Table of Content

25 July 2018 Volume 36 Issue 4

  

Anatomic basis of the lateral calcaneal artery perforator skin flap

HUANG Hai-hua, WU Ze-yong, CHEN Xiu-feng, LI Xiao-fang, WANG Sui-jiang

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  361-366.  doi:10.13418/j.issn.1001-165x.2018.04.001

Abstract ( 433 )  

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Objective　To report the vascular anatomy of the integument in the Achilles tendon area, with an emphasis on the lateral calcaneal artery perforators emerging superficially along the lateral margin of the Achilles tendon.　Methods　16 cadaveric legs were dissected to investigate the perforators arising from the vertical segment of the lateral calcaneal artery(LCA) in terms of number and location relative to the tip of the lateral malleolus, and distribution.　Results　The peroneal artery (PA) ended into the anterior perforating branch and LCA at the level of (6.6±1.1) cm (range 5.5~9.4 cm) above the tip of the lateral malleolus. LCA pierced the fascia separating the deep posterior and superficial posterior compartment of the lower leg, proceeded between the Achilles tendon and peroneal tendons. It followed a curve around the lateral malleolus. Both PA and LCA, especially the LCA, gave off an average of (3.6±0.7) perforators with an average diameter of ( 0.9±0.29) mm that contributed to nourishment of the integument overlying the Achilles tendon.  Conclusions　The integument overlying the Achilles tendon derives its blood supply through the perforators of the LCA primarily and that of the PA secondarily. It provides the anatomic basis for appreciating the LCA with regard to its terminology, clinical significance, perforator flap design and hindfoot surgery.

Clinical significance of the cervical sympathetic trunk in anterior lateral cervical surgical approach

NIE Zheng, JIANG Heng, SHAN Jian-lin

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  367-370.  doi:10.13418/j.issn.1001-165x.2018.04.002

Abstract ( 610 )  

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Objective　To understand the anatomical relationship between sympathetic nerve and the cervical fascia，and provide a more reliable method for avoiding sympathetic trunk injury in the anterolateral cervical surgery.　Methods　42 specimens of Faure Marin's fixed adult cadavers were divided into two groups, with 30 in the first group and 12 in the second group. The spatial relationship between the sympathetic trunk and the superficial layer of the prevertebral fascia（Alar fascia）and the degree of connection were investigated. In the second group，relationship between the cervical sympathetic trunk and the carotid sheath was observed.　Results　In the first group, the distance between the cervical sympathetic trunk and the centrum of the vertebral body at the 7 cervical vertebra was the smallest, about 20 mm. In all the specimens, the cervical sympathetic trunk was closely adhered to the Alar fascia above the seventh cervical vertebrae, and some even could be seen as being wrapped in the superficial fascia of the cervical fascia. It was not easy to be separated from the Alar fascia. The cervical sympathetic trunk was also pulled apart together when the Alar fascia was pulled outward in the second group. In all specimens the cervical sympathetic trunk were tightly adhered to the posterior aspect of the carotid sheath.　Conclusion　The cervical sympathetic trunk is tightly adhered to the deep surface of prevertebral fascia and can be pulled away naturally with the Alar fascia. In the anterolateral cervical approach，there is no necessity to identify or separate sympathetic trunk. The cervical sympathetic trunk can be effectively protected by pulling the superficial cervical fascia merely.

The origin of superior thyroid artery and its clinical significance

CHEN Jing，LI Xiao-zhi，CHEN Zhuo-kai，GUAN Li-zhi，ZHUANG Zhuo-kai，MA Ming-jian，QIU Yu-min，WU Xiao-xin，ZHUANG Hong-jie，YE Feng，XU Da-zheng

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  371-374.  doi:10.13418/j.issn.1001-165x.2018.04.003

Abstract ( 2074 )  

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Objective　To explore the origin of superior thyroid artery and its clinical significance.  Methods　The bilateral cervical regions of 118 cadavers fixed with formalin were dissected. The origin of the superior thyroid artery and the distance from the origin to the common carotid artery bifurcation were observed and statistically analyzed.　Results　The origin of the superior thyroid artery could be divided into three types: the common carotid artery bifurcation（A）, the external carotid artery（B） and the common carotid artery（C）. The percentages of three types were 30.93%, 37.71% and 30.51% respectively. There was a significant difference in the distribution of the origin of the superior thyroid artery between the left and right sides（P<0.05）. The distance from the origin of the superior thyroid artery originating from the external carotid artery to the common carotid artery bifurcation was less than the distance from the origin of the superior thyroid artery originating from the common carotid artery to the common carotid artery bifurcation.　Conclusions    The superior thyroid artery is one of the most important arteries in head and neck surgery. Its retrospective analysis will provide anatomic basis for clinical study.

The digital study of evaluating contact areas of the 2~5 metacarpophalangeal joint

KANG Yong-qiang, RUI Yong-jun, WU Yong-wei, MA Yun-hong, YANG Tong, PAN Xiao-yun, YU Jiong, GU Jun, HUI Tao-tao, XU Peng

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  375-379.  doi:10.13418/j.issn.1001-165x.2018.04.004

Abstract ( 520 )  

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Objective　To build the 3-dimensional(3D) model and measure the effective joint contact areas of the metacarpophalangeal joint (MPJ) during flexion.　Methods　Ten healthy volunteers whose hands had no previous trauma or other pathological diseases were examined. All volunteers were male and right-handed. Three-dimensional computed tomography (CT) scanning was performed at 30° intervals during passive flexion from 0° to 90° with use of a CT scanner. The images data were obtained from CT scanning and then imported into the image processing software Mimics 17.0 to build the 3D model. the effective joint contact areas and the width of the contact region of the four fingers were measured in the model. The software SPSS 22.0 was adopted for data analysis.　Results　In the process of 2-5 MPJ flexion, the contact areas involved in joint activities from the dorsal to palm side gradually increased. From 0° to 90° flextion, The estimated MCH contact areas for the index finger was from (32.92±2.47) mm2 to (80.05±2.51) mm2; the middle finger from (35.90±2.48) mm2 to (88.63±2.04) mm2, the ring finger from (31.51±1.07) mm2 to (74.84±1.88) mm2, and the little finger from (26.19±2.12) mm2 to (57.80±0.81) mm2，respectively. 　Conclusion　In the process of 2~5 MPJ flexion, the view from the coronal plane, only about 1/2 of the articular surface belongs to the effective joint contact surface at 0 ° position, and all surfaces belong to the effective joint contact surfaces at 90° position, showing a trapezoidal increase in the contact areas.

Cardiovascular variation: a case report

WU Ming-sheng, SHAN Zeng-qiang, WANG Wen-tao, CHENG Ping

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  379.  doi:10.13418/j.issn.1001-165x.2018.04.029

Abstract ( 440 )  

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Age-related changes in the configuration of the L4 lamina and facet joints of lumbar spine

WANG Zheng, LI Lun-Chao, ZHENG Shuai

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  380-382.  doi:10.13418/j.issn.1001-165x.2018.04.005

Abstract ( 443 )  

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Objective　To explore the age-related morphologic changes of lumbar laminas and facet joints morphology.　Methods　Three hundred spinal disease-free people coming for physical examination in our hospital underwent lumbar X-Ray examination were included in our study. All  subjects were divided into 6 groups based on age (group I: 30 years of age, group II: 31~40 years, group III: 41~50 years, group IV: 51~60 years, group V: 61~70 years, and group VI: 70 years of age). We measured the distance of laminas waist (a) and inferior articular process (b) of lumbar 4. Then the Ratio of a/b was calculated.　Results　The value of a/b of group I to VI was 0.825±0.101, 0.836±0.088, 0.840±0.098, 0.858±0.084, 0.878±0.091 and 0.890±0.119 , respectively. The value of a/b in group VI was higher than other groups and statistical differences were found between group VI and other groups except group V.  Conclusion  The value of a/b gradually increases as people become older. This means value of transverse diameter of the vertebral canal becomes small and the orientation of the L4~L5 facet joints becomes more vertical with age.

The measurement and classification of lumbar laminae interval space

BIE Ye-jun, CHANG Xiao-tao, XU Yan-xiao, WU Kai, ZHANG Shi-fei

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  383-386.  doi:10.13418/j.issn.1001-165x.2018.04.006

Abstract ( 1314 )  

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Objective　To measure the height，width and area of lumbar laminae interval space，and to create a classification of the shape in lumbar laminae interval space.    Methods   156(male: 67, female: 89) X-ray pictures with anteroposterior positions were selected randomly from the database of Changping hospital (2015.02-2017.10). The height，width and area of lumbar laminae interval space were measured, then a classification of the shape of each lumbar laminae interval space was created.    Result   （1）The differences in height of each lumbar laminae interval space was not statistically significant（P＞0.05）. The differences in width of lumbar laminae interval space between L1~2 and L2~3 were not statistically significant（P＞0.05）, and the differences in other segments were statistically significant（P＜0.05）. The differences in the area between the lumbar laminae interval space of L4~5 and L5~S1 was statistically significant（P＜0.05）, and the differences in other segments was not statistically significant（P＞0.05）；（2）The differences in the height of lumbar laminae interval space(from L1~2 to L5~S1) between male and female were not statistically significant（P＞0.05）. The differences in the width of lumbar laminae interval space （from L2~3 to L5~S1）between male and female were statistically significant (P＜0.05）. The area of L2~3, L3~4 and L4~5 lumbar laminae interval space between different sex was statistically significant( P＜0.05).    Conclusion    The width of lumbar laminae interval space is significantly increased from L3~4 to L5~S1, and the area of lumbar laminae interval space in L5~S1 is larger than that in L4~5; The width of lumbar laminae interval space between L4~5 and L5~S1 in different sex is different; The shape of lumbar laminae interval space in L1~2 and L2~3 is like a oval, the shape in the L3~4 is a fan, and the shape of L4~5 and L5~S1  is similar to a butterfly.

Scapula measurement based on 3D model and scapula plate design

SHI Hui-ming, WANG Fei, HU Yuan-jun, LV Hai-xia, WANG Sheng-hai, CHEN Liang, SHEN Xue-ying

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  387-391.  doi:10.13418/j.issn.1001-165x.2018.04.007

Abstract ( 528 )  

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Objective　To provide anatomical data for the design of the F-shaped scapular plate system through measurement of  the scapula.　Methods　The CT data of 50 normal adult scapulae from 25 males and females, respectively, were imported into the computer and 3D model was established to measure and analyze the scapular fracture of the main fixed area.　Results　Scapula neck CD=（10.35±0.95）mm, lateral DE=（72.99±6.53）mm and EF=（52.14±6.73）mm, scapular body HJ=（36.42±2.23）mm and HK=（41.00±2.57）mm. Neck-lateral ∠CDE=（127.89±6.02）°, Lateral twist angle∠DEF1（167.20±3.67）° and ∠DEF2=（172.46±4.76）°. The thickness of the points: C=（15.65±1.99）mm, D=（17.53±2.83）mm, G=（10.21±1.83）mm, H=（9.74±1.99）mm, I=（9.62±1.65）mm, J1=（10.21±1.35）mm, J2=（9.12±1.36）mm, K1=（7.22±1.99）mm, K2=（8.58±2.22）mm. There  were differences between the male and female group in terms of CD, DE, EF, ∠DEF2, point D, G, H, I, J1, J2 (P<0.05).　Conclusion　According to the obtained data and taking into consideration the anatomical and surgical characteristics, a reasonable and practical F-shaped scapular locking plate system can be designed.

Prepare decellularized adipose tissue by freeze-thaw cycle and mechanical homogenization

PENG Zhang-song, HE Yun-fan, LU Feng

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  392-396.  doi:10.13418/j.issn.1001-165x.2018.04.008

Abstract ( 583 )  

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Objective　Decellularized adipose tissue (DAT) was prepared by physical homogenization to improve its ability of spontaneous lipid induction.　Methods　In this study, we used homogenization method to remove lipid from adipose tissue, a novel DAT (DAT-1) was fabricated after subsequent decellularization process. Ordinary DAT served as control.　Results　The results revealed that DAT-1 achieved the same decellularization efficiency, but exhibited better retention of ECM components (laminin and collagen Ⅳ) and in vivo recellularization, compared to those with ordinary DAT.　Conclusions 　Mechanical homogenization is a rapid and efficient method to remove lipid from adipose tissue, which could avoid the use of harsh chemical agent and lead to the better retention of ECM components, promoting the in vivo adipose tissue regeneration of DAT.

Preparation and identification of liver specific DEK knockout mice

WANG Chao-xuan1, HOU Yu2, CHEN Zhe2, SUN Hang1

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  397-401.  doi:10.13418/j.issn.1001-165x.2018.04.009

Abstract ( 1565 )  

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Objective　To establish a stable liver-specific DEK knockout mice and provide the important animal model for further studying the biological function of DEK gene in the liver.  Methods  Mating and identification of DEKflox/flox mice with Alb-Cre mice were carried out, and the DEKflox/+/Alb-Cre mice were screened. Mating and identification of DEKflox/+/Alb-Cre mice with DEKflox/flox mice was carried out,  and the DEKflox/flox/Alb-Cre mice were screened. Mating and identification of DEKflox/flox/Alb-Cre mice with DEKflox/flox mice were carried out, and screening the DEKflox/flox/Alb-Cre mice was performed. The DEKflox/flox/Alb-Cre mouse was a liver-specific DEK knockout mouse and the DEKflox/flox mouse was a control mouse. The mouse genotypes were identified by PCR. We used Real-Time PCR and Western Blotting to detect the expression of DEK mRNA and protein levels in mouse liver. We used Immunofluorescence to detect DEK gene expression in mouse liver. The hepatic tissue morphology of the mouse liver was observed using hematoxylin-eosin staining.    Results    PCR results indicate that mouse genotypes are consistent with DEKflox/flox/Alb-Cre. Compared with DEKflox/flox mice, DEK mRNA and protein levels were significantly reduced, and liver tissue morphology showed no significant difference.  Conclusion　In this study, the liver-specific DEK knockout mice are successfully constructed using the Cre/Loxp technology, providing an important animal model for further study of the role of DEK genes.

Effect of VIP on the expression of TREM-2 in mouse fibroblasts with LPS stress and its mechanism

LI Shu-fen, SONG Zhuo-hui, YANG Hui-hui, LIU Yong-ping, XIONG Jian-bing, GUAN Cha-xiang, SUN Guo-ying

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  402-407.  doi:10.13418/j.issn.1001-165x.2018.04.010

Abstract ( 489 )  

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Objective　To observe the effect of VIP(vasoactive intestinal peptide) on TREM-2 expression in mouse fibroblasts induced by LPS(lipopolysaccharides) and to explore its possible signaling pathway.   Methods　ALI animal model was established by intraperitoneal injection of LPS, and VIP lentivirus tracheal infusion was used, and the expression of TREM-2 in lung tissue was detected by qPCR. qPCR and flow cytometry were used to detect the effect of VIP on TREM-2 expression in LPS-induced fibroblasts, and to observe the effects of PKC signal pathway blocker (H-7), PKA signal pathway blocker (H-89), MAPK signal pathway blocker (PD98059) and CaM signal pathway blocker (W-7) on the regulation of VIP expression TREM-2.　Results　The TREM-2 mRNA expression of lung tissue in mice decreased in ALI, while VIP could increase TREM-2 mRNA expression in lung tissue. LPS down-regulated the expression of TREM-2 mRNA in mice fibroblast, and VIP up-regulated the expression of TREM-2 mRNA in a time-dependent manner (0 h, 3 h, 6 h, 12 h, 24 h), and reached the peak at 6 h. VIP dose related with the TREM-2 mRNA expression (10-10 mol/L, 10-9 mol/L, 10-8 mol/L, 10-7 mol/L). The up-regulation effect of VIP on TREM-2 mRNA and protein expression in mouse fibroblasts (stress by LPS for 6 h) could be blocked by H-7, PD98059, and W-7. 　Conclusion　LPS can down-regulate the TREM-2 expression of mouse fibroblasts, while VIP can up-regulate the expression of TREM-2 in LPS induced fibroblasts, and the intracellular signal transduction pathway may be related to PKC, MAPK and CaM.

miR-217 inhibits proliferation, migration, and invasion of esophageal squamous cell carcinoma cells by regulating lncRNA MALAT1

XU Jian, JIANG Yue-quan, CAI Hua-rong, YIN Zhe, ZHANG Qi

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  408-413.  doi:10.13418/j.issn.1001-165x.2018.04.011

Abstract ( 571 )  

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Objective　To investigate the inhibitory effect of miR-217 on proliferation, migration and invasion of esophageal squamous cell carcinoma cells by regulating lncRNA MALAT1.　Methods　qPCR was used to detect the expression of miR-217 in esophageal squamous cell carcinoma and different cell lines. Dual luciferase reporter assay detected the interaction between miR-217 and MALAT1. MTT assay was used to detect the proliferation of esophageal squamous cell carcinoma cells after miR-217 was inhibited. Scratch healing assay and Transwell invasion assay were used to detect the migration and invasion of esophageal squamous carcinoma cells after miR-217 was inhibited. The effect of miR-217 on the expression of MALAT1 downstream protein was detected by Western blotting.　Results　Compared with normal esophageal tissue, the expression of miR-217 in esophageal squamous cell carcinoma was relatively up-regulated, and the expression of miR-217 was the highest in Ec109 cells compared with other cell lines. Dual luciferase assay confirmed that miR-217 could specifically bind to 3'UTR of MALAT1 and regulate the expression and activity of MALAT1. Inhibition of miR-217 expression could inhibit esophageal squamous cell carcinoma cell proliferation, migration and invasion ability. Down-regulation of miR-217 after MALAT1 MIA2, ROBO1 expression was significantly down-regulated.　Conclusion　miR-217 can regulate the expression of MALAT1 and affect the biological behavior of esophageal squamous cell carcinoma cells.

Expression changes of mitochondrial protein with age in mouse forebrain development

LV Jing, DENG Li, GUAN Wei-kang, ZHU Yan, GUO Kan, GAO Xiao-qing, YANG Chao-xian

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  414-418.  doi:10.13418/j.issn.1001-165x.2018.04.012

Abstract ( 333 )  

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Objective    To investigate the changes of mitochondrial protein expression in different stages of mouse forebrain development.    Methods    The forebrain tissues of fetal mice with 12.5 and 17.5 days pregnancy (E12.5, E17.5), 2-day-old neonatal mice , 3-week-old young mice and 2-month-old mice were collected to detect the expression levels of COX IV, HSP60, OGDH, PDHE1α mRNA and protein in different development stages by QRT-PCR and Western blotting.    Results    The mRNA level of COX IV was low in forebrain tissue from E12.5 to 2 days, and it increased significantly and reached the peak at 3 weeks. The mRNA levels of HSP60 and PDHE1α were significantly increased at E17.5, and the OGDH mRNA level had an obvious rise at 2 days, and all three reached the peak at 2 months. The proteins of COX IV, HSP60 and OGDH showed no significant difference from E12.5 to 3 weeks, but increased evidently at 2 months; and the protein of PDHE1α increased significantly with forebrain development and peaked at 2 months. In addition, there was a positive correlation between mRNA and protein expression levels of COX IV, HSP60, OGDH, PDHE1α.    Conclusion   COX IV, HSP60, OGDH and PDHE1α may be involved in mouse forebrain development and be closely related to age.

The regulation of hypoxic induced factor on autophagy of myocardial cells in oxygen-glucose deprivation model

SONG Hai-yan, LIAN Hui, ZHANG Yi-min, FU Sheng-qi

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  419-422.  doi:10.13418/j.issn.1001-165x.2018.04.013

Abstract ( 541 )  

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Objective　To investigate the effect of HIF-1α on autophage-associated genes Beclin1, LC3I and LC3II, and the regulation on autophagy.   Methods　The model of oxygen-glucose deprivation (OGD) was established, and western blot was used to detect interference effect of HIF-1α siRNA. The CCK-8 assay was used to detect the effect of HIF-1α siRNA on the activity of myocardial cells in OGD model. The effect of HIF-1α siRNA on autophagy-associated genes Beclin1, LC3I and LC3II expression was detected by RT-qPCR and western blot.    Results   The results of western blot showed that HIF-1α siRNA could effectively knock down the expression of HIF-1α in myocardial cells in OGD model. The result of CCK-8 assay showed that HIF-1α siRNA could reduce the activity of myocardial cells in OGD model. RT-qPCR and western blot results showed that HIF-1α siRNA could reduce the expression of the autophagy-associated genes Beclin1, LC3I and LC3II, and reduce the ratio of LC3II to LC3I at mRNA and protein level.  Conclusion    HIF-1α siRNA could knock down the expression of HIF-1α in the OGD model, resulting in further decrease of the activity of myocardial cells，with the Beclin1 expression and ratio of LC3II/LC3I reduced. HIF-1α plays a role of myocardial protection in the OGD model by regulation of autophagy.

Architecture of periodontal capillary casting in Wistar rat periodontitis model

LAI Qiu-hua, ZHANG Jie-xin, ZHOU Xiao-han, WANG Ya-jie, LI Ye, LIU Yang, BI Zhen-yu, OUYANG Jun

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  423-425.  doi:10.13418/j.issn.1001-165x.2018.04.014

Abstract ( 622 )  

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Objective　To build the periodontal capillaries casting of Wistar rats by perfusion of their capillaries with microgranular materials, which provided a morphological method for study the microcirculation of periodontitis.　Methods　8-week-old Wistar rats were used to establish the animal model of periodontitis. Micropump was implanted from the inlet of the left ventricle of the aorta, and the liquid of the microgranular material was perfused to rely on the pressure of the pump. The swelling and redness of the skin indicated the success of perfusion. After the filling material was fully polymerized in the specimen for 24 hours, the soft tissue was removed by corrosion. The capillary cast specimens of periodontitis were  observed with the S-3000N scanning electron microscope (SEM).    Results  Under scanning electron microscope from 30, 2000, until 4500 times, the casting of the periodontal capillary, the three-dimensional space morphology and distribution of the capillaries of structures such as the gingival margin, gingival crevicular, gingival papillae  could be clearly viewed in the casting of the periodontal capillary.  Conclusion  The capillary cast can provide the morphological methods for periodontitis microcirculation research, and can be coordinated with the molecular biologic research of periodontitis, revealing various pathological changes of periodontitis from different aspects.

Clinical application of the descending genicular artery as the recipient artery for free anterolateral thigh flap

LIU Jun, LI Feng-feng, WU Yong-wei, MA Yun-hong, ZHOU Ming, YIN Fei, KANG Yong-qiang, WANG Ya-peng, HUI Tao-tao, RUI Yong-jun

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  426-429.  doi:10.13418/j.issn.1001-165x.2018.04.015

Abstract ( 613 )  

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Objective 　To investigate the clinical feasibility of using the descending genicular artery as the recipient artery when the anterior or posterior tibial artery cannot be used to repair the wound around the knee joint by the free anterolateral thigh flap.    Method    From January 2015 to May 2017, the application of the descending artery and great saphenous vein as the recipient vessels for the anterolateral thigh flaps for resurfacing of large-sized skin and soft-tissue defects complicated with bone and tendon exposure around the knee in 7 cases. among the 7 cases, 4 were the male, and 3 female . The flap size ranged from 18 cm × 8 cm to 38 cm × 8 cm.    Results    All patients were followed up for 6~14 months, with an average of 8.9 months. Two largest flaps had necrosis at about 6 cm and 4 cm proximal to the distal margin of the flap, respectively. After the resection, the residual wound were healed with secondly skin grafting. Conclusion    Preoperative accurate positioning through color Doppler ultrasound and measurement of the diameter of the descending genicular artery, blood flow, the use of intraoperative microsurgical techniques to expand the diameter of the descending genicular artery, the descending genicular artery can be used as the recipient artery for the free anterolateral thigh  flap intended for resurfacing of soft-tissue defecst around the knee, and satisfactory clinical efficacy can be achieved.

The clinical application of prefabricated-decompression arterialized vein flap

LI Zheng, ZHANG Zhen-wei, YU Shao-xiao, KE Yu-hai, XIONG Yi, LIN Hui-xin, CHEN Wen-feng

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  430-432.  doi:10.13418/j.issn.1001-165x.2018.04.016

Abstract ( 404 )  

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Objective　To investigate clinical effects of prefabricated-decompression arterialized vein flap.   Methods　From January 2016 to May 2017, 24 cases of soft tissue defects of fingers and thumbs were repaired with the prefabricated-decompression arterialized vein flap. The flaps ranged from 2.0cm×2.0 cm to 6.0 cm × 4.0 cm. The perfusion volume of the flaps was measured by the laser flash spot doppler blood flow imaging instrument.   Results   24 flaps survived completely, only 1 flap suffered partial margin blister and ecchymoma. No blister and swelling were found in the other 23 flaps. Patients were followed up for 3 to 24 months. The appearance of flaps was satisfactory and the texture was soft and good.   Conclusion　There is a significant effect by using the prefabricated-decompression arterialized vein flaps, which has a reduced lead through a better balance of perfusion and drainage.  With prefabricated-decompression adjustment, the survival rate and quality of the flaps can improved significantly.

 Clinical application of medial plantar artery flap carrying sensory nerve in repairing soft tissue defect of heel

XIAO Rong， WANG Jian-hua， WU Yu-qiang

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  433-435.  doi:10.13418/j.issn.1001-165x.2018.04.017

Abstract ( 401 )  

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Objective　To investigate the clinical efficacy  of medial plantar artery flap carrying sensory nerve in repairing soft tissue defects in heel area.　Methods　From June 2016 to November 2017, 12 patients with calcaneal nodule defect (less than 1 cm in length) were treated in our hospital. The medial plantar artery flap carrying sensory nerve was used to repair the wound. The wound area ranged  from 3 cm × 4 cm to 10 cm × 6 cm. The flap size ranged from 3.5 cm × 4.5 cm to 11 cm × 7 cm. The clinical efficacy was evaluated by observing the appearance, blood flow, elasticity and two-point discrimination of the flap. 　Results　All  flaps survived completely. 10 cases were followed up for 6~14 months. The flaps were satisfactory in appearance without bulkiness, soft in texture, good in elasticity. The two-point discrimination was 5 mm to 9 mm. 8 patients with no bone defect wore shoes, 2 patients with bone defect and without walking limitation needed to wear heeled shoes with soft soles  and walk half an hour to feel local tingling pain.  Conclusions  The medial plantar artery flap with the sensory nerve can better reconstruct the appearance, sensation and function of the heel. It is an effective way to repair the soft tissue defect of the heel.

Surgical treatment of subdural tumors, repair of dura mater, and the treatment of postoperative cerebrospinal fluid leakage

HUANG Xue-liang, ZHU Shuang-fang, LIN Yu-cong, ZHOU Chu-song

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  436-439.  doi:10.13418/j.issn.1001-165x.2018.04.018

Abstract ( 602 )  

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Objective　To analyze the relationship between the repair method of  dura mater after and cerebrospinal fluid leakage(CSFL).   Methods    From Jan. 2010 to Dec. 2016, 200 patients with subdural tumors were treated by posterior surgery, including 89 males and 111 females, with an average age of 46.2 years (4 months -82 years). Radiological images of fractures, internal fixation, repair method of dura mater, occurrence of CSFL and its treatment were recorded and analyzed after follow-up.    Results   CSFL was found in 26 of the 200 patients after operation. 85 cases were treated with internal fixation, of which 22 cases had CSFL (25.9%). 115 cases did not place internal fixation, of which 4 cases had CSFL (3.5%). There were 30 cases of simple suture of dura, of which 8 cases had CSFL (26.7%). 136 cases had spinal membrane sutured and covered, of which 16 cases had CSFL (11.8%); 29 cases had spinal membrane sutured and covered with protein glue, of which 2 cases had CSFL (6.9%). 5 cases were repaired by myofascial or fat because of dural defects, and did not show CSFL. The incidence of CSFL in patients with  coverage of the spinal membrane or (and) biological protein gum, myofascia or fat after suture of the dura was statistically significant (P<0.05). In 10 patients with leakage of cerebrospinal fluid that underwent extended drainage time, there was no incision complications, and the average time for stitch removal was 11.8±1.7 days; and 2 cases in 16 patientswith early removal of drainage tube developed intracranial infection, 1 cases sinus tract, 1 cases dural pseudocyst formation, the average time for stitch removal was 18.5±8.5 days, and the difference were statistically significant (P<0.05). Conclusion    Placement of internal fixation in the surgery of subdural tumor can increase the incidence of CSFL. Spinal dura mater, fibrin glue, myofascial or fat repair dura can reduce CSFL. The proper extension of the drainage time after the CSFL after operation can promote the healing of the incision and reduce the incidence of related complications.

Reconstruction plate-screws parallel to the cartilage surface of the posterior wall fractures of the acetabulum using computed tomography images

WU Hao-jun, HE Yan-xia, CHEN Hang, LIU Yan-zhi，ZHENG Yue-yu，CHEN Guang-hua

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  440-444.  doi:10.13418/j.issn.1001-165x.2018.04.019

Abstract ( 498 )  

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To study the safe angle and length for screw placement in the posterior wall to avoid intraarticular screw penetration and to provide a theoretical reference for clinical treatment of acetabular fracture.　Methods　A chart review of posterior wall acetabular fractures treated from 2008 to 2016 yielded the study group that met the inclusion criteria. The study group included 15 consecutive patients who had open reduction of posterior wall fracture and internal fixation with plate and screws. Operative and non-operation notes were reviewed and axial view computed tomography scans were analyzed to determine the modified safe angle and length for screw placement in the posterior wall.　Results    All of the above mentioned angles were with respect to the perpendicular of the longitudinal axis of the anterior column without violation of the hip joint away from the acetabular rim，the average width of dangerous zones in the posterior acetabuluar wall was (9.56±1.74)mm in  the operative side and (9.57±1.71) mm in the uninjured side; the average width of safe zones in the posterior acetabuluar wall was (31.67±2.61)mm in the operative side and (31.36±2.75) mm in the uninjured side；the average parallel angle to the cartilage surface of the posterior wall  was (62.33±3.46)° in the operative side and (63.05±3.89)° in the uninjured side, the average length of the screw was （31.67±2.61）mm in the operative side and（31.36±2.75）mm in the uninjured side. There was no statistical difference of data between the posterior wall of acetabulum in the two sides (P>0.05).　Conclusion　1/4 region of the posterior acetabuluar wall close to the acetabular rim is the dangerous zone for screw placement, 3/4 region away from the margin of acetabulum is the safe zone.  The screw angle is 60 degrees to be parallel to the quadrilateral plate, and the length of the screw is 30 mm.

Implantation of self-made claw-shaped press plate and hollow screw for the repair of the split fracture of greater tuberosity of humerus: a prospective, randomized, and controlled study

YIN Fei, LIU Jun, YIN Qu-dong, WU Yong-wei, LU Yao, MA Yun-hong, LI Fen-feng, RUI Yong-jun

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  445-448.  doi:10.13418/j.issn.1001-165x.2018.04.020

Abstract ( 452 )  

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 Objective    To compare the recovery of shoulder function after conventional self-made claw-shaped press plate and hollow-screw fixation for repair of the split fracture of greater tuberosity of humerus.　Mehtods　A prospective randomized controlled study was performed in 32 patients with split fracture of greater tuberosity of humerus who were assigned into 2 groups from January 2014 to January 2016. Group A (n=16) received treatment using self-made claw-shaped press plate and group B(n=16) received treatment using hollow-screw fixation. The fracture healing time ,VAS scores, the United States Scores of Shoulder, Elbow Surgeons and Constant and Murley Scoring Systems were utilized to assess the therapeutic outcomes.  Results　The mean follow-up period was 21.2 months. Group A (n=16) was better than group B (n=16) in the United States Scores of Shoulder and Elbow Surgeons and Constant and Murley Scoring Systems(P<0.05). There was no significant differences in the VAS scores and fracture healing time (P>0.05).  Conclusion    The study suggests that self-made claw-shaped press plate in the repair of split fracture of greater tuberosite of humerus is an ideal fixation method with allowance for the early functional exercise.

Early research of the platelet-rich plasma (PRP) combined with the bone grafting through a femoral neck window at high location for the treatment of the osteonecrosis of the femoral head

JIANG Liang-bin, XIAO Bo-lian，LIU Song, WEI Biao-fang

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  449-452.  doi:10.13418/j.issn.1001-165x.2018.04.021

Abstract ( 528 )  

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Objective　To investigate the potency of the platelet-rich plasma（PRP）combined with the bone grafting through a femoral neck window at high location for the treatment of the osteonecrosis of the femoral head.　Methods　From July 2015 to July 2017, 18 cases（27 hips）of osteonecrosis of the femoral head were treated with platelet-rich plasma combined with core decompression and ilium support（PRP group）and 16 cases（24 hips）with core decompression and ilium support only（control group）. At 1, 3，and 6 months after operation, patients were followed up for Harris hip score，VAS score and radiographic measures.　Results　All the patients were followed up thoroughly and the follow-up periods were 6 months. At 6 months after operation, the shape of the femoral heads in the PRP groups was good, showing no deformation and collapse. The ilium made integration with the surrounding bone without infection. Harris score of PRP group before and after treatment increased from（67.85±9.72）points to（88.51±6.13）points. Harris score of control group before and after treatment increased from（69.85±8.15）points to（78.42±6.28）points. VAS score of PRP group before and after treatment increased from（4.5±1.3）points to（1.6±1.1）points. VAS score of control group before and after treatment increased from（4.2±0.8）points to（2.4±0.9） points. There were statistically significant differences between two groups. There were statistically significant differences in the pre-therapy and post-treatment (P<0.05). There were statistically significant differences in the post-operation between two groups (P<0.05).　Conclusions　Use the platelet-rich plasma（PRP）in clinical can relieve hip pain and improve joint function, and is thus highly valuable in clinical use．

Application of fibreoptic bronchoscope-assisted nasogastric tube positioning in COPD patients with mechanical ventilation

ZHANG Da-cheng，SHAO Jin-lian，CUI Hai-yan

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  453-456.  doi:10.13418/j.issn.1001-165x.2018.04.022

Abstract ( 640 )  

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Objective　To investigate the clinical effect of fiberoptic bronchoscope（FOB）-assisted nasogastric tube positioning in chronic obstructive pulmonary disease（COPD）patients with mechanical ventilation.    Methods    40 mechanically ventilated COPD patients, enrolled from March 2014 to October 2016, were randomly divided into 20 patients（test group）with FOB-assisted nasogastric tube positioning and 20 patients（control group）with routine indwelling nasogastric tube.    Results    The indexes, including the first-attempt success cases, the first-attempt success rates, intubation time, number of complications, were significantly better in the test group as compared with the control group， which was opposite case for expenses (19 vs 9, 95.0 vs 47.3, (8.37±1.34) vs (17.9±3.80), 4 vs 12, (262±0) vs (12±0), P<0.05). There were no statistical differences in heart rate, systolic blood pressure, diastolic blood pressure, pulse oxygen saturation, arterial PaO2 and arterial PaCO2 between before and after indwelling nasogastric tube in the test group ((87.7±13.5) vs (89.9±13.8), (114.35±10.6) vs (115.1±9.2), (67.4±14.0) vs (68.7±9.9), (96.9±2.3) vs（97.2±2.2), (88.5±2.2) vs（82.0±19.2), (45.9±18.0) vs (38.4±2.6), P>0.05).   Conclusion    If the routine method is difficult in COPD patients with mechanical ventilation, it should be replaced by FOB-assisted operation because it is simple , quick, safe and reliable. Furthermore, slight injury can be incurred and high success rate can be achieved.

Impact of qualified arc angle isokinetic training on the function of knee osteoarthritis

LIANG Gui-ying, ZHANG Ming-sheng, ZHANG Lei, LI Xin-ping, YE Yun-yi

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  457-460.  doi:10.13418/j.issn.1001-165x.2018.04.023

Abstract ( 449 )  

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Objective　To evaluate the effect of qualified arc angle isokinetic training on the function of Knee osteoarthritis. 　Methods　78 participants with right knee osteoarthritis were divided randomly into group A, group B, and group C. There were 26 cases in each group. Aside from regular exercise therapy, patients in all groups also accepted isokinetic training. Patients in group A accepted isokinetic exercise knee of extension training with 90 ° to 10 °; Patients in group B accepted knee extension isokinetic exercise training with 60 ° to 10 °; patients in group C accepted knee extension isokinetic exercise training with 30 ° to 10 °.  All groups were trained 3 times per week, and the training lasted for 8 weeks in total. American hospital for special surgery index（HSS）, maximum peak torque (PT), visual analogue scale method (VAS), and joint motion detection threshold (JMDT) were assessed before and after the treatments in 3 groups.    Results    There was significant difference in the PT, HSS, and VAS compared to the prior treatment (P<0.05), Group A improved significantly than Group B and Group C. JMDT turned better than before but there was no significant difference (P>0.05).　Conclusion　Different qualified arc angle isokinetic training can make an improvement on knee function. Larger arc angle isokinetic training can help knee function evidently.

A loop left testicular artery: 1 case report

LI Zhen-qian，MA Jian-jun，DUAN Ke-feng，YING Yan-min，ZHENG Wen-jing，TAN Yi-heng，JIN Wei-qiang，JING Shi-xiang

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  460.  doi:10.13418/j.issn.1001-165x.2018.04.030

Abstract ( 649 )  

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Displaying the nerve distribution of SD rat skin by a further modified Sihler's intramuscular nerve staining method

SHI Quan, WEI Zai-rong, YANG Sheng-bo, JIN Wen-hu, LI Hai, WANG Da-li, WANG Bo

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  461-464.  doi:10.13418/j.issn.1001-165x.2018.04.024

Abstract ( 298 )  

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Objective　To investigate the application of the further modified Sihler's intramuscular nerve staining method in displaying the nerve distribution of SD rat skin.　Methods　After six adult SD rats were selected and sacrificed, the skin was harvested against muscle surface on the dorsal and ventral side. Finally, 6 pieces of the dorsal skin and 6 pieces of the ventral skin were obtained. After fixation in 10% formaldehyde solution for 1 month,  the skins were defatted by anhydrous ethanol for 3 days, and digested in 0.25% collagenaseⅠand Ⅲ solution for 3 days. After these steps, the skins were stained using the further modified Sihler's intramuscular nerve staining method.　Results　A total of 12 pieces of SD rat skin were stained, among which 10 pieces obtained a good staining result. In the process of removing the pigment, the epidermis often fell off and even if it did not fall off, a boundary between the epidermis and dermis could not be found on the tiled skin and the nerve branches in the epidermis could not be seen; it was difficult to remove partial subcutaneous fat completely in the anatomical process. Therefore, obvious nerve distribution in partial subcutaneous fat was visible to naked eyes. By virtue of X-Ray film viewer, it could be seen by naked eyes that the skin was light purple in color, and the nerves were black in color and had an uneven distribution with different shape and diameter. It could even be seen that the nerves were twisted and knotted.　Conclusion　Skin nerve distribution visible to naked eyes can be clearly displayed after SD rat skin is stained by the further modified Sihler 's intramuscular nerve staining method. These results have a certain significance for the determination of nerve fiber density in each region of SD rat skin and the study of nerve regeneration after skin flap transplantation in animal models. 

A study based on optimizing the quality of paraffin embedding for fine puncture tissue

LIN Qian，FANG Qing-quan

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  465-469.  doi:10.13418/j.issn.1001-165x.2018.04.025

Abstract ( 518 )  

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Objective    to optimize the method of paraffin-embedded fine puncture tissue, and improve the quality of paraffin embedding.    Methods    The conditions including embedding molds at different temperatures, adding water or not at the cold plate, different embedding angles, and different secondary wax injection angles were tried, and the embedding acceptability, embedding time, tissue structure integrity, wrinkles, knife marks, cell display effect, and reticular fiber staining effect for small puncture tissues were analyzed and compared.   Results   ① The embedding acceptability was significantly higher  using the embedding mold preheated to 66 ℃ than that at room temperature（χ2=5.26，P＜0.05）. The integrity of histological structure, cell transparency, contrast and clarity of nucleoplasm and reticular fiber integrity were all better than normal temperature group (P＜0.05). ② Both embedding acceptability and efficiency were better by adding a  small amount of water to the cold plate compared to that without water(P＜0.05).③ Setting the embedding angle (between biopsy tissue and embedding mold) to 30°~45°, slices showed better quality  than the angle set to 0° or 90° (P＜0.05). ④ The embedding acceptability in the embedding mold at a tilt of 10°~25° during secondary wax injection was significantly higher than that at untilted ones（χ2=4.82，P＜0.05）.   Conclusion    By optimizing the conditions including embedding mold temperature, embedding machine cold plate, tissue embedding angle, and secondary wax injection angle can significantly improve the embedding acceptability, embedding efficiency, ensuing slices’quality, cell display effect, and reticular fiber dyeing effect for fine puncture tissues.

The progress of orthoses treatment of adolescent idiopathic scoliosis

XU Yang-yang, SU Bao-ke, FENG Hui-mei, WANG Hai-yan， LI Xiao-he

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  470-473.  doi:10.13418/j.issn.1001-165x.2018.04.026

Abstract ( 398 )  

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Application of imaging technique in the navigation of "precision hepatectomy"

LIU Ke, BO Kai-rui, LIU Lin, ZHAO Rui, YUAN Hang, CHEN Zhong-heng

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  474-476.  doi:10.13418/j.issn.1001-165x.2018.04.027

Abstract ( 646 )  

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Research progress of application of scaffold materials on cartilage tissue engineering

ZHANG Fei, DANG Yuan, YU Ping

Chinese Journal Of Clinical Anatomy. 2018, 36(4):  477-479.  doi:10.13418/j.issn.1001-165x.2018.04.028

Abstract ( 605 )  

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