Chinese Journal of Clinical Anatomy

Anatomical studies of the perforator-based intermediate dorsal pedal neurocutaneous vascular flap

HUANG Lei, HU De-qing, WANG Tian-quan, NIU Peng, HONG Xu, QI Rui-lin, ZHENG He-ping

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 601-604. doi:10.13418/j.issn.1001-165x.2016.06.001

Abstract ( 639 )

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Objective　To provide anatomical basis of the perforator-based intermediate dorsal pedal neurocutaneous vascular flap for repair of soft tissue defects of the forefoot.　Methods　The following contents were investigated in 30 adult feet specimens perfused with red latex. ①The course and distribution of the intermediate dorsal cutaneous nerve. ②The 3rd dorsal perforator of the plantar arch and its anastomosis with the intermediate dorsal cutaneous neural nutrient vessels. Simulated operation was performed on another fresh specimen.　Results　①The intermediate dorsal cutaneous nerve mainly arose from the lateral branch of the superficial peroneal nerve. Crossing the surface of the cruciate ligament, it proceeded forward to the proximal part of the 4th metatarsal gap and then divided into the 3rd and 4th dorsal metatarsal branches, which were distributed in part of dorsal pedal and digital skin. ②The intermediate dorsal cutaneous neural nutrient vessels was multiple in segments and sources, which was closely related to operation type. The 3rd dorsal perforator of plantar arch had a relatively constant position located at the proximal part of the 4th intermetatarsal space. It gave out numerous tiny vessels which anastomosed closely with branches of intermediate dorsal cutaneous neural or paraneural nutrient vessel chain.　 Conclusion　The intermediate dorsal pedal neurocutaneous vascular flap based on the 3rd dorsal perforator of plantar arch could be transferred to repair the soft tissue defects of forefoot.

Anatomic characteristic and clinical significance of carpometacarpal ligament of thumb

LI Jian-feng，WU Jin-ying， LI Hai-lei, LIU Jing-da， ZHAO Liang， LI Da-cun

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 605-608. doi:10.13418/j.issn.1001-165x.2016.06.002

Abstract ( 2550 )

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Objective　To study the anatomical characteristics of the ligaments of the carpometacarpal joint of thumb and the role of the ligaments in the thumb movement.　Methods 　20 fresh hand specimens of adult male cadavers were dissected under the magnifying glass, and the starting and ending points and attachment sites of the carpometacarpal joint of thumb. The length, width, thickness and maximum length of each ligament in the neutral position were measured. The range of the motion of the joint was also measured.　Results　There are 5 ligaments around the carpometacarpal joint of thumb. Among these ligaments, the dorsal radial ligament, posterior oblique ligament, and anterior oblique ligament are the joint capsular ligament, while the first inter-metacarpal ligament, and the ulnar ligament are the extra capsular ligament. The dorsal radial ligament is the thickest (2.08±0.27 mm), and the thinnest is the anterior oblique ligament（1.14±0.17 mm）.The anterior oblique ligament is the widest（9.33±1.09 mm）, and the narrowest is the posterior oblique ligament（7.23±0.88 mm）. The longest elongation is the dorsal radial ligament（57.33%±9.21%）, and the shortest is the anterior oblique ligament（38.43%±8.26%）.　Conclusion　The carpometacarpal joint of thumb has three stable structures. In the joint capsule and ligaments structure, the dorsal radial ligament is thickest and most tenacious. It is the main ligament to maintain the joint stability. The anterior oblique ligament is thin and loose，making it vulnerable to degenerative change when injured or spontaneously strained, which then should be reconstructed in the first place.

Anatomical analysis of the thumb carpometacarpal joint ligaments

ZHANG Yu, XU Nan-wei, SUN Rong-bin

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 609-614. doi:10.13418/j.issn.1001-165x.2016.06.003

Abstract ( 1825 )

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Objective　To dissect the ligaments surrounding the first carpometacarpal joint and observe its histologic characteristics, and to explore the role of the supporting ligaments in maintaining the stability of the first carpometacarpal joint.　Methods　Ligaments connection site and direction were identified in 10 frozen fresh cadavers and its width, length, and thickness were measured and recorded for morphometric analysis and comparison. The dorsal and volar ligaments were excised from the fresh- frozen specimens for further histological observation.　Results　Seven ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments complex (dorsal radial, dorsal central, posterior oblique), whose thickness were (1.24±0.12) mm , (1.91±0.15) mm, and (1.61±0.12) mm, resepectively. Two volar ligaments (anterior oblique and ulnar collateral), whose thickness were (0.78±0.11) mm, and (1.03±0.11) mm, respectively. Two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal), whose thickness were (0.78±0.19) mm, and (0.89±0.19) mm, respectively. The dorsal ligaments were significantly thicker (P<0.01) than the volar ligaments. The dorsal radial ligament, dorsal central ligament and posterior oblique ligament had a significantly greater cellularity compared with the anterior oblique ligament. Cells in posterior oblique ligament were also more than the ulnar collateral ligament; there were significant differences (P<0.05).Conclusions　Three dorsal ligaments are a thick and tough complex, which play a more important role in thumb carpometacarpal joint stability.

Positioning surface observation of C7 spinous process and clinical significance

ZHANG Lei, ZHOU Xin, QI Ji, ZHANG Shao-qun, WANG Guo-you, FU Shi-jie, LI Yi-kai

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 615-618. doi:10.13418/j.issn.1001-165x.2016.06.004

Abstract ( 1866 )

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Objective　The aim of this study is to study the accuracy of C7 spinous process on palpation positioning of healthy adults, and to explore the causes and clinical significance.　Method　500 healthy adult volunteers (354 males and 146 females) were enrolled into this study. Three orthopedic physicians used palpation to locate the surface mark of the C7 spinous process with an aluminum sheet, and then the surface palpation positioning accuracy of the C7 spinous process was observed by cervical lateral X-ray. Meanwhile, the length of C6, C7 and T1 was measured by X-ray and CT 3D reconstruction, and the results were analyzed. Result 98.8% (494) of the subjects’ C7 could be accurately positioned through surface palpation, but surface palpation of 1.2% (six subjects were male) subjects was positioned in C6. In X-ray, the length of C6 spinous process was （2.97±0.11）cm, the length of C7 spinous process was （3.16±0.16）cm, the length of T1 spinous process was（3.20±0.15）cm; in CT 3D reconstruction, the length of C6 spinous process was （2.98±0.12）cm, the length of C7 spinous process was （3.18±0.17）cm, the length of T1 spinous process was （3.50±0.16）cm. In X-ray and CT 3D reconstruction, there was statistically significant difference (P< 0.01) in three vertebral spinous process length, but there wasn’t statistically significant difference (P> 0.05) in the length of C6, C7, T1 spinous process as measured by the two kinds of imaging examination. Conclusion The surface palpation positioning method of C7 spinous process was affected by many factors, so there may be some errors. X-ray, CT and other auxiliary methods can be used to ensure the accuracy and safety of clinical diagnosis and treatment.

Morphometric measurement of the cervical spine for minimally invasive pedicle screw fixation using reverse engineering and three-dimensional reconstruction

ZHOU Zi-jia, SUN Qiu-min, WEN Chao-lun, CHEN Xi, LIU Fang, WANG Ai-ping, LI Yan-bing

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 619-624. doi:10.13418/j.issn.1001-165x.2016.06.005

Abstract ( 619 )

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Objective　To study the entry point of cervical pedicle screw insertion and its three-dimensional relationship of the spinous process, and to provide anatomical basis for percutaneous cervical pedicle screw fixation and the design of the aiming device.　Methods　3D models were imported into UG13.2 imageware for measurement. We took the 70%、80% and 90% as our research foundation, and several measurements were conducted, including the biggest inscribed circle radius(R), the lateral angle(Ap) and the length of pedicle insertion channel(L).The intersection between entry axis and coronal plane was defined as point C. Besides, point E and point F respectively represented medial and lateral midpoints of the pedicle. The angel between line CE and line CF was calculated(Ac). The distance from the entry point(B) and point C to each reference plane; BD and CD represented to the distances from point B and point C to the end of the spinous process, respectively.　Results　(1) The inscribed circle radius from C3 to C7 ranged from 2.79 mm to 3.89 mm.(2)The PSC length increased with the increase of borderline depths. (3)The bigger the borderline depths, the larger the insertion angle. (4) The maximum of Ac from both C3 to C7 appeared at 70% borderline depth.(5)The distance from point B and point C to sagittal plane and spinous process increased with the increase of borderline depth.　Conclusion　The three-dimensional relationship of the cervical pedicle and its relationship of spinous process in 70%,80%, and 90% boundary depths in this study have been analyzed, which can provide the anatomical basis for percutaneous cervical pedicle screw placement and its locating device design.

Anatomical study of brachiocephalic vessels in type A aortic dissection and its clinical significance

WU Jin-lin, ZHANG Liang, YU Cun-tao, JIANG Wen-xiang

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 625-629. doi:10.13418/j.issn.1001-165x.2016.06.006

Abstract ( 831 )

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Objective　The study is to provide data support for the production and improvement of artificial blood vessels and to provide reference for aortic endovascular treatment by determining the dimension of the brachiocephalic vessels in the setting of type A aortic dissection. 　Methods　331 cases with type A aortic dissection were reviewed by CTA, and the shape, diameter and angle were studied.　Results　In a total of 331 cases, 91.5%(303 cases) are with a normal aortic arch and 8.5%(28 cases) with a variant aortic arch. In 25.4%(77 cases), the opening of the three branches is lower than that of the aortic arch. In the distribution of the three branches, IA is more common in the posterior position, while LCCA and LSA are more common in the middle. IA is most likely to be involved in the dissection. From IA to LSA, the diameter of the three branches at the opening is (16.2±3.6), (11.0±3.3), and (12.9±3.6)mm respectively. The diameter of the three branches 2 cm distal to the opening is (12.0±3.0), (9.0±1.9), and (9.8± 2.1) mm, respectively. The average IA-LCCA distance is (10.1±5.5)mm(2~20 mm). The average LCCA-LSA distance is (14.1±5.9)mm(2~27 mm). In the coronal plane of aortic arch, the angles of the brachiocephalic artery and the aortic arch are (62.5± 26.5)°, (57.8±23.4)°, and (64.9±23.5)°, respectively. In the aortic cross section, the angles of the brachiocephalic artery and the aortic arch are (121.1±24.7)°, (107.3±19.4)°, and (100.5±16.1)°, respectively.　Conclusion　This research obtained the detailed anatomical data of brachiocephalic vessels in the setting of type A dissection, which is not consistent with the existing artificial blood vessel. The study can provide data support for the further improvement of artificial blood vessels.

The types of the sacroiliac joint on the pelvic anteroposterior radiography and its clinical implications

YANG Xian-wen, ZHANG Shao-qun, CHEN Zu-jiang, LI Yi-kai

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 630-634. doi:10.13418/j.issn.1001-165x.2016.06.007

Abstract ( 1293 )

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Objective　To explore the radiological types of the sacroiliac joint on the anteroposterior radiography of the pelvis, providing guidance for the clinicians to know more about the sacroiliac joint.Methods　950 cases (male and female account for half respectively) of normal sacroiliac joints were observed on the anteroposterior radiography of the pelvisand then the radiological types of the sacroiliac joint were classified according to the number of the sacroiliac spaces and the characteristics of their shape.　Result　 (1) The normal sacroiliac joints on the anteroposterior radiography of the pelvis can be classified to three types: ①8.8% of males (42 cases) and 25.7% of females (122 cases) were classified as type I, which was called single gap on both sides type;②79.2% of males(376 cases) and 46.7% of females(222 cases) were classified as type II, which was called double gaps on both sides type;③12% of males(57 cases) and 27.6% of females(131 cases) were classified as type III, which was called one side single gap and the other side double gaps type;(2) Double gaps on both sides type can be particularly classified to four subtypes:①0.8% of males(3 cases) and 6.6% of females(15 cases) were classified as 2 double gaps type;②56.4% of males(212 cases) and 69.8% of females(155 cases) were classified as 12 double gaps type;③2.1% of males(8 cases) and 1.8% of females(4 cases) were classified as 21 double gaps type;④41.8% of males(157 cases) and 19.8% of females(44 cases) were classified as 121 double gaps type;(3) One side single gap and the other side double gaps type can also be classified to two subtypes:①26.3% of males(15 cases) and 49.6% of females(65 cases) were classified as Single gap on left and double gaps on right type;②73.7% of males(42 cases) and 50.4% of females(66 cases) were classified as double gaps on left and single gap on right type.　Conclusions　(1) The most common type of the normal sacroiliac joints on the anteroposterior radiography of the pelvis is the double gaps on both sides type, in which the largest proportion of all four subtypes is the “12” double gaps type, but the constituent ratio of each type on gender has a significant variation.

Clinic value of female pelvic shape in South of China

LIU Ping, WANG Yue-zhi, CHEN Chun-lin, CHEN Lan, ZHOU Jian-wei, WANG Jian-ping, LIAO Ke-dan, TANG Lian, TANG Lei

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 635-638. doi:10.13418/j.issn.1001-165x.2016.06.008

Abstract ( 1150 )

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Objective　To analyze the current situation of the shape and size of female pelvic inlet in South China and to explore its trends.　Methods　844 images and clinical data of female patients with gynecological diseases who underwent CT scan in Nanfang Hospital were collected and 3D model of pelvis was reconstructed for measurement ofthe transverse and anteroposterior diameter, and then judgement of the shape of their inlet. Those patient were divided into 3 groups according to the age. Patients was an ageunder 40 years was assigned into the first group, between 41 to 50 years assigned into the second group, over 50 years assigned into the third groups. The shape and size of pelvic inlet in the three groups were explored, and the relationship between age and the shape and size of pelvic inlet was also explored.　Result　(1)The morphologic classification of 844 female pelvic inlets among 3 groups was significantly different(P<0.001) . (2)Transverse diameter of pelvic inlet and anteroposterior diameter of pelvic inlet differences among the 3 groups had statistical significance（P＜0.001）. (3)Age was negatively correlated with the anteroposterior diameter of the pelvic inlet（r=-0.292，P＜0.001）. (4)Pelvic inlet area for each groups was also significantly different（P＜0.001）.　Conclusion　The shape of the female pelvic inlet in south China has changed in the last 30 years, with being transversely oval more common than being verticallyoval. This trend is beneficial to engagement of vaginal delivery.

The establishment of visual model of the scaphoid bone and its nutrient artery

WANG Min， ZHOU Xiao-bing, ZHAO Sheng，TAN Jian-guo, DING Mao-chao，MEI Jin

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 639-642. doi:10.13418/j.issn.1001-165x.2016.06.009

Abstract ( 685 )

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Objective　To study the blood supply of the scaphoid bone by the three-dimensional visualization model，and to provide technical platform for basic research and clinical application.　Methods　Eight fresh cadavers were injected for three-dimensional reconstruction of the carpal and scaphoid's nutrient arteries using a spiral computed tomography scanner and three-dimensional reconstruction by MIMICS.　Results　(1)The radial bone，ulnar bone, proximal wrist bone, and the radial artery were reconstructed.(2)There were 3 major nutrient arteries in the scaphoid bone.(3)The model could display the location, origin, distribution, and adjacent structures of the scaphoid bone and its blood distribution. The reconstructed structures could be continuously rotated in 3D space at different velocities.　Conclusions　The model can clearly display the scaphoid bone and sources of its nutrient arteries, distribution, and provide visual digital anatomical information for clinical diagnosis and treatment of scaphoid bone diseases.

The study of human adipose-derived stem cells in promoting the tendon-bone healing in a rabbit anterior cruciate ligament reconstruction model

CHEN Ping, QU Rong-mei, HAN Zhong-yu, YANG Yu-chao, YIN Yu-kun, TIAN Jing, ZHANG Li

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 643-646. doi:10.13418/j.issn.1001-165x.2016.06.010

Abstract ( 602 )

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Objective　To investigate whether human adipose-derived stem cells (hACSs) can promote tendon-bone healing.　Methods　Unilateral anterior cruciate ligament reconstruction using autologous semitendinosus tendons were conducted on 30 New Zealand rabbits(weighing 2~2.5kg), which were randomly divided into 2 groups. Rabbits in the experimental group were injected with hASCs in the tibial and femoral bone tunnels while rabbits in the control group were injected with equal normal saline. All experimental animals were sacrificed at 2 weeks, 4 weeks and 8 weeks after surgery. The specimens were harvested for gross observation and histological analysis.　Results　At 2 weeks after operation in the control group, a lot of inflammatory cells infiltrated the tendon-bone interface while the inflammatory cells decreased at 4 weeks. At 8 weeks postoperatively, sharpey’s fibers were found in the interface forming indirect insertion. In the experimental group, the tendon-bone interface was filled with fibro-cartilage cells and a few osteoblasts at 4 weeks after surgery. New bones can be found in the tendon-bone interface at 8 weeks postoperatively in the experimental group and formed the direct insertion. Conclusion hASCs can promote tendon-bone healing by forming a direct insertion in a rabbit anterior cruciate ligament reconstruction model.

Generation of non-integrating induced pluripotent stem cells with episomal plasmids and differentiation into neural stem cells

LIN Cheng-kai, RONG Li-ming, LIU Bin

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 647-654. doi:10.13418/j.issn.1001-165x.2016.06.011

Abstract ( 580 )

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Objective　To study the induction of non-intergrated induced pluripotent stem cells (iPSCs) with episomal plasmid vectors, and differentiating into neural stem cells in vitro.　Methods　Non-integrating mouse iPSCs were induced from mouse embryonic fibroblasts (MEFs) with plasmid vectors pCEP4-EO2S-ET2K. For the differentiation of neural stem cells (NSCs), iPSCs were cultured in suspension and adherent cultural plate for 2 times with different mediums. The characterization of iPSCs and NSCs were then investigated.　Results　Our results demonstrated that mouse iPSC could be effectively generated and the pluripotency of iPSC was similar to that of mESCs. In addition, no vector integration was found in iPSCs of 10th passages. Quantitative real-time PCR showed that the neural stem cell marker gene expression was significantly improved in iPSC-derived NSCs, which was similar to that of wild-type NSCs. Immunofluorescence demonstrated that iPSC-derived NSCs expressed NESTIN and PAX6 and could differentiated into neurons, oligodendrocytes and astrocytes in vitro.　Conclusions　 Non-integrated iPSCs could be generated with episomal plasmid vectors and differentiated into NSCs which could be the ideal seeding cells for the treatment of spinal cord injury.

Effects of electro-acupuncture combined with BMSCs transplantation on the expressions of AQP-4 in rats subjected to intracerebral hemorrhage

FAN Guang-Bi， XIAN De-Hai， DENG Li，TANG Hua-Jun，ZHANG Yan-ru, YANG Chao-Xian

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 655-660. doi:10.13418/j.issn.1001-165x.2016.06.012

Abstract ( 370 )

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Objective　To explore effects of electro-acupuncture stimulation combined with bone marrow mesenchymal stem cells( BMSCs) transplantation on the expression of Aquaporins-4（AQP-4）in rats after intracerebral hemorrhage.　Methods　ICH rats models were established by injecting the collagenase and heparin into the right caudate nucleus. After 3 days, the animals were treated with BMSCs transplantation and electro-acupuncture (Ea-BMSCs group), or dealt with BMSCs transplantation (BMSCs group), electro-acupuncture (Ea group) and physiological saline injection (Control group) respectively. The brain tissues of rats were collected at 1, 3, 5, 7 and 14 d after treatment. And then, immunohistochemical method and Western Blotting were used to detect expression of AQP-4, dry and wet ratio method was used to detect water content of brain. LSD method was performed for statistical analysis.　Results　①AQP - 4 was found in the pia mater, cerebral cortex, choroid plexusand the area surrounding the hemorrhage, which had been expressed in astrocytes together with GFAP . ②Water content of each group begun to increase at 3d, quickly peaked at 5d, and then gradually decreased. ③AQP - 4 of the control group and Ea group begun to increase at 3d, peaked at 5d, and then gradually decreased similar to the water content; Nevertheless, it peaked again at 14d on the BMSCs group and Ea- BMSCs group. ④Expression of AQP-4 in the Ea-BMSCs group was lower than the control group at 5 d and 7 d（P＜0.05）; There was no difference when compared with the BMSCs group. At 14d, Expression of AQP-4 in the Ea-BMSCs group was higher than the control group and BMSCs group（P＜0.05）.　Conclusion　Electro-acupuncture combined with BMSCs transplantation can significantly reduce the brain water content,which is probably correlated with up-regulation AQP-4.

Protective effect of chymase inhibitor on renal function in diabetic hamsters

ZHANG Meng-shu, LIU Jin-lei, LIU Xue-zheng，ZHOU Hong-li, ZHANG Rong-ming

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 661-667. doi:10.13418/j.issn.1001-165x.2016.06.013

Abstract ( 429 )

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Objective　To observe the protective effect of chymotrypsin inhibitors on diabetic hamster kidney, and to explore mechanism underlying the protection.　Methods　Diabetic hamsters was established by intraperitoneal injection of STZ. The animal chymotrypsin, RAS components: ACE, renin, ANG-I, ANG-II; oxidative stress levels: 8-OhdG, NOX-4, p22phox, and the expression of TGF-β1 were determined by molecular biologic techniques, immunohistochemistry, western blotting technique.　Results　Chymotrypsin inhibitors inhibited the increase of ANG-II in diabetic hamster kidney, but significantly reduced the level of 8-OHdG secretion. NOX-4 and p22phox staining indicated significantly increased products of oxidation products in diabetic glomerulus and tubules, which could be significantly inhibited by chymotrypsin inhibitors (P<0.01). Western blot confirmed that the level of NOX-4 and p22phox increased in the diabetic group than in the control group, and chymotrypsin inhibitor could significantly reduce its expression. Glomerular TGF-β1 expression in the diabetic group was higher than that in the control group, and the chymotrypsin inhibitor therapy could significantly reduce the levels of TGF-β1.　Conclusions　Chymotrypsin inhibitors can protect diabetic hamster kidney function, and the underlying mechanism is through reducing renal ANG-II levels and oxidative stress levels to protect diabetic kidney damage.

Evaluation and comparison of different spinal fusion model in rats

ZHANG Zhao-fei, LIU Zhi-xiang, YANG Jun-long, LAI Zhen, JIANG Jian-ming

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 668-671. doi:10.13418/j.issn.1001-165x.2016.06.014

Abstract ( 335 )

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Objective　To compare the superiority and fusion rate of three different spinal fusion models in rats.　Methods　Sixty SD rats were randomized into three groups, A: underwent intervertebral fusions (with internal fixation); B: underwent posterolateral lumbar fusions (intertransverse); C: underwent intervertebral fusions (without internal fixation). For each group, palpation, X-ray, and histology were evaluated at 3 and 6 weeks after fusion.　Results　All groups did not show fusion 3 weeks after fusion. The fusion rate in A and B group were 40%. However, the fusion rate in C group was only 20% 6 weeks after fusion.　Conclusion　Intervertebral fusions and posterolateral lumbar fusions have good and enough bone graft bed, which are feasible and easy, therefore causing less postoperative complications. In conclusion, these operations are suitable for fusion model of rat which can enhance the rate of spinal fusion with bone substitute material.

Hemodynaic of cerebral arterial circle affected by stenosis in ICA: A finite element analysis

LIN Wei-shen, ZHOU Yi-qiang, HUANG Xue-cheng, LI Yi-kai

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 672-676. doi:10.13418/j.issn.1001-165x.2016.06.015

Abstract ( 445 )

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Objective　The cerebral arterial circle is usually associated with the internal carotid artery (ICA) stenosis. The finite element method was used to analyze the influence of stenosis on the hemodynamics in the circle and find out the compensatory mechanism of communicating arteries.　Methods A fluid-solid coupling 3D finite element model was created using MIMICS10.0 and ANSYS14.5. The healthy and the diseased (ratios of stenosis include 15%, 30%, 45%, 60%, 70%, 80%, and 90%) situations were simulated. Blood flow was then monitored at the communicating arteries (ACoA,PCoA).　Results　A fluid-solid coupling 3D finite element model including blood and vessels was created for the first time. Blood flow in ACoA and the right PCoA increased according to the increase of stenosis ratio, but decreased when the stenosis ratio was up to 90%. Blood flow in the left PCoA increased slightly through the whole course. Conclusion　The ACoA and PCoA of affected side open gradually to compensate the loss of blood according to the increasing of stenosis ration, and decompensate when the rate was up to 90%. Stenosis in the internal carotid was proved mechanical associate with intracranial ischemic disease.

A comparative study of a MRI scoring system with traditional outcome evaluation after anterior cruciate ligament reconstruction

WU Bing, LU Wei, WANG Da-ping, LIU Hai-feng, ZHU Wei-min, OU Yang-kan, LIDing-fu, LI Sheng

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 677-684. doi:10.13418/j.issn.1001-165x.2016.06.016

Abstract ( 773 )

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Objective　To investigate an appropriate method of magnetic resonance imaging (MRI)scoring system to assess anterior cruciate ligament (ACL ) graft health at different time after ACL reconstruction, and to determineif the MRI scoring results correlate with commonlyused clinicalknee joint function outcome evaluation results.　Methods　Based on a subset of 54 participants enrolled in an ongoing single bundle ACL reconstruction clinical trial, AP knee laxity, IKDC and a MRI scoring system based on graft volume,signal intensity (SI) and graft tension were assessed during the follow-up, and then correlation of MRI scoring results and traditional clinical knee joint function results were determined using the linear correlation and linear regression statistical methods in SPSS software.　Results　All the 54 patients were followed up with a mean follow-up period of 18.3±4.3 months. The average score of AP knee laxity, IKDC and MRI assessment were 85.12±9.45, 83.07±12.63, 75.19±7.20 respectively. MRI scoring results and clinical knee joint function scoring had positively linear correlation, and the correlation coefficient was statistically significant (r=0.696, P=0.001; r=0.767,P=0.000). The regression equationfitted according to the MRI score (X) and clinical knee joint function of subjective and objective score was statistically significant (P<0.01). MRI scoring can predict traditional clinical knee joint function of subjective and objective results.　Conclusions　Just as subjective and objective scoring of traditional clinical knee joint function , the MRI scoring system can also be used to assess outcomes of ACL reconstruction,thus supplementing and improving current clinical evaluation methods for ACL graft health and laying a foundation for a more scientific postoperative evaluation system of ACL graft healing process.

Clinical study of the femur footprint center positioning in the ACL single-bundle anatomical reconstruction

XU Cong, WANG Yong-wei，LI Jia, CAO Xiang-yu，LIU Wen-tao, DU Yuan-liang, DAI Hai-feng, LIU Qing-chen, LV Yong-ming

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 685-688. doi:10.13418/j.issn.1001-165x.2016.06.017

Abstract ( 457 )

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Objective　To explore the effective femur tunnel positioning method and primary clinical results in arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction after the acute anterior cruciate ligament (ACL) rupture.　Methods　All patients with ACL rupture were evaluated after arthroscopic single-bundle ACL reconstruction by means of the autogenous semitendinosus and gracilis tendons and footprint center positioning method in the femur tunnel. The accuracy of the above-mentioned techniques was intra-operatively evaluated through observing the bone marks of lateral femoral epicondyle， and the drawer test，Lachman test, Pivot-shift test, the Lysholm, Tegner and international knee documentation committee (IKDC) scores were used to estimate knee joint function and stability before and after ACL reconstruction.　Results　(1)the lateral femoral epicondyle was found in all the patients during ACL reconstruction, but the resident ridge was found in only 48 patients. (2)after 3 and 24 months of ACL reconstruction, the negative rate was 79%, 77% for the drawer test, 80%, 71% for the Lachman test and 97%, 95% for the pivot shift test.(3) there were significant differences in Lysholm,Tegner,IKDC scores compared with that prior to ACL reconstruction (P<0.01).　Conclusion　The femur footprint center positioning method in the ACL single-bundle reconstruction provides enough knee joint stability and satisfactory clinical results, but the remnant preservation of ligament in the femur footprint is essential and importantly depended on. While the lateral femoral epicondyle can be easily found, that is not the case for the resident ridge.

Repairing foot and ankle wounds by antegrade or retrograde posterior tibial artery perforator flap

LU Zhi-ping, JU Ji-hui, JIANG Guo-dong, CHEN Jian-sheng

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 689-692. doi:10.13418/j.issn.1001-165x.2016.06.018

Abstract ( 1093 )

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Objective　To investigate the clinical effects of repairing foot and ankle wounds by the antegrade or retrograde posterior tibial artery perforator flap. Methods 13 cases with skin defects of foot and ankle were repaired using the antegrade or retrograde the posterior tibial artery perforator flap. 5 wounds were located in the dorsal aspect of the foot, 3 wounds located in the heel , and 5 wounds e located in the medial aspect. 4 defects with exposed bone or tendon underwent emergency operation of the posterior tibial artery perforator flap, 5 cases with no deep tissues exposure underwent emergent vacuum sealing drainage and a second stage flap surgery, and the other 4 cases with skin necrosis received a perforator flap coverage in second stage. The defects ranged from 1.5 cm×2.0 cm to 7.0 cm×14.0 cm. Antegrade or retrograde perforator flaps of posterior tibial artery with a size ranging from 2.5 cm×3.5 cm to 8.0 cm×15.0 cm were used to repair foot and ankle wounds. Results All flaps and skin grafts survived. The patients were followed up for 6 months to 18 months, with an average of 12months.The flap texture was similar to the normal skin with no significant bulky appearance. Scar was small at the direct suture skin donor sites and skin graft donor sites had no obvious scar. Good ankle flexion and extension, normal gait after operation were achieved. Conclusion the antegrade or retrograde posterior tibial artery perforator flap is a good method for repairing the foot and ankle wounds.

Clinical application of descending genicular artery perforator flap for wounds on extremities

ZHOU Guang-liang, JU Ji-hui, JIANG Guo-dong, ZHANG Yu-jun, LI Lei, HOU Rui-xing

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 693-696. doi:10.13418/j.issn.1001-165x.2016.06.019

Abstract ( 701 )

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Objective　To investigate the efficacy of the descending genicular artery perforator flap for resurfacing limb wounds.　Method　According to the course of the descending genicular artery, branches and anastomosis, the descending artery perforator flap was planned and harvested in a pedicled pattern for reconstruction of defects in the medial aspect of the upper 1/3 of the leg and the knee in 5 cases, and in a free pattern for reconstruction of defects over the hand in 4 cases.　Results　In the total 9 cases of clinical application, all flap survived uneventfully, and the wound healed by first intension. After follow-up of 1 to 24 months, the flaps were excellent in texture, and similar in color to the normal skin, and satisfactory in the appearance, and not impairing the normal function of the limbs. Conclusion The descending genicular artery perforator is constant in anatomical location, good in blood supply, and simple in the surgical method, and should be regarded as a feasible approach to reconstruct the limb wounds.

Preliminary clinical application of 3D printing technology on treatment of SchatzkerType II and III fractures of tibial plateau

QIU Wei-hua, KONG Xiang-xue, LI Jian-yi, LIN Li-jun, LUO Chun-qiang

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 697-699. doi:10.13418/j.issn.1001-165x.2016.06.020

Abstract ( 675 )

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Objective　To investigate the application value of 3D printing technology on articular surface reduction of Schatzkertype II and IIIfractures of the tibial plateau.　Methods　11 patients of tibial plateau fracture (Schatzkertype II and III) were recruited whose CT data were used for three-dimensional (3D) printing to guide the articular surface reductions (3D printinggroup). As a contrast, 16 patientsof tibial plateau fractures (Schatzkertype II and III) were recruited and were treated by conventional surgical methods (Traditionalgroup). The maximum step height of articular surface after reduction and operation time were recorded and compared using independent-sample T test.　Results　The average operation time in the 3D printing group was(112.3±6.8)min, which was significantly shorter than that in the traditional group (121.7±12.8 min)(t=2.223，P=0.036). The maximum step height of articular surface in the 3D printing group were (2.8±0.4)mm, which was significantly less than that in the traditional group (3.1±0.5)mm (t=2.123，P=0.044). Conclusion　The 3D printing technology could improve the articular surface reduction of tibial plateaufractures(Schatzkertype II and III) and decrease the operation time.

Clinical and neuroimaging characteristics of hypertrophic olivary degeneration

WU Lei, AN Hong-wei，SUN Xuan, JIN Di，DONG Zhao，HUANG De-hui, WU Wei-ping

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 700-705. doi:10.13418/j.issn.1001-165x.2016.06.021

Abstract ( 643 )

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Objective　Hypertrophic olivary degeneration (HOD) is a unique transsynaptic degeneration with special clinical manifestations, occurringdelayed damage after the primary damage to the dentato-rubro-olivary pathway(DROP). This paper aims to investigate the clinical and neuroimaging characteristics of HOD.　Methods　We retrospectively analyzed the clinical data of 11 patients with HOD. Results　Of the 11 patients, 10 were male and 1 female, with an average age of 53.5 years old. Primary diseases included midbrain hemorrhage (n=1), pontine hemorrhage (n=8) ，pontine infarction(n=1) and pontine gliomas (n=1). The onset of HOD symptoms，which included dizziness, nystagmus, palatal myoclonus, hypermyotonia, involuntary movement, abnormal posture, ataxia，was meanly 3.8 months later than that of the primary diseases. Enlargement and increased T2 signal intensity of the inferior olive distant from the primary damage were MRI features of HOD. When the primary lesion only affected the unilateral central tegmental tract or red nucleus, HOD was ipsilateral and symptoms occurred in the contralateral side. If the lesion involved both the central tegmental tracts or superior cerebellar pedunculus or red nuclei, HOD and symptoms were bilateral. Baclofen, clonazepam and carbamazepine could be used to alleviatethe clinical symptoms. Conclusion　We should be vigilant about the occurrence of HOD secondary to lesions involved the DROP, in which delayed symptoms could be vital clues.ataxia and involuntary movement are the most common clinical manifestation,and brain MRI is of great help for further diagnosis.

The diagnosis and antidiastole on supernumerary cusp of tooth by CBCT: a case report

CHE Chun-xiao, JIANG Ke-yu, HU Song-ling, LU Yu-ying, HE Xiang-yi

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 706-710. doi:10.13418/j.issn.1001-165x.2016.06.022

Abstract ( 1198 )

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Objective　To report a case of supernumerary cusp on the bucca of left maxillary second molar diagnosed by Cone Beam Computed Tomography(CBCT), and to analyze its genesis,diagnosis and antidiastole. The clinic application of CBCT is correspondingly discussed.　Methods　The supernumerary cusp was diagnosed by oral general examination, oral local X-rayand CBCT. The respective features of supernumerary cusp, fused teeth, geminated teeth and concresence of teeth, especially differential points between them were discussed.　Results　A case of supernumerary cusp on the bucca of the left maxillary second molar was diagnosed definitely by the combined application of oral general examination, periapical radiograph and CBCT.　Conclusion　Oral accessory examinations are important, sometimes even necessary in diagnosing oral-maxillofacial diseases such as supernumerary cusp. CBCT has many advantages, such as short scanning time, low ionizing radiation, and high resolution. Therefore, CBCT can improve accuracy of diagnosis, which is why it has been applied in various areas of dentistry.

Research progress of choke vessels’angiogenesis of perforator flaps

LI Hong, CHEN Shi-xin, TANG Mao-lin, MAO Yi-hua

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 711-712. doi:10.13418/j.issn.1001-165x.2016.06.023

Abstract ( 557 )

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The progress on study of animal model and basic research of perforator flap

WEI Jian-wei, DONG Zhong-gen

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 713-715. doi:10.13418/j.issn.1001-165x.2016.06.024

Abstract ( 648 )

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The left brachiocephalic vein drains into coronary sinusand azygos vein absent: a case report

TIAN Rong-hua, ZHANG Xu，DENG Guang-yao, LIU Xin-ping

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 716. doi:10.13418/j.issn.1001-165x.2016.06.025

Abstract ( 623 )

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Variation of the right hepatic artery from the celiac trunk: a case report

LI Wen-jin，MA Jian-jun，KANG Peng-cheng，ZHANG Min，HOU Bo-wen，SHANG Jin，LI Peng-liang，LIU Yan-ya

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 629. doi:10.13418/j.issn.1001-165x.2016.06.026

Abstract ( 581 )

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The bilateral variation of musculocutaneous nerve: a case report

CHEN Hua-you, HONG Yang, MA Ji-yuan, LIANG Wei-bing, ZOU Yue-hua, QIN Xiang-zheng

Chinese Journal Of Clinical Anatomy. 2016, 34(6): 696. doi:10.13418/j.issn.1001-165x.2016.06.027

Abstract ( 440 )

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