Table of Content

25 May 2015 Volume 33 Issue 3

  

Anatomy study about the meningovertebral ligaments in the posterior cervical epidural space

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  241-245.  doi:10.13418/j.issn.1001-165x.2015.03.001

Abstract ( 969 )  

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Objective   To study the meningovertebral ligaments in the posterior cervical epidural space, and discuss their clinical significance.  Methods   First, the dorsal meningovertebral ligaments in cervical region were observed endoscopicly on 13 adult embalmed cadavers，and then the spinal canal was open，the morphology，orientation，attachment sites and distribution of the ligaments were observed by naked eyes and  a surgical microscope. The length，width and thickness or diameter of the ligaments under the surgical microscope were measured using vernier caliper. Finally，H&E staining and Massons trichrome staining was adopted to find out the morphological and histological characteristics of meningovertebral ligaments.  Results   The meningovertebral ligaments can be found in all of 13 cervical specimens, being located between the dura and the ligamenta flava or lamina. Most of the meningovertebral ligaments attach to the ligamenta flava. The occurrence rate of the meningovertebral ligaments is 100% at C1/2、C4/5 ligamenta flava（72.4%）. The greatest thickness of the meningovertebral ligaments can be observed at the C1/2 ligamenta flava, which is (1.04±0.61)cm(0.3～2.01cm). The orientation of the ligaments mostly is craniocaudal. the morphology of the ligaments can be classified into four types: strip type, cord type, grid type, and thin slice type. Histologic examination of the meningovertebral ligaments revealed collagen fibrous connective tissue.  Conclusion    The meningovertebral ligaments originate from the dura and attach to the ligamentum flavum or lamina. The meningovertebra can immobilize the dual, and maintain the spinal cord at the right place. Moreover, the meningovertebral ligaments is an important structure that  can pose a potential risk for inadvertent dural cervical surgery. Dissecting the meningovertebral ligaments before cervical flavectomy or laminectomy may be an important step in reducing postoperative cerebrospinal fluid leaks and epidural hematoma, which may result in significant benefits for patients and health care organizations.

The characteristic of anatomical structures and clinical significance of the deltoid ligament

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  246-248.  doi:10.13418/j.issn.1001-165x.2015.03.002

Abstract ( 1860 )  

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Objective   To observe the anatomical structures of the medial ankle ligament, and provide anatomical basis for the clinical minimally invasive repair of the medial ankle ligament.  Methods  Morphological observation of the medial ankle ligament through peeling and dissecting 8 cases of adult male corpses without pathological changes was made, and  relevant data were collected and statistical analysis was made.  Results   The deltoid ligament has superficial and deep layers with up to 6 different bands. From anterior to posterior, the superficial layer consisted of the following: tibionavicular ligament (length 18.22~26.14 mm), the tibiospring ligament (length 6.24~10.40 mm), tibiocalneal ligament (length 10.32~14.36 mm) and superficial posterior tibiotalar ligament (length 8.32~13.52 mm). While the deep layer consisted of the anterior tibiotalar ligament (length 11.32~15.62 mm) and the deep posterior tibiotalar ligament (length 10.22~12.60 mm, width 6.72~9.84 mm, thickness 1.72~2.24 mm).   Conclusions   It is helpful to distinguish the components and bundles according to the shape of the medial ankle ligament. Profound knowledge of the anatomical characteristic of the medial ligament can facilitate a good planning of surgical program.

Anatomical study on the design of the reversed peroneal myocutaneous flap

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  249-253.  doi:10.13418/j.issn.1001-165x.2015.03.003

Abstract ( 465 )  

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Objective   To apply the visualized anatomical basis for the design and clinical application of the reversed peroneal musclo-cutaneous flap.   Methods   20 fresh lower extremity specimens were used with arteries injected with red latex. The musculus peroneus brevis and longus were dissected and the originations, courses, branches and the distributions of the peroneal arteries were studied; Another 2 fresh lower extremity specimens with the arteries injected with plumbous oxide and latex were CT scanned and the bones and arteries were 3D-reconstructed and studied.  Results  The diameter of the originate peroneal artery was (3.7±0.7) mm, the artery gave off many muscular branches to the soleus muscle, long flexor muscle of great toe, musculus peroneus brevis and longus and the skin. The pedicle of the perforator arteries from the peroneal artery was (3.5±1.3) cm. The last part of the peroneal artery with the diameter of (1.2±0.4) mm, passed through the interosseous membrane of the leg and branched into the ascending and descending branches. Upside of the belly of the musculus peroneus brevis, the superficial peroneal artery, which came from the anterior tibial artery and with the diameter of (1.8±0.5)mm, ran forward and passed through the interosseous membrane and laid between the musculus peroneus longus and the anterior muscles of the leg.   Conclusions   The reversed musculus peroneus brevis and longus musculo-cutaneous flap pedicled with the cutaneous arteries and the end arteries of the middle and lower part of the leg can be designed and be used to repair the defect of the foot and the lower leg.

The feasibility study of free bilateral anterolateral femoral flaps to repair the whole hand degloving injury 

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  254-258.  doi:10.13418/j.issn.1001-165x.2015.03.004

Abstract ( 547 )  

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Objective   To explore the study of free bilateral anterolateral femoral flaps in treating the whole hand degloving injury.  Methods   The study includes experiments of living body measurement and autopsy experiments. In the Living body measurement, 50 healthy adults without hand diseases were randomly selected. Skin of the hand were divided into two parts：the dorsal and palmar parts. The vertical and horizontal length of the palmar and dorsal parts of the skin was measured and recorded. The skin area was calculated from the above data according to the living body measurement. The autopsy experiments included model establishment and simulation operation. The models of degloving injuries of hands in two left hands of fresh cadaver specimens were established. We divided the wound and the degloved skin into two parts: the dorsal part and the palm part. The dorsal wounds of models of degloving injuries of hands were covered with the anterolateral femoral flap of the ipsilateral thigh and palm sides were covered by anterolateral femoral flap of the contralateral thigh.    Results    Among the measurement data of 50 healthy adults, the vertical length of the palmar part was (13.84±0.88)cm (12.51~15.03 cm), the width was (14.48±1.11) cm(12.85~16.66 cm). The vertical length of the dorsal part was (12.15±1.09) cm (10.77~13.77 cm) , and the width was (14.92±1.11) cm(14.92~17.33 cm). All data mentioned above were smaller than the maximal size of the flap reported in the literature.   Conclusion   Free bilateral anterolateral femoral flaps can respectively provide a large enough soft tisssue to cover the wound surface of dorsal and volar sides of the hand. The surgical approach of combined free bilateral anterolateral femoral flaps in treatment of degloving juries of the hand is feasible.

The anatomical study of volar dual-channel surgical approach for treatment of distal radioulnar fracture

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  259-261.  doi:10.13418/j.issn.1001-165x.2015.03.005

Abstract ( 949 )  

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Objective  To study the anatomical basis of volar dual-channel  surgical  approach  for treatment of distal radioulnar fracture.  Methods   Ten fresh adult upper limb specimens were dissected and observed. A longitudinal incision was made between the flexor carpi radialis tendon and palmaris longus tendon.  Carpal canal was bypassed from the ulnar and radial sides respectively and   the surgical field exposure of distal radioulnar fracture was observed.   Result    Maximum transverse exposed distance of radial lateral channel was (3.0±0.29) cm and maximum transverse exposed distance of ulnar lateral channel was (2.3±0.26) cm, 3 cm above the volar wrist creases. Compared with radial lateral channel, ulnar lateral channel got better exposure of the ulnar aspect of the distal radius and distal ulnar bone.   Conclusion   Volar dual-channel surgical approach of the distal radioulnar fracture, which is a safe and effective surgical methods with satisfying exposure, is worth of clinical promotion. 

Microanatomy of the carunculae major artery and its clinical significance

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  262-264.  doi:10.13418/j.issn.1001-165x.2015.03.006

Abstract ( 728 )  

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 Objective    To provide exact and reliable morphological data for the operation of endoscopic sphincterotomy (EST).    Method   (1) 20 cadeveric duodenum and pancreas were perfused with latex.  (2)The resource, number, diameter, branches of all carunculae major arteries of these specimens and the distance from vascular origin to Vater bulb, the inner margin of duodenum and carunculae major were observed.         Results   (1) Carunculae major arteries originated from the anterior and posterior arterial arches, and each had two branches. The diameter of the two branches of the anterior carunculae major artery was (1.3±0.1) mm and (1.0±0.2) mm. The distance from the vascular origin of the two branches to the Vater’s ampulla, the inner margin of duodenum and carunculae major was (5.7±0.6) mm and (6.0±0.4) mm, (8.7±1.1) mm and (9.7±1.7) mm, (16±0.9) mm and (16±1.5) mm, respectively. The diameter of the two branches of the posterior carunculae major artery was (0.62±0.02) mm and (0.98±0.06) mm. The distance from the vascular origin of the two branches to Vater’s ampulla, the inner margin of duodenum and carunculae major were (11±0.7) mm and (16.4±0.4) mm ,(13±0.3) mm and (17.9±0.3) mm, (16±0.7) mm and (19.2±0.6) mm, respectively. (2) The first branch of the anterior carunculae major arteries was at the direction 10~11 o'clock and the second branch was at the position 2~3 o'clock. The first branch of the posterior carunculae major arteries was at the position of 8~9 o'clock and the second branch was at the position of 4~5 o'clock. The branches of carunculae major arteries were primarily located at the position of 8~11 o'clock and secondarily at the position of 2~5 o'clock, and least at 11~1 as well as 6~7 o'clock.   Conclusion    In EST the incision should be made at the direction of 11~1 or 6~7 o'clock.

The study on the measurement of related lines and the positioning of human foramina infraorbitale

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  265-268.  doi:10.13418/j.issn.1001-165x.2015.03.007

Abstract ( 594 )  

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Objective  To study the relevant radial lines, the size, and the location of foramina infraorbitale, providing scientific and reasonable basic materials for clinic application.   Methods   The long and short diameter of infraorbital foramina in 60 cadavers (120 sides) were measured by ordinary vernier caliper.  The shape of the hole, the number of  accessory infraorbital holes were also record;  the distance between the infraorbital foramen and the inferior margin of the eye socket, the distance from the line between the infraorbital foramen to the anterior midline of the face were measured. The distance between the infraorbital foramen and the piriform foramen, and the distance from the line between the infraorbital foramen the piriform foramen to the anterior midline of the face were measured.   Results   The probability of foramina infraorbitale being elliptical in shape accounted for 90%, circular for 10%.  The total occurrence rate of  accessory foramen was 2.5%. The long diameter of the foramina infraorbitale ranged from 2.48 mm to7.59 mm, with an average of (4.24±0.91) mm; The short diameter of the foramina infraorbitale ranged from 1.37 mm to 3.63 mm, with an average of (2.55±0.48) mm; The distance between the foramina infraorbitale and the edge of orbital ranged from 5.16 mm to 13.63 mm, with an average of (8.54±1.60) mm;  The distance between the foramina infraorbitale and the piriform aperture ranged from 11.73 mm to 23.17 mm, with an average of (16.55±2.01) mm.  Conclusion  The study has completed the morphological data of human foramina infraorbitale, providing the scientific data for the clinical research on the foramina infraorbitale measurement.

Ex vivo evaluation of dual-source CT detecting and characterizing the coronary atherosclerotic plaques

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  269-272.  doi:10.13418/j.issn.1001-165x.2015.03.008

Abstract ( 571 )  

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Objective   To evaluate the ability of dual-source CT contrast enhancement scanning detecting and characterizing the coronary atherosclerotic plaques.   Methods    Coronary arteries were scanned by contrasted-enhanced DSCT with an axial slice thickness of 0.6 mm. According to the CT attenuation values, plaques were classified as calcified, mixed and non-calcified. Histopathologic classification was considered the standard of reference.    Results   Histopathology detected 75 plaques, among which 63 plaques were found at DSCT.  The sensitivity of DSCT for detecting all plaques was 84%(63/75), for detecting I-III type plaques was 0%, for detecting IV type、Va type、Vb type and Vc type plaques were 77.8% 、80% 、97.9% and 85.7%, respectively. The mean CT attenuation values of calcified、mixed and non-calcified (416.5±94.4 HU, 142.8±48.6 HU, 46.3±34.2 HU, respectively; p<0.05) were significantly different. There was significant difference between the mean attenuation values of predominantly lipid-rich and fiber-rich plaques (30.4±24.4 HU and 73.3±23.3 HU, respectively; P<0.01). Conclusion Dual-source CT contrast enhancement scanning can detect different types of coronary atherosclerotic plaques. The plaque mean CT attenuation values can represent predominant plaque component which were correlated well with histopathologic classification.

The clinical value of 256 slice CT perfusion imaging and three-dimensional reconstruction of breast disease

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  273-277.  doi:10.13418/j.issn.1001-165x.2015.03.009

Abstract ( 726 )  

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Objective   To explore the significance of 256 slice CT perfusion imaging and three-dimensional reconstruction technology for diagnosis and preoperative evaluation of breast disease.   Methods  50 patients found breast tumors by color doppler ultrasound or mammography underwent 256 slice CT perfusion scan, combined with the postoperative pathological results, analyzed the perfusion imaging indexes of different nature of breast neoplasm tissue and normal breast tissue, and three-dimensional reconstruction of guidance for clinical surgery.   Results   The perfusion imaging indexes of 256 slice CT had important reference value in differential diagnosis of benign and malignant breast tumors, three-dimensional reconstruction model could observe lesions in all situations, and provided the basis for preoperative assessment.   Conclusion   256 slice CT perfusion imaging can be helpful to differentiate the breast cancer from benign breast tumor from the aspects of hemodynamics. three-dimensional reconstruction can provide more information for clinical diagnosis, treatment, and help to preoperative evaluation of breast cancer.

Multi-slice computed tomography imaging anatomy study of adrenal vein

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  278-283.  doi:10.13418/j.issn.1001-165x.2015.03.010

Abstract ( 730 )  

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Objective   Using MSCT to display the normal anatomic structure and variation of the adrenal vein accurately and to provide image anatomy data for clinical application.   Methods   108 patients with abdominal examination of CTA were retrospectively analyzed. A thin layer of MIP and MPR technique was applied to evaluate and measure the adrenal vein diameter, length and line path.   Results   ①  Display rate and variation rate in the right side was 64.81% (70/108) and 5.71% (4/70). The adrenal vein drained directly into the inferior vena cava in 7 o'clock to 8 o'clock direction, accounting for a majority of 42.42% (28/66). The diameter of adrenal vein was (2.19±0.56) mm, the length of vein outside the gland  was (15.02± 1.82) mm, the distance between the sites where the right and left the adrenal veins joint the inferior vena cava  was (240.69±12.96) mm; the inferiorly-oriented  angel of adrenal vein into the inferior vena cava was (60.25± 17.85)°. ② Display rate and variation rate on the left side was 97.22% (105/108) and 14.29% (15/105); adrenal vein was (2.39±0.56) mm, the length of vein outside the gland was (17.28±4.01) mm, the shared trunk between the diaphragmatic-adrenal veins was (3.65±0.93) mm, the distance from the point of diaphragmatic-adrenal vein  draining into the left renal vein was (14.07±6.77) mm, the distance from the point of the diaphragmatic-adrenal vein draining into the left renal vein to the left side of the inferior vena cava was (32.89±4.85) mm, the inward angel of the diaphragmatic-adrenal vein drainging into the left renal vein  was (118.06±18.49)°,the inferiorly-oriented angel of the adrenal vein draining into the diaphragmatic-adrenal vein(156.15± 13.81)°.   Conclusion    MSCT can display most of the right adrenal vein and the vast majority of the left adrenal vein in normal  and abnormal passageway. Measurement of  relevant imaging anatomy data can provide the imaging data for operation scheme such as AVS.

Experimental study on individual guide templates produced by CNC machine tool technology assisted pedicle screws insertion in the lower cervical spines

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  284-287.  doi:10.13418/j.issn.1001-165x.2015.03.011

Abstract ( 589 )  

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Objective  Using of computer aided design and CNC machine tool technology for individual guide templates of lower cervical pedicle screws provides a new method for processing.    Methods   According to pre-operative CT scan data, 3D reconstruction models of lower cervical vertebra were obtained by Mimics; a based on the 3D model, the individual guide templates were designed and were subsequently produced by a CNC machine. The templates were used for lower cervical vertebrae screw placement in  cadavers. Subsequently, CT scan was performed to evaluate the screw position.    Results    All 10 K-wires were inserted into the cervical pedicles. The absolute deviations were (0.44±0.23) mm in axial plane and (0.37±0.20) mm in sagittal plane. In the simulated insertion, 9 screws position were in grade 1, 1 screw was in grade 2.   Conclusion    Pedicle screws placement assisted by individual guide templates is highly accurate and simple. It is a new alternative to lower cervical pedicle.

The feasibility research of orthostaticcervicaltransforaminal morphologic measurements using 2D/3D registration techniques

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  288-290.  doi:10.13418/j.issn.1001-165x.2015.03.012

Abstract ( 680 )  

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 Objective   To investigate the feasibility of orthostatic cervical transforaminal morphologic measurements using 2D/3D registration techniques.    Method    Seven healthy adult volunteer's cervical spines were CT scanned and then 3D reconstructed;  And two orthogonal X-ray images of cervical vertebrae in the same orthostatic posture were also harvested.  A virtual fluoroscopic scene was then created in software Mimics and wasused to reproduce the relative positions of the orthogonal images using 2D/3D image registration technology.  Transforaminal morphologic measurements were performed in Software Rapidform. Result   The cervical orthostatic posture could be reproduced and the morphologic data, such as inter foraminal area, could be calculated.  A total of 56 intervertebral foramen were measured in supine and upright positions: supine foramen area was ??(50.9±14.2) mm2 and orthostatic foramen area was ??(83.6± 23.5) mm2, showing significant difference(t= -8.107, P<0.05 ). Conclusion  Orthostatic cervical transforaminal morphological parameters could be calculated using2D/3D registration techniques. However, it’s efficiency and accuracy need further investigation.

The establishment and significance of standard parts library of proximal tibia plates based on thin-section CT image

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  291-294.  doi:10.13418/j.issn.1001-165x.2015.03.013

Abstract ( 478 )  

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 Objective   To discuss the method of establishing standard parts library of proximal tibia plates and its clinical significance.    Methods    The original image of six sets of full-size proximal tibia plates date were collected which is scanned by thin-section CT, and processed with Mimics 14.0 for the three-dimensional reconstruction, then the models were exported to Geomagic by STL format for morphological optimizing.  The optimized models were exported to Mimics for volume rendering. Cylinder-shaped screw channels was drawn by MedCAD for simulation of channel direction of real-locking screws, and the establishment of standard parts library of plates with screws was then completed.   Results   (1) The establishment of 186 standard parts library of plates with screws was completed. (2) By morphological optimizing in Geomagic and volume rendering in Mimics, the 3D model of plate has high simulation degree. Conclusions   (1) Based on CT scan data ,the standard parts library of orthopedic plate can be achieved by reverse engineering software.  (2) The selective combinations between plate and screw channels were suitable for digital design of fracture internal fixation operation.

Computer simulation of the 3D modeling to study the best screw channel in Atlantoaxial pedicle

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  295-300.  doi:10.13418/j.issn.1001-165x.2015.03.014

Abstract ( 588 )  

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 Objective    To study the regular patterns of atlantoaxial pedicle channel, screw safety zone, and the best screw channel by means of 3D-array model； To establish standards and simplify preoperative design for axis pedicle screws operation.   Methods   CT scan of axis data of 14 healthy adult from PACS system were collected and imported into Mimics10.01software to reconstruct three-dimensional (3D) models. Then, the 3D reconstruction models were imported into 3Dmax 2009 as .dwg format for analysis of the pedicle screw channels. The three-dimensional coordinates and the origin were determined, then the array model was imported.as for the atlas ,  the screw with a diameter  of 3.5 mm and  a length of  22 mm  was used as an object of study.  As for the axis, the screw with a diameter of  3.5 mm and a length of 24 mm was used as an object of study the screw placement in the safety zone was simulated and the optimal placement scheme was explored. the best placement data was recorded and was then used for guidance of computer simulation of pedicle screws.    Results    There are 185 elements that meet the demand to place the screws in the atlas, and there are 395 elements that meet the demand to place the screws in the axis. In the transparent mode, 53 nails, 27 nails in the atlas and 25 nails in the axis, all precisely gained entrance to the vertebral body through the vertebral arch pedicle. Therewas no significant difference between the left side and the right side (P> 0.05).  Conclusions    The digital 3D modeling technology is a standard, simple, accurate way in the preoperative design and measurement for axis pedicle surgery.

Study of 3D reconstruction technique in flap design of reconstructed digits for the additional plastic surgery

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  301-304.  doi:10.13418/j.issn.1001-165x.2015.03.015

Abstract ( 663 )  

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　Objective　This study aimed to introduce a new method using 3-D reconstruction and CAD（computer aided design）techniques to evaluate the morphological difference between second toe and fingers.  Methods  The plaster models for the first to fourth fingers and second toe in the right side of 20 healthy persons were included in the study. To get the 3-D reconstruction data of these models with helical CT set. Software was used to simulate the toe pulp flap harvesting surgery and flap transplantation, and  the 3-D configuration of flap was obtained.   Results   The simulant toe pulp flap could be divided into teardrop and elliptical shape. The simulant transfer flap could be divided into crab claw and cross shape. The flaps of the first to fourth fingers from the same person belonged to the some type.   Conclusion   The new method can provide  accurace three-dimensional evaluation of the shape of the flap, which could be used for the preoperative design. 

Construction of CRMP4 lentiviral vector and its influence on neurite development

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  305-310.  doi:10.13418/j.issn.1001-165x.2015.03.016

Abstract ( 468 )  

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Objective   This study aimed to investigate the influence of CRMP4 on the neurite growth in the hippocampal neuron.   Methods   To obtain the CRMP4 gene fragments by PCR amplification technology, then connect the gene to the viral vector. After PCR, enzyme restriction digestion and sequencing verification, the plasmids was packaged by transferring 293T cells to prepare Lentivirus Vector. The CRMP4 lentivirus vector was used to transfect hippocampal neurons cultured in vitro and neurite length of neurons was analyzed.   Results   The sequence of CRMP4 amplified by PCR was right and the gene fragment was inserted into lentivirus vector. The concentration of the virus was at the titer of 1.0×107~1.0×108 TU/ml. In the control cells, GFP was expressed in the neurites and cell bodies. Hippocampal neurons have two types of highly polarized cell processes, axons and dendrites with the development. When infected by CRMP4 Lentivirus Vector, the neurite outgrowth was obvious, and a lot of dendrites arose from cell bodies. The results of neurite lengths showed that over-expression CRMP4, the neutrite outgrowth was increased significantly and a lot of dendrites werefound. In cells without CRMP4 expression, the neutrites were few, and the length of neutritesdiminishedsignificantly when compared with CRMP4 over-expressing cells (P<0.05).   Conclusion   The lentivirus vector of CRMP4 was successfully constructed and overexpression of CRMP4 is beneficial to neurite development including neurite outgrowth and formation of branches.

Research of lentiviral-mediated Runx2 transferred into bone marrow mesenchymal stem cells promoting osteogenic differentiation

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  311-315.  doi:10.13418/j.issn.1001-165x.2015.03.017

Abstract ( 506 )  

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Objective   To obtain the recombinant BMSCs with the reprogramming Runx2 gene mediated by lentiviral vectors, and detect the levels of the osteogenesis-related genes expression, in order to elucidate that Runx2 is able to promote BMSCs' differentiation.    Methods   Runx2 genes were amplified by RT-PCR and linked to the lentivirus vector, then transfected 293T cells together with packing plasmids. Lentivirus titer was identified. BMSCs were obtained from 4 weeks old SD rats' tibia bone marrow and isolated and were cultured. Analysis of cell surface markers CD90 and CD105 was performed by flow cytometry to confirm the cultured cells were BMSCs, which were finally transfected by Runx2 recombinant lentivirus. The expression of the osteogenic-related gene was studied through RT-PCR.   Results    Runx2 gene linked with expression vector, was confirmed through enzyme digestion and sequencing. The virus tilter was 1.6×109 TU/ml. The expression percentage of CD90 and CD105 was 99.8%and 99.3%, indicating the successful culture of BMSCs. After being infected with lentivirus, cells of BMSCs-Runx2 became osteogenous. The control BMSCs stayed the same as pre-infected. The expression of Runx2, OCN, osteoectin, ALP, BMP-2, OPN increased over time and achieved the highest on day 14 in experimental groups, while the control group didn't show the expression, verifying that Runx2 is able to promote BMSCs' differentiation.Conclusion    Lentiviral-mediated Runx2, which was transfered into bone marrow mesenchymal stem cells,  could promote the osteogenic differentiation.       

Apoptosis of oligodendrocyte mediated by Caspase-12 in nerve fiber degeneration after compression spinal cord injury in rats

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  316-319.  doi:10.13418/j.issn.1001-165x.2015.03.018

Abstract ( 571 )  

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Objective   To investigate the correlation between the demyelination and apoptosis of oligodendrocyte and the mechanism of apoptosis in the compression spinal cord injury(CSCI).   Methods Eighty-four adult Sprague-Dawley rats were randomly divided into 3 groups, a normal group（n=12）, an operation group（n=36） and a sham operation group（n=36）. The CSCI model was established with a self-made device in the operation group. The operation process in the sham operation group was the same as the operation group except the compression of spinal cord. The segments of compression spinal cord were properly taken at an interval of 1, 3 and 7 days after operation. Luxol fast blue (LFB),Immunofluorescence (IF) and TUNEL staining were performed to observe the pathological degeneration of white matters and apoptosis of oligodendrocyte. Western Blot was used to detect the expression of Caspase-12.    Results   LFB staining showed that the degeneration of nerve fiber occurred in the white matter and a great number of fibers were lost after compression. IF and TUNEL double staining demonstrated oligodendrocytes apoptosis occurred in spinal cord and the cell number of oligodendrocytes apoptosis increased significantly compared with the normal and sham operation group (P<0.05). Expression of Caspase-12 also increased after compression significantly. Conclusion   Demyelination occurrence and the apoptosis of oligodendrocyte may be related to the demyelination. Caspase-12 may be mediated the cell apoptosis.

Negative effect of 17β-E2 on lipid droplets through CIDEc and Plin1 in primary human adipocyte

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  320-324.  doi:R329.28； R622

Abstract ( 274 )  

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Objective   To evaluate the effect of different concentrations of 17β-estradiol（17β-E2）on adipocytes lipid droplet growth and CIDEc, Plin1 mRNA expression in vitro.    Methods    Human primary adipose tissue-derived stem cells(hASCs) were isolated from liposuction aspirates of three patients and cultured, passaged and  identified the cell surface markers. hASCs were induced differentiated at 0 mol/L(17β-E2 free DMEM/F12),10-8 mol/L, 10-7 mol/L and 10-6 mol/L 17β-E2 and ICI182780 was added to culture human primary preadipocytes. The expression of CIDEc and Plin1 mRNA was detected by RT-PCR after staining with oil red O.  Result   Different concentrations of 17β-E2 suppressed CIDEc mRNA and Plin1 mRNA expression in human primary preadipocytes. The expression peak of CIDEc and Plin1 mRNA occurred at 7 and 4 days.  At 10-6 mo/L 17β-E2，the expression of CIDEc and Plin1 mRNA were the lowest. Andwith the increase in 17β-E2 concentration，the expression of CIDEc and Plin1 mRNA was in decline.  Conclusion   17β-E2 reduces CIDEc and Plin1 mRNA expression in adipocytes，in which inhibited CIDEc and Plin1 expression may contribute to the negative effect of 17β-E2 on lipid droplets.

Introduction  and evaluation of an anterior interbody fusion model on rabbits 

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  325-330.  doi:10.13418/j.issn.1001-165x.2015.03.020

Abstract ( 454 )  

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 Objective    In order to provide a standardized model for tissue engineering research，we took  measurement of lumbar bodies on rabbits to establish a stable interbody fusion model.    Methods    Forty-four healthy adult New Zealand white rabbits (2~2.5 kg) were randomly divided into an anatomical analysis group (group A, n=10), an interbody fusion with fixation group (group B, n=12), an interbody fusion with no fixation group(group C, n=12) and a blank control group (group D, n=10). Animals in group B、C、D underwent x-ray examination at 4 weeks after operation. At 12 weeks all rabbits were euthanasized, the fusion segments were tested by manual palpation testing, x-ray, Micro-CT, biomechanical and histological examinations.    Results    Because of the fixed screws into the spinal canal，one case with spinal cord injury in group B suffered paralysis of the lower limbs. The result of manual palpation testing showed the fusion rate of group B is 100% (12/12), while the group C is 75% (9/12). There is no obvious destruction in intervertebral spaces in group D.  The bone graft position of group B was superior to group C and the radiographic score of group B is significantly higher than group C （P<0.05）as shown by imaging tests. The histology indicated there was new formation bone at the fusion position between the interbodies  and only soft tissue existed at the failed fusion position. in biomechanic test， the maximal load of group B was higher than that of group C (P<0.05).    Conclusions    Making a lumbar fusion model on rabbit according to the lumbar anatomy is safe and reliable. The fixation can provide a stable space for the bone grafting fusion ， prevent graft from extruding from the fusion position, as well as do some help to improve the fusion effect.

The right hepatic artery and middle colic artery arose from a common stem origining from superior mesenteric artery: one case report

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  330.  doi:10.13418/j.issn.1001-165x.2015.03.033

Abstract ( 388 )  

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The improved primary cell culture method of craniopharyngioma

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  331-335.  doi:10.13418/j.issn.1001-165x.2015.03.021

Abstract ( 586 )  

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Objective    Using new method to culture the craniopharyngioma cells in order to provide the foundation of clinical and basic researches on cell level.    Methods    Using new method to culture, purify and pass two pathological patterns of craniopharyngioma cells. The cells were identified by morphology under microscope, immunohistochemistry and proliferation assay.    Results    The craniopharyngioma cells cultured by the new method were seen around the tumor piece with better state and greater numbers than the cells cultured by the traditional method. These two kinds of cells were determined to be the craniopharyngioma cells. The proliferation assay showed that the cells were still proliferating and dividing in vitro.    Conclusions    Using new method which was simple and cheap to culture the craniopharyngioma cells could harvest better cells in state and greater in numbers. Though this method could not solve all the problems about cell culture of craniopharyngioma, it could still provide the foundation of clinical and basic researches about tumor biological characteristics on the cell level by establishment of a stable cell line.

Clinical observation of heterotopic ossification after Discover cervical disc replacement

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  336-340.  doi:10.13418/j.issn.1001-165x.2015.03.022

Abstract ( 772 )  

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  Objective    To analyze the cause of heterotopic ossification of Discover artificial cervical disc replacement in the treatment of cervical vertebra disease and to explore preventive countermeasures.   Methods   We retrospectively reviewed radiographic and clinical outcomes in 23 patients who received the Discover cervical disc prosthesis. Static and dynamic X ray was taken for measurement of the range of motion. Replacement segment was assessed for heterotopic ossifications   at the latest follow-up  according to McAfee classification method.    Results    23 patients were followed up for 27~36 months. In the last follow-up, the average sagittal range of motion was 5.5°±2.2°，and the average coronal range of motion was 3.4°±1.2° and 3.6°±0.8°. A total of 5 patientsdemonstrated the prosthesis replacement segmental heterotopic ossification at the last follow-up, the incidence being 21.7%.  Conclusions  heterotopic ossification can occur after DISCOVER artificial cervical disc replacement in the treatment of cervical spondylosis; the incidence is consistent with the literature report; the surgeon should try consciously to prevent the occurrence of heterotopic ossification in order to avoid the loss of the mobility of the replacement segment.

The tibialis anterior tendon as anatomical landmark in the extramedullary alignment system of the total knee arthroplasty

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  341-343.  doi:10.13418/j.issn.1001-165x.2015.03.023

Abstract ( 952 )  

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Objective   To explore the effect of the tibialis anterior tendon in the total knee arthroplasty of the extramedullary alignment.   Methods    The ankle center and the tibial coronal alignment in 59 lower limbs of the 59 osteoarthritis were confirmed with X-ray and was marked in the skin, the medial border of tibialis anterior tendon was also marked in the skin. The distance of the tibialis anterior tendon to the ankle center was measured at the ankle line, the distance of junction of tibialis anterior tendon and tibial coronal alignment to the ankle line also was measured. The independent t test was performed for both distances.   Results    The distance of the tibialis anterior tendon to the ankle center was (13.32±2.75) mm (P<0.001), and the distance of the junction of the tibialis anterior tendon and the tibial alignment to the ankle line was (71.23±6.45) mm (P<0.001).   Conclusion    The tibialis anterior tendon has 2 points that could serve as the distal tibial anatomical landmark in extramedullary alignment of total knee arthroplasty, it could be applied in the total knee arthroplasty clinically.

The application value of CoflexTM interspinous process device in the treatment of degenerative lumbar spinal stenosis

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  344-348.  doi:10.13418/j.issn.1001-165x.2015.03.024

Abstract ( 717 )  

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 Objective   To evaluate the application value of the Coflex interspinous process devicefor  treatment of degenerative lumbar spinal stenosis.   Methods   115 cases of degenerative lumbar spinal stenosis treated with surgery  were retrospectively analyzed ,the followed-up period was more than 5 years. The coflex group have 54 cases, and the fusion group have 61 cases. The perioperative indicators were compared between the two groups. The JOA、VAS、ODl and SF-36 scores were compared between the two groups. The range of the increase of intervertebral motion,  the loss of the intervertebral height and the Pfirrmann grade of the adjacent segments disc were measured at the pre-operative period and the final follow-up.   Results   The observational index had no statistical difference between the two groups (P> 0.05). The range of increase of intervertebral motion of adjacent segments revealed no statistical difference (P> 0.05).The range of loss of intervertebral height of adjacent segments was greater in the fusion group, showing statistical difference (P< 0.01) between the two groups. The adjacent segment disc Pfirrmann grading progressed more obviously in the fusion group, demonstrating statistical difference (P< 0.05) between the two groups.    Conclusion   The coflex implant and lumbar fusion  have equivalent efficacy in the  treatment of degenerative lumbar spinal stenosis, and the coflex implant can delay the adjacent segment pathology in radiology.

Application of calcium phosphate combined with iliac screws in the lumbosacral tuberculosis

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  349-353.  doi:10.13418/j.issn.1001-165x.2015.03.025

Abstract ( 667 )  

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Objective   To investigate a surgical treatment of lumbosacral tuberculosis by posterior debridement and internal fixation with iliac screws and pedicle screw, filling bone defects and intervertebral space with antibiotics&calcium phosphate.  Methods   A retrospective analysis of the clinical data was performed in 42 cases of lumbosacral tuberculosis patients (19 cases of male and 23 cases of female; age:19 to 75 year-old with an average of 38 years old) treated with two different surgical methods. Twenty-one patients with lumbosacral tuberculosis in the treatment group were treated by a single-stage posterior debridement and internal fixation with iliac screws and pedicle screws. Bone defects and intervertebral space filled with antibiotics-calcium phosphate were performed in these cases. 21 patients in the control group were implemented with anterior debridement and autogenous ilium grafts and vertebral pedicle screw fixation. All patients were followed up with an average of 12 months. Segmental lesions were L4/5~S1/2. 42 patients had varying degrees of kyphosis. The preoperative kyphosis angle was 5°~18° with an average of 9°.  Results After operation, spinal fusion was achieved in treatment group. Bone graft fusion time was 3 to 6 months with an average of 4 months, and that of control group ranged from 5 to 9 months with an average of 7 months. Postoperative imaging results showed that kyphosis was partly corrected. The postoperative kyphosis angle in the treatment group was 0~4° with a mean of 2°, but the postoperative kyphosis angle in the control group was 3°~11° with an average of 7° (P＜0.05). According to Chen score, among the 21 cases in the treatment group, the therapeutic efficacy was excellent in 17 patients, good in 2 patients. the excellent & good rate was 90.5%. However, The therapeutic efficacy was only excellent in 13 patients, good in 3 patients in the control group. the excellent & good rate was 76.2%. Lesion segments were stable and no recurrence was found in all final follow-up cases.   Conclusion    One-stage posterior debridement together with antibiotics-calcium phosphate grafting and internal fixation is an effective method for the treatment of lumbosacral tuberculosis.

Comparative study of efficacy of vertebral side clearance and traditional approach pedicle screw placement  technology on  thoracolumbar fractures

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  354-356.  doi:10.13418/j.issn.1001-165x.2015.03.026

Abstract ( 704 )  

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Objective    Comparative study of the efficacy of  vertebral side clearance and the traditional approach nailing technology application on thoracolumbar fracture.    Methods    From April 2011 to December 2012, a total of 142 patients with thoracolumbar fractures underwent surgical treatment in our hospital. The patients were randomly divided into observation group (71 cases) and control group (71 cases) in a digital method. Patients in both groups of underwent pedicle screw surgery in a posterior approach patients in the observation group  received the paraspinal muscle pedicle screw technology; patients in the control group  received the set nail technology through the traditional approach. The surgical length, blood loss and drainage were compared in both groups during the surgery. VAS score and correction rate of postoperative vertebral height were compared 3 d, 1 month and 6 months after surgery.   Results   In the study group, the surgical duration was (89.52±12.15) min, blood loss was (139.61±36.25) ml, drainage was (99.62±9.15) ml, which was significantly lower than the control group (138.57±9.98) min, (413.54±29.83) ml, (373.14±11.83) ml. Differences were statistically significant ( P<0.05). In 3 d, 1 month, half a year after the surgery,  VAS score in the observation group was  (5.01±0.98), (2.33±1.13) and (0.71±0.69), respectively, which was significantly lower than that in the control group being (5.55±1.15), (3.09±1.25) and (1.74±0.85), respectively  (P <0.05). The correct rate of the observation group was （96.80±2.51）%, and of the control group was （95.68±2.89）%. There was no statistically significant difference（P>0.05）.   Conclusion    Paraspinal muscle pedicle screw technology , having the advantages of  being shorter in surgical duration, as reliable as the traditional approach when it comes to the correction rate, and deliver a good surgical outcome, is worthy of promotion.

Clinical study of minimally invasive spatium intermuscalare of multifidus for transforaminal lumbar interbody fusion

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  357-359.  doi:10.13418/j.issn.1001-165x.2015.03.027

Abstract ( 779 )  

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Objective    To explore the clinical outcome of through spatium intermuscalare of multifidus for transforaminallumbar interbody fusion.  Methods   From April 2010 to April 2012，27 patients underwent screw fixation plus transforaminallumbar interbody fusion through spatium intermusculareof multifidus. There were 12 males and 15 femaleswith the mean age of 58.2 years (range，46~74years). Among them 7 cases  hadfar-lateral lumbardisc herniation，3 cases had post-discectomy recurrence，and 17 cases had degenerative instability.  Results  The average skin incision length was 4.2 cm (range，4.0~4.5 cm)，the average operative time was 90 min(range，70~160 min)，and the average blood loss was 130 ml (range，90~250 m1)．All cases were followed up for 8~20 months (average 13.6 months)．Postoperative radiography showed no evidenceof instrument failure，and all cases got bone fusion．At final followed-up the average leg pain VAS decreased from 7.4±1.1 preoperatively to 2.4±1.3 postoperatively，the averse low back pain VAS decreased from 6.7±1.3 preoperatively to 1.8±1.5 postoperatively． According to Nakai ncriterion，22 cases were rated asexcellent，3 cases as good，and 2 case as fair with the total excellent and good rate of 92.6％. Conclusions   Transforaminallumbar interbody fusion  through spatium intermusculareof multifidus  has some advantages of minimal invasiveness，less blood loss，less complications and reliable curative effect．It is a satisfactory lumbarfusion method undersuitable indication．

Translocation of tibial bone flap pedicled with descending branches of supramalleolar artery  for treatment of avascular necrosis of talus

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  360-363.  doi:10.13418/j.issn.1001-165x.2015.03.028

Abstract ( 492 )  

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Objective   To investigate the value of clinical application of  translocation of the tibial bone flap pedicled with vascular pedicledescending branches of supramalleolar artery descending branches for treatment of avascular necrosis of talus.   Methods    8 patients with traumatic ischemic necrosis of talus from March 2010 to December 2013 were treated by translocation of thetibial bone flap pedicled with vascular pedicled with descending branches of supramalleolar artery , and ankle joint was immobilized with plaster slab for 4 weeks after operation.   Results    The following-up ranged from 6 to 24 months, with an average of 12 months. Ankle joint function in the final following-up wasassessed according to kenwight curative effect standard: 6 cases were excellent, 2 cases good.    Conclusion    This bone flap has the advantages of constant vessels, abundant blood supply and the simple operation process, which is an effective method to treat avascular necrosis of talus.

Ultrasound measurements of the amount of juice for prediction of the risk of occurrence of vomit during emergency surgery

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  364-367.  doi:10.13418/j.issn.1001-165x.2015.03.029

Abstract ( 495 )  

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Objective   To explore the use of ultrasound in measuring antral cross-sectional area (CSA) and calculating the amount of gastric juice in non-traumatic conditions, for predicting the occurrence of vomiting.    Methods    Patients were placed in semi-recumbent position. An ultrasound system with an abdominal imaging mode and a transducer C60x /5-2MHz convex array probe was employed to scan the abdomen (xiphoid) around the sagittal plane. The left lobe of the liver and the abdominal aorta were used as the body markers.  The probe was rotated slightly clockwise or counterclockwise to obtain a clear picture of the gastric antrum. gastric antrum was measured for the maximal diameter (D1 and D2) in the ultrasound image in a sagittal and vertical direction, and  CSA was then calculated (CSA = π × D1 × D2/4). The amount of gastric juice was calculated based on Bouvet regression equation. All the patients were divided into three groups according to the amount of juice: A: gastric volume ≤0.4ml/kg; group B: 0.4ml/ kg < juice volume ≤0.8ml/kg; group C: gastric volume> 0.8 ml/kg.    Results    (1) The feasibility using ultrasound for measurement of antrum CSA was confirmed.  (2) A positive correlation between CSA and volume of gastric antrum could be found in ultrasound measurement before induction of anesthesia. (3) Ultrasound measurements of gastric antrum and CSA  in emergency surgery before induction of anesthesia can be used to determine the probability of peri-operative vomiting. (4) Gastric residual volume greater than 0.8ml/kg could be used as an indication of a high possibility of occurrence of peri-operative vomitting.   Conclusion   Ultrasound can be used for  measurement of antral cross-sectional area (CSA) and calculation of the amount of gastric juice; it is feasible to predict vomiting, and can be expected to be used in future emergency surgery.

Anatomy of sphenoid sinus and its important adjacent structures：current status of the research

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  368-370.  doi:10.13418/j.issn.1001-165x.2015.03.030

Abstract ( 732 )  

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The clinical application and progress on Peroneal artery perforator flap

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  371-374.  doi:10.13418/j.issn.1001-165x.2015.03.031

Abstract ( 748 )  

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An anastomosis branch between common hepatic artery and lienal artery and left gastric artery origin from lienal artery: case report

Chinese Journal Of Clinical Anatomy. 2015, 33(3):  375.  doi:10.13418/j.issn.1001-165x.2015.03.032

Abstract ( 493 )  

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