the clinical efficiency of the combined thoracic and abdominal multiple organ procurement.　Methods　We used U type thoracic incision combined with big cross abdominal incision, to set up in situ perfusion of thoracic and abdominal organs, while during the procedure of organs perfusion, we separated and en bloc harvested thoracic and abdominal organs.　Results　From 2003 to now, 8 cases underwent this surgical treatment, with the harvesting of 8 donor hearts, livers, pancreases, 8 pairs of lungs and 16 kidneys respectively. Warm ischemic time was about 2.0±1.2 min. No donor organs and vessels were damaged. Heart transplantation was performed in 6 cases, heart-lung combined transplantation in 2, double lung transplantation in 3, single lung transplantation in 5, liver-kidney combined transplantation in 2, pancreas-kidney combined transplantation in 3 and kidney transplantation in 11, respectively. The functions of all transplanted allograft recovered well.　Conclusions　Using combined thoracic and abdominal multiple organ procurement, the surgical process is rapidly and safely, which short the warm ischemic time and improve the activity and functions of donor organs.

Internal fixation of the unstable pelvic fracture based on the anatomic features of the pelvis

WENG Yang-Hua, TUN Xian-Kui, BANG Yang-Guo, OU Yao-Fen

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  470-472. 

Abstract ( 393 )  

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Objective　To explore clinical efficiency of different surgical internal fixations on treating the unstable pelvic fracture according to the anatomic features of the pelvis.　Methods　65 cases suffering from the unstable pelvic fractures, were included in this study. Anterior approach, with the replacement and plate fixation of symphysis pubis or ramus of pubis, was performed for 31 cases of Tile B type fracture. 8 cases combined with ilium fracture among them were replaced and fixed through iliac fossa approach. As well, anterior approach also was used for fixing damaged anterior girdle of 34 cases of Tile C type fracture. However, the damaged posterior girdles were treated with the replacement and the posterior sacroiliac screw fixation under X-ray guide for 11 among 17 cases of sacral bone fracture or dislocation of sacroiliac joint, while, 4 cases treated with transiliac gudgeon fixation, 2 cases with tensile plates fixation between bilateral posterior iliac spine through posterior approach. For 9 cases of sacroiliac joint fracture and dislocation, 6 fixed with transdermal screw, and 3 with the plate. 8 cases combined with acetabulum fracture were fixed with the plate. Results　According to the index of Matta score, which analyzed the greatest distance of the pelvic fracture displacement under X-ray evaluation, 56 cases (86.1%) were excellent, with the shorter displaced distance of the less of 4mm, 5 cases(7.7%)  were fine, with the displaced distance of 4~10mm, 4 cases (6.2%) were better, with the displaced distance of 10~20mm, and no case was bad, with the greater displacement distance of 20 mm. Conclusions　It is important to select reasonable internal fixation proposal for treating the unstable pelvic fracture, according to the different fracture types and anatomic features of pelvis.

Clinical analysis and selection of internal fixation methods for treating the unstable distal radial fracture 

TUN Yun-Cheng, HE Lin-Guan, LIANG Kai-Chao, JIANG An-Rui

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  473-474. 

Abstract ( 448 )  

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Objective　To explore therapeutic effects of different internal fixations on treating the unstable distal radial fracture.　Methods　From Jan. 2004 to Jan. 2009，50 cases suffering from the unstable distal radial fracture were treated with Kirschner wire or plate fixation, combined with bone graft or not. Patients were followed-up and the data were collected.　Results　Wrist function was evaluated according to the Sarmiento standards. The results were excellent in 26 cases, good in 13 cases, better in 7 cases, poor in 3 cases, and the excellent rate was about 79.6% (1 case lost). For 15 cases of open injury, 1 case combined with disconnection of long thumb extensor tendon had a transposition reconstruction surgery of inherent long thumb extensor tendon, 2 cases with skin defect recovered after skin graft, and 13 cases received I healing. Conclusions　In order to provide stable fixation, reduce complications and achieve good clinical efficacy, different fixation methods should be taken to treat unstable distal radius fractures in various situations.

Evaluation of Tuffier's line and the lowest points of the ribcage on the location of conus medullaris

LI 　Jue, ZHANG Wen-Jun, WANG Shou-Beng, ZHANG Xiao-E, BANG Shu-Ling

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  475-477. 

Abstract ( 1115 )  

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Objective　To estimate the level of lumbar spine and the location of conus medullaris, taking the Tuffier's line and the lowest points of the ribcage as the new markers.　Methods　Simple X-ray and MR (T1-weighted, midline, sagittal, spinecho) of 216 healthy adults (male 98, and female 118), aged from 18 to 94, were performed to assess the position of conus medullaris, according to the guide of the Tuffier's line and the lowest points of the ribcage. This location point was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or interspace. The data were collected and statistically analyzed.　Results　Corresponding to the spine, the conus medullaris, Tuffier's line and the lowest points of the ribcage were at the lower 1/3 of L1 about 29.72±2.032, at L4~5 about 16.11±1.192, and at L2~3 about 24.69±1.909, respectively, furthermore, the above parameters were significantly sexual different. The spinal position located by the lowest ribcage was correlated with the age.　Conclusions　At the erection position, the tuffier's line corresponds to the level of L4~5 or L4, and the lowest ribcage corresponds to the lower third level of L2~3. Those two lines can be taken as the location markers to confirm the level of intervertebral space.

Clinical application and development of experimental research of radiofrequency use on articular cartilage lesions

CHEN 　Qi, WANG Da-Beng, SHU Wei-Min

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  478-480. 

Abstract ( 952 )  

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Variations of left testicular artery and vein: a case report

BO Xia-Meng, LIANG Diao-Jia, HUANG Kang-Kang, BO San-Jiang

Chinese Journal Of Clinical Anatomy. 2011, 29(4):  480. 

Abstract ( 395 )  

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