Table of Content

25 May 2019 Volume 37 Issue 3

  

Clinical applied anatomy of anterior communicating artery aneurysm treated by supraorbital lateral-longitudinal fissure approach

ZHANG Guang-hui, HAN Rui-zhang, JIN Hua, WANG Yu-hai

Chinese Journal of Clinical Anatomy. 2019, 37(3):  241-244.  doi:10.13418/j.issn.1001-165x.2019.03.001

Abstract ( 595 )  

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Objective　To study the anatomy of anterior communicating artery complex (ACoAC) by supraorbital lateral-longitudinal fissure approach under microscope, and to provide anatomic reference for clinical clipping of the anterior communicating artery aneurysm (ACoAA).　Methods　ACoAC exposed through the supraorbital lateral-longitudinal fissure approach was observed under microscope in a total of 20 adult cadavers (40 sides) , and relevant data were measured and recorded.　Results　The supraorbital lateral-longitudinal fissure approach could better expose ACoAC. In particular, the superior and posterior superior areas of the anterior communicating artery could obtain a good surgical field of vision. The length of the anterior communicating artery (AComA) was (2.80±1.12) mm. The middle outer diameter was (1.79±0.82) mm. The distance from the anterior edge of optic chiasma was (4.59±2.22) mm. 　Conclusion　The supraorbital lateral-longitudinal fissure approach has the characteristics of good visual field and small brain tissue injury, which should consider favorably in treatment of the anterior communicating artery aneurysms (ACoAA) categorized as the superior and posterior superior type.

Anatomic measurement of the spinoglenoid notch and analysis of its clinical significance

ZHAO Hong-jin, LIU Yang, LI Jing, ZHANG Lei

Chinese Journal of Clinical Anatomy. 2019, 37(3):  245-248.  doi: 10.13418/j.issn.1001-165x.2019.03.002

Abstract ( 1777 )  

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Objective　To investigate the anatomic morphology and clinical significance of the spinoglenoid notch based on dry scapular bones.　Methods　In a total of 282 scapular bones (left 134, right 148),  the following data were measured using Vernier caliper and Goniometer: the width of spinoglenoid notch (the distance from medial aspect of the glenoid to the scapular), the thickness of the spinoglenoid notch (the thickness of the nadir of the spinoglenoid notch), the depth of spinoglenoid notch, the angles of the spinoglenoid notch. 　Results　The average width and depth of the spinoglenoid notch were (12.75±1.06) mm and (11.65±1.89) mm.  There was statistical difference between the two sides of body (P<0.05). The average thickness of spinoglenoid notch was (9.93±1.57) mm. The distance from the spinoglenoid notch to the suprascapular notch was (18.73±3.18) mm (P>0.05). There was statistical difference of the angles of the spinoglenoid notch between the two sides of body (40.24±8.69) (P<0.05).　Conclusion　The width, thickness and depth of the spinoglenoid notch are all the risk factors contributing to the suprascapular nerve entrapment syndrome. The smaller the angles of the spinoglenoid notch, the greater the chance of scapular nerve compression. The data presented in this study can provide a reference for clinicians to choose the best surgical approach and the internal fixation site to reduce the risk of intraoperative nerve injury, thus minimizing intraoperative risks. 

Anatomical structure and three-dimensional reconstruction segmentation of fetal gastric artery

GUAN Wang, HUANG Hai-long

Chinese Journal of Clinical Anatomy. 2019, 37(3):  249-253.  doi: 10.13418/j.issn.1001-165x.2019.03.003

Abstract ( 410 )  

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Objective　To explore the anatomical structure of fetal gastric artery and its clinical application.　Methods　Gross specimens of fetal gastric arteries was perfused and measured. The data of CT scanning was introduced to reconstruct the three-dimensional fetal gastric artery and segment the blood vessels in Mimics 19.0 software. The results were compared with the adult gastric artery.　Results  The fetal gastric artery perfusion specimens showed clearly the distribution and anastomoses of the arteries in the fetal stomach. The biofidelity and the third dimension of three-dimensional visualized model were high and strong. The main branches of the arteries in the fetal stomach, the distribution and shape of fetal gastric arteries could be observed by model segmentation.　Conclusion　The blood supply of fetal surgery is evidently different from that of adult gastric artery, which provides anatomical basis for fetal intrauterine surgery and basic research of fetal medicine.

Effects of gut microbiota, GRP78 and TLR4 on the development of liver cirrhosis in rats

CHEN Yun-xia, ZHANG Hui-ying, YANG Ze-xi, LAI Li-na, MENG Li, LI Xu-jiong

Chinese Journal of Clinical Anatomy. 2019, 37(3):  254-260.  doi:10.13418/j.issn.1001-165x.2019.03.004

Abstract ( 665 )  

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Objective 　To study the effects of gut microbiota, glucose-regulated protein 78 (GRP78) and toll-like receptors 4 (TLR4) on the development of liver cirrhosis in rats.　Methods　Thirty-six male SD rats were randomly divided into a normal control group (N) and a hepatic cirrhosis model group (M). The liver cirrhosis was induced by compound factors. Each group was sampled at 4, 6 and 8 week time points. Injuries of liver and intestinal mucosa were assessed with H&E stain. The gut microbiota was examined with automated ribosomal intergenic-spacer analysis (ARISA) on fecal DNA, and the bacterial translocation was assessed by standard microbiological techniques on blood, mesenteric lymph nodes (MLN), ascites and liver. The levels of alanine aminotransferase (ALT), endotoxin and homocysteine (Hcy) in the plasma were detected by enzyme-linked immunosorbent assay (ELISA). The expression of GRP78 and TLR4 was analyzed using quantitative real-time PCR and Western blotting.　Results　Compared to group N, the pathologic change of liver and small intestine was obvious in group M, and the levels of ALT, endotoxin, Hcy in the plasma were significantly and gradually increased. The occurrence of bacterial translocation (BT) was increased in the liver of group M compared to that of group N. BT was not detected in the blood in any group. The expression of GRP78 was significantly and gradually increased in the tissues of liver and  ileum in group M. In liver homogenate, the expression of TLR4 in group M was significantly and gradually increased in 6 weeks, and significantly higher than group N at 8 weeks, but lower than group M at 6 weeks. In ileal homogenate, the expression of TLR4 in group M was also significantly and gradually increased in 6 weeks, but was significantly decreased than group N at 8 weeks.　Conclusion　With the progress of liver cirrhosis, the dysbiosis of gut microbiota becomes more and more serious, the expression of GRP78 increases significantly and the expression level of TLR4 decreases significantly in ileal homogenate, which may result in the gradual increase of the intestinal mucosal barrier damage, and cause significant increase of the occurrence of BT and level of endotoxin, eventually affecting the expression of GRP78 and TLR4 in liver, and worsening liver injury then.

Effect of genistein on the number and function of HUVECs in preeclampsia patients and its mechanisms

LIU Li-xing , MIN Xian-hui , ZHANG Min, HOU Sai-rong

Chinese Journal of Clinical Anatomy. 2019, 37(3):  261-266.  doi: 10.13418/j.issn.1001-165x.2019.03.005

Abstract ( 350 )  

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Objective　To study the effect of genistein on endothelial cell damage in preeclampsia.  Methods　Human umbilical vein cells (HUVECs) were isolated from 20 normal pregnant women (control group) and 40 preeclampsia patients. Half of cells from the preeclampsia patients were treated with genistein (PE+Gen group) and the other half were untreated (PE group). HUVEC barrier function and proliferation were investigated using bovine serum albumin and MTT assays, respectively. Markers for oxidative stress and apoptosis were also assessed. 　Results　Compared to the PE group, HUVEC barrier function, proliferation, glutathione peroxidase activity, and Bcl-2 gene and protein expression were significantly increased in the genistein treatment group (PE+Gen), whereas 8-hydroxy-2’-deoxyguanosine levels and Bax gene and protein expression were significantly decreased (P<0.01). There was no significant difference between PE+Gen and control groups.　Conclusion　Genistein reduces endothelial cell damage possibly through antioxidant and anti-apoptotic mechanisms, and it may be useful in preeclampsia prevention and treatment.

Promotion of osteoporosis by high-salt dietary through activation of osteoclasts in mice

YANG Yang, WU Wen-bin, LIU Bin, ZHANG Liang-ming, LUO Chun-xiao, RONG Li-min

Chinese Journal of Clinical Anatomy. 2019, 37(3):  267-272.  doi:10.13418/j.issn.1001-165x.2019.03.006

Abstract ( 929 )  

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Objective　To clarify the promotion effect of mouse osteoclast differentiation and osteoporosis by high-salt dietary.　Methods　Bone marrow mononuclear cells of C57 mice were obtained and induced to differentiate into osteoclasts. During this procedure, cells were cultured in each of 3 kinds of medium: no salt addition (control group), addition of 20 mmol/L salt (low-dose group), and addition of 40 mmol/L salt (high-dose group). The quantity of formed osteoclasts was acquired and compared among all 3 groups. In in-vivo study, a total of 24 C57 mice were divided into 3 groups randomly and equally: a normal group (regular feeding), an ovariectomy group (removal of ovary and regular feeding), and a high-salt group (removal of ovary, fed with 8% salt and drinking normal saline). At 6 weeks after administration, in all 3 cohorts, the number of generated osteoclasts in left femurs, as well as indicators associated with bone resorption and protection in serum were acquired. Moreover, bone histomorphometric parameters in right femurs were obtained and compared between each group using micro-CT.　Results　High-salt medium ex vitro enhanced the formation of osteoclasts significantly. Similarly, in vivo study found the largest number of osteoclasts in the high-salt group in comparison with the other 2 cohorts. Also in this group, C-telopeptide of type I collagen and receptor activator of nuclear factor-κ B ligand increased at different levels, while osteoprotegerin decreased remarkably. With respect to bone histomorphometric parameters in the high-salt group,  bone volume/total volume, cortical wall thickness, trabecular number and trabecular thickness were significantly increased whereas bone surface area/ bone volume, trabecular spacing and trabecular pattern factor were increased at various levels.　Conclusions　High-salt dietary enables the occurrence of osteoporosis through activating differentiation of bone marrow mononuclear cells into osteoclasts and strengthening of overall bone-resorption potential.

Regulatory effect of miR-146 on hyperthyroid cardiopathy

QIANG Zheng, JIN Bei-fang, LU Qin-zhen, TAN Hui-yuan, LIU Fang

Chinese Journal of Clinical Anatomy. 2019, 37(3):  273-277.  doi: 10.13418/j.issn.1001-165x.2019.03.007

Abstract ( 538 )  

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Objective　To discuss the effect of miR-146 and its target genes IRAK1 and TRAF6 on regulating of hyperthyroid cardiopathy. 　Methods　Male C57BL/6J mice (n=60) were randomly divided into a Control group (n=30) and a T4 group (n=30). Mice in the T4 group were intraperitoneally injected with T4 diluent (1 μg/g). Mice in the control group were intraperitoneally injected with normal saline (150 mL). After 7 weeks, electrocardiogram was made after anesthetization; ELISA was used to detect serum TT3 and TT4; HE and Masson stain was used to observe the heart morphological change. qPCR was used to detect the expression of miR-146. Western blot was used to detect the protein level of IRAK1 and TRAF6.　Results　Compared with the Control group, heart rate was significantly increased and electrocardiogram was abnormal in mice of the T4 group; Serum TT3 and TT4 were significantly increased (P<0.001). Cardiomyocytes was disordered in structure and more abundant in collagen fiber; miR-146a and miR-146b were significantly up-regulated, P<0.001; IRAK1 and TRAF6 were significantly down-regulated, P<0.001.  Conclusion　miR-146 may regulate hyperthyroid cardiopathy by IRAK1 and TRAF6.

Changes of PRDM16, UCP1, FAS and ACC expression of dopamine D2 receptor knockout mice

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

Chinese Journal of Clinical Anatomy. 2019, 37(3):  278-281.  doi:10.13418/j.issn.1001-165x.2019.03.008

Abstract ( 733 )  

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Objective　To observe the expression of PRD1-BF1-RIZ1 homologous domain containing 16 (PRDM16), uncoupling protein 1 (UCP1), fatty acid synthase (FAS) and acetyl Coenzyme A carboxylase (ACC) in dopamine D2 receptor knockout mice.　Methods　The body weight and fat mass of wild type group (WT) and dopamine D2 receptor knockout group (D2KO) were compared. Real-time quantitative RT-PCR and Western blotting analysis were used to detect PRDM16, UCP1, FAS and ACC expression in BAT of both groups.　Results　Body weight of the WT group was (23.78±0.54) g while D2KO group was (20.54±1.15) g. The epididymal adipose tissue (eAT) fat mass was (1.083±0.02) g while the D2KO group was (0.978±0.03) g. The subcutaneous adipose tissue (sAT) fat mass was (1.85±0.05) g while the D2KO group was (1.72±0.03) g. The brown adipose tissue (BAT) fat mass was (31.38±4.22) mg while the D2KO group was (42.44±2.47) mg. Compared with the WT group, the mRNA and protein expression of UCP1 in BAT were significantly decreased in D2KO group while the mRNA and protein expression of PRDM16, FAS, ACC were significantly increased. The mRNA and protein level of ACC did not change between two groups.  Conclusion　The expression of PRDM16, UCP1, FAS and ACC in BAT may be related to the weight loss of dopamine D2 receptor knockout mice. Compared with the WT group, the mRNA and protein expression of UCP1 in BAT is significantly decreased in D2KO group while the mRNA and protein expression of PRDM16, FAS, ACC is significantly increased.

Autophagy induces drug resistance in human hepatocellular carcinoma cells line HepG2 by increasing CXCL17 protein expression

ZHOU Zhi-tao, LU Yan-meng, ZHANG Qian-bing

Chinese Journal of Clinical Anatomy. 2019, 37(3):  282-286.  doi:10.13418/j.issn.1001-165x.2019.03.009

Abstract ( 450 )  

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Objective　To investigate the mechanism of the development of cisplatin resistance in a hepatocellular carcinoma cell line.　Methods　Over-expression of CXCL17 gene was induced in human hepatocellular carcinoma cells. Western blotting was used to investigate the protein expression of full length CXCL17. Flow cytometry and electron microscopy were used to examine the apoptotic morphological changes after cisplatin treatment in HepG2.　Results　CXCL17 over-expression cells was more resistant to cisplatin-induced cytotoxicity and apoptosis than HepG2 cells. Compared with HepG2 cells, CXCL17 over-expression cells exhibited less apoptosis and more autophagy with decreased CTR1 protein expression.  Conclusion　Cisplatin induces drug resistant phenotype by decreasing the protein level of CXCL17, suggesting an autophagic response to cisplatin as a survival mechanism that can promote chemo-resistance.

Effect of PJ34 on blood-brain barrier integrity after injecting of rt-PA in rats with cerebral ischemia-reperfusion

ZHANG Yu-peng, LI Fang, CHEN Zhu, MAO He, WANG Dong-yu

Chinese Journal of Clinical Anatomy. 2019, 37(3):  287-291.  doi:10.13418/j.issn.1001-165x.2019.03.010

Abstract ( 419 )  

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Objective　To investigate whether the poly-ADP ribose polymerase-1 (PARP-1) inhibitor PJ34, N- (6-oxo-5,6-dihydrophenanthridin-2-yl)-2-dimethylamino can improve the integrity of the blood-brain barrier after rt-PA administration in rats with cerebral ischemia reperfusion.　Methods　Totally 60 rats were randomly divided into a sham operation group, an IR group, a rt-PA group and a PJ34 group. IR group: focal cerebral ischemia 2 h reperfusion model was made by modifying Zea Longa method. PJ34 group and rt-PA group: the fish line was removed 2 h after ischemia, rt-PA (10 mg/kg) was administered to the tail vein, and PJ34 or physiological saline (3 mg/kg) was intraperitoneally injected. The neurological function score was evaluated, the permeability of the blood-brain barrier was measured by Evans blue staining, and the expressions of MMP-9, Claudin-5 and ZO-1 was analyzed by immunohistochemistry.　Results　The mNSS score, Evans blue content and MMP-9 expression in rt-PA group were significantly higher than those in the IR group, and those in PJ34 group were lower than those in rt-PA group, but were  higher than those in IR group (P＜0.05). The expression of Claudin-5 and ZO-1 in rt-PA group was lower than that in IR group, higher in PJ34 group than in rt-PA group, but lower than that in IR group (P<0.05).    Conclusions    PJ34 can effectively improve the integrity of blood-brain barrier of rt-PA rats after cerebral ischemia by inhibiting the expression of MMP-9 and increasing the expressions of Claudin-5 and ZO-1.

The regulatory effects of miR-143-3p on proliferation, apoptosis and invasion on human colon cancer cell via targeting MAPK1

ZHANG Zhi-qian, ZHANG Guang-xin, PENG Xiao-dong

Chinese Journal of Clinical Anatomy. 2019, 37(3):  292-298.  doi:10.13418/j.issn.1001-165x.2019.03.011

Abstract ( 813 )  

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Objective　To investigate the relationship between miR-143-3p targeting MAPK1 and its effect on proliferation, apoptosis and invasion of human colon cancer cells.　Methods　qRT-PCR was used to detect the effect of transfection and the expression level of MAPK1 mRNA. Double luciferase reporter assay was used to detect the targeting relationship between microRNAs-143-3p and MAPK1. The expression level of MAPK1 protein was detected by Western blot. The proliferation multiple was detected by CCK-8. The proliferation was detected by Hoechst staining. The cell invasion was detected by in vitro invasion test. The expression of Ki67, VEGF，MMP-2 and claspase-3 was detected by Western blot.　Results　miR-143-3p mimic inhibited the expression of MAPK1 mRNA and protein in SW620 cells. miR-143-3p mimic and MAPK1 wild-type reporter plasmid decreased the activity of luciferase significantly. After miR-143-3p mimic transfection, the proliferation and invasion of SW620 cells were significantly decreased, the number of apoptotic cells was significantly increased, the expression of Ki67, VEGF and MMP-2 was significantly decreased, and the expression of cl-caspase-3 was significantly increased. The miR-143-3p mimic alleviated the induction effect of high expression of MAPK1 on proliferation and invasion of SW620 cells and inhibition effect on cell apoptosis.　Conclusion　miR-143-3p can inhibit proliferation and invasion of human colon cancer cells and induce apoptosis through possible targeting inhibition of MAPK1.

Finite element analysis of the stress distribution in articular surface during flexion and extension of 2~5 metacarpophalangeal joint

KANG Yong-qiang, RUI Yong-jun

Chinese Journal of Clinical Anatomy. 2019, 37(3):  299-303.  doi:10.13418/j.issn.1001-165x.2019.03.012

Abstract ( 718 )  

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Objective　To establish a three-dimensional finite element model of the metacarpophalangeal joint (MPJ), and analyze the stress distribution of the MPJ surface in the flexion and extension of the MPJ.　Methods　The hands of one healthy volunteer were examined. Three-dimensional CT scanning was performed at 30° intervals during passive flexion from 0° to 90° with use of a CT scanner. The CT scan data were used to establish the three-dimensional finite element model of the MPJ. The load distribution of the MPJ was observed by applying 10, 20, 30, 40 and 50 N loading along the radial direction of the phalanx at four angles, and the results were analyzed.　Results　The number of nodes and the number of units of the four sets of MPJ mesh models with different bending angles were basically the same. Each group of models has about a total of 40070 nodes and 178903 tetrahedral units. Under the same load, the greater the angle of bending, the greater the stress on the MPJ surface. During the angles of 0°, 30°, 60° and 90°, the peak stress range of the metacarpal head of 2~5 MPJs was respectively, 0.20~2.46, 0.22~1.58, 0.22~1.69, 0.22~2.25 MPa.　Conclusion　During the flexion and extension of the MPJ, the greater the angle of bending, the greater the contact stress of the MPJ surface, and the wider the range of stress distribution.

Biomechanical comparison of two modified Goel techniques for the treatment of basilar invagination by finite element analysis 

ZHANG Bao-cheng, CAI Xian-hua, LIU Hai-bo, WANG Zhi-hua, XU Feng, KANG Hui, DING Ran

Chinese Journal of Clinical Anatomy. 2019, 37(3):  304-310.  doi:10.13418/j.issn.1001-165x.2019.03.013

Abstract ( 350 )  

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Objectives 　To determine the biomechanical differences between C2 pedicle screw and bicortical C2 laminar screw with intra-articular Cage in C1~2 fixation by finite element analysis. 　Methods   A validated three-dimensional finite element model of the upper cervical spine (C0~2) was established, and an unstable model was also established after removing the transverse ligament. Two different implanted models: C1 lateral mass screws+Cage+C2 pedicle screw (C1L+Cage+C2P) and C1 lateral mass screws+Cage+bicortical C2 laminar screw (C1L+Cage+BC2L) were integrated at the C1~2 segment into the unstable model. To study the biomechanics, vertical load of 40 N was applied in the inferior direction on the occipital condyles, to simulate head weight and 1.5 Nm torque was applied to the occiput to simulate flexion, extension, lateral bending, and rotation.　Results　There was no significant difference in the range of motion between C1L+Cage+BC2L and C1L+Cage+C2P implanted models ( <0.1° for all loading cases)，and also there was no significant difference in stress distribution and maximum stress between the 2 implanted models. Bone graft stress of the 2 implanted models, especially the C1L+Cage+C2P fixation model, were minimum under extension loading condition. 　Conclusions 　Our results indicate that the C1L+Cage+BC2L fixation offers similar stability to C1L+Cage+C2P for the treatment of basilar invagination. Compared to C2P technique, the BC2L is an easy, effective technique and it can avoid vertebral artery and spinal cord injury. To avoid the instrumentation failure and stress shelter, neck extension movement should be restricted or banned after surgery.

Effect of long bone borehole depth on screw fixation strength

XU Di-wei, LI Shi-qi, LI Chang-shu, BAI Yu-zhe, YI Si, TANG Lei, ZHONG Shi-zhen

Chinese Journal of Clinical Anatomy. 2019, 37(3):  311-315.  doi:10.13418/j.issn.1001-165x.2019.03.014

Abstract ( 606 )  

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Objective　To study the effects of borehole patterns on bone microstructure and screw fixation strength in orthopedic plate and screw fixation. 　Methods　Eight anti-corrosive femoral specimens were taken. Each specimen was marked with 10 boreholes and randomly divided into two groups: through-hole and semi-through-hole. Two types of boreholes were drilled and screws were inserted to test pullout force. The depth of screw placement was the same in both groups. The cortical thickness of the two groups of boreholes was taken from the amount of the cut-off bone segment. Finally, the microstructure of the porous bone tissue was observed and compared by stereomicroscope.　Results　 The thickness of bone cortex in through-hole and semi-through-hole groups were (0.687±0.046) cm and (0.706±0.014) cm, respectively. There was no significant difference in the thickness of bone cortex between the two groups. The pull-out force of screw in through-hole and semi-through-hole groups was (3.495±0.345) kN and (4.008±0.548) kN, respectively. There was significant difference in the pull-out force between the two groups. The average height of tear zone on the outer annular bone plate at the exit of through-hole and semi-through-hole groups was (0.256±0.045) cm and (0.078±0.035) cm, respectively, and there was significant difference between the two groups. 　Conclusion　The semi-through holes can be used when steel plate screws were used to fix drilling holes. The depth of screw placement remains unchanged. While meeting the same bone-screw contact area as through holes, it can provide stronger screw fixation strength due to lighter damage of the outer ring bone plate at the outlet side.

Retrospective analysis of bone cement leakage in percutaneous vertebroplasty

ZHA Ding-sheng, XU Wu-yan, HUANG Jia-wen, LI Ya-qi, CHEN Shi-jun, LIN Zhen, LIN Hong-sheng, ZHA Zhen-gang, WU Hao

Chinese Journal of Clinical Anatomy. 2019, 37(3):  316-321.  doi:10.13418/j.issn.1001-165x.2019.03.015

Abstract ( 569 )  

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　Objective　To analyze the characteristics of percutaneous vertebroplasty (PVP) bone cement leakage, and to investigate the risk factors of PVP bone cement leakage.　Methods　A total of 111 patients (147 vertebral body) with osteoporotic vertebral compression fractures (osteoporotic vertebral compression fracture, OVCF) who were treated with PVP in our hospital from January 2016 to December 2018 were selected. Preoperative DR, 3D CT and MRI examinations were performed for all vertebral segments with fracture, and postoperative DR or 3D CT reexaminations were performed. The effects of gender, age, vertebral body position and vertebral body injury (fissure sign, cortical bone injury) on the rate of bone cement leakage and the characteristics of bone cement leakage were analyzed.　Results　Gender, age and vertebral body position had no significant effect on the bone cement leakage rate. Vertebral fissure sign combined with cortical injury was related with the highest rate of cement leakage, and cortical injury was related with the highest amount of cement leakage, and the differences were statistically significant (P＜0.001). The incidence of bone cement pervertebral leakage was the highest, followed by intervertebral disc leakage and  intraspinal leakage in sequence. The difference was statistically significant (P=0.005).  Conclusion　Vertebral body injury is an important cause of bone cement leakage in PVP treatment. Careful observation of the imaging characteristics of preoperative vertebral body injury is of great significance in prevention of  bone cement leakage. 

Modified far-lateral approach for treatment of upper cervical spinal canal lesions

LIU Tie-jian, CHEN He, XIA Hai-jun, ZHANG Guan-hua, LIU Zhang, HUANG Li-jin

Chinese Journal of Clinical Anatomy. 2019, 37(3):  322-327.  doi:10.13418/j.issn.1001-165x.2019.03.016

Abstract ( 542 )  

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Objective　To summarize the surgical procedures and complications of a modified Far-lateral approach for treatment of upper cervical spinal canal lesions. 　Methods　The clinical data of 18 patients with upper cervical spinal canal lesions treated by modified Far-lateral approach were retrospectively analyzed from January 2016 to October 2018 in our hospital.   Results　As seen in the approach, the visual field was clear and comprehensive, which could fully reveal the ventral lesions of the cranial-cervical junction and upper cervical spinal cord, and also fully reveal the communicating tumors of vertebral canal. All tumors were completely resected under the microscope. The approach inflicted less damage to the bone. In all patients in the group, the posterior median tension band of the corresponding segmental vertebral body was retained. During the process of closing the vertebral canal, the incision muscle was sutured to the corresponding attachment. This approach had mild impact on the static and dynamic stability of the spine. No internal fixation of spine was done to the patients. Two cases of subcutaneous effusion occurred after operations. There were no cases of operative death or intracranial infection. At the last follow-up, 18 patients recovered well (Karnofsky scores were above 80) without occurrence of adverse prognosis and cervical instability.  Conclusion　The modified Far-lateral approach for the treatment of upper cervical spinal canal lesions has a good visual field exposure with low incidence of surgery-related complications. According to the current follow-up, the approach causes little damage to cervical stability. 

Observation on the curative effect of temporal palpebral plate fixation combined with shortening of orbicularis muscle in recurrent aged patients with lower eyelid turnover

CHENG Ya-hui

Chinese Journal of Clinical Anatomy. 2019, 37(3):  328-330.  doi: 10.13418/j.issn.1001-165x.2019.03.017

Abstract ( 189 )  

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Objective　To investigate the clinical effect of temporal palpebral plate fixation combined with shortening of the orbiculus in recurrent aged patients with lower eyelid varus.　Methods　We selected 28 cases (31 eyes) with recurrent lower eyelid turnover in the elderly who were admitted to our hospital from July 2014 to January 2017，aged 59~84 years (average 70.2 years). All patients were treated with temporary side eyelid plate fixation combined with shortening of the orbiculus muscle. The operative effect and recurrence rate 1，3，6 and 12 months after operation were observed respectively.　Results　One month after the operation, three eyes showed mild overcorrection. Three months after the operation, one eye returned to the normal shape, and two eyes still retained mild overcorrection. Six months after the operation, all eyes returned to the normal shape. There was no recurrence during the follow-up period of one year.　Conclusion  The treatment of recurrent lower palpebral varus in the elderly is reliable and stable with temporal palpebral plate fixation combined with shortening of the  orbiculus.

Effectiveness and safety of microwave ablation with "liquid isolation zone" in the treatment of high risk benign thyroid nodules   

LU De-bin, ZHANG Yan, WU Feng-lin, GAO Fang, XUE Yao-ming, LIU Shi-qun

Chinese Journal of Clinical Anatomy. 2019, 37(3):  331-334.  doi:10.13418/j.issn.1001-165x.2019.03.018

Abstract ( 1057 )  

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Objective　To investigate the clinical efficacy and safety of ultrasound-guided microwave ablation in the treatment of high-risk benign thyroid nodules.　Methods　From July 2017 to May 2018, patients with high-risk benign thyroid nodules underwent percutaneous microwave ablation after ultrasound-guided injection of "liquid sequestration belt". Prior to surgery and 6 months after surgery, the length, volume, volume reduction ratio and relevant clinical manifestations of nodules were assessed, including cosmetic and symptomatic scores, thyroid function and thyroid-related antibodies. At the same time, the complications such as toothache, hoarseness and dysphagia were followed up.   Results    A total of 54 patients (49 females and 5 males) with complete follow-up data were enrolled, with an average age of (44.6±11.85) years (20~66 years). The average length and diameter of the initial nodule were (2.90±1.18) cm and decreased significantly to  (1.90±0.94) cm after 6 months(P<0.001). The initial nodule volume was (7.81±8.76) mL and significantly decreased to (2.66±3.23) mL at the last follow-up( P<0.001), with an average reduction of (69.65±15.27)%. The scores of symptoms and cosmetology decreased (P<0.001). There were 2 cases of toothache during the operation. The toothache was relieved after stopping ablation. One case had hoarseness after ablation, but no treatment was given. The voice recovered after 1 month. Intraoperative bleeding occurred in one cases. No patients developed  dysphagia.  Conclusion  Ultrasound-guided percutaneous microwave ablation after injection of "liquid isolation zone" can improve the appearance and symptoms of high-risk benign thyroid patients, and ensure the safety of surgery.       

Under-malleolus minimal incision, poking reduction and simple internal fixation in the treatment of compressive intra-articular fractures of calcaneus 

TU Yong-gang, REN Shao-dong, CHEN Ze-qun, MA Bang-xing, ZHANG Shi-fei, YUAN Hao-bin

Chinese Journal of Clinical Anatomy. 2019, 37(3):  335-339.  doi:10.13418/j.issn.1001-165x.2019.03.019

Abstract ( 576 )  

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 Objective　To explore the clinical effect of minimal incision, poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus.  Methods    From June 2012 to October 2016, 15 patients with compressive intra-articular fractures of calcaneus were included. All 15 patients with articular surface collapse＞2 mm underwent minimal incision poking reduction and Kirschner wire internal fixation. The incision length, surgical duration, incision healing, fracture healing, loss of articular surface reduction, and ankle joint function were used for evaluation. The Bohler angle and the Gissane angle were measured in X-ray. The three-dimensional CT was used to measure the articular surface reduction and re-collapse. Ankle function was evaluated according to the Maryland Foot Function Rating criteria.    Results   The incision length was 3~5 cm, surgical duration was 32~56 min, intraoperative blood loss was 10~30 mL, and the incision healed smoothly. There was no significant difference in Bohler angle and Gissane angle immediately and 1 year after operation. The anatomic reduction ratio of articular surface was 93.3%. According to Maryland Foot Score system, 10 cases were rated as excellent, 3 as good, 1 as fair, and the rate of excellent and good outcomes was 92.9%. There were no significant differences in the Bohler angle and Gissane angle immediately after surgery and the last follow-up (P>0.05).   Conclusion　The minimal incision poking reduction and Kirschner wire internal fixation in the treatment of compressive intra-articular fractures of calcaneus can expose fully. It has the advantages of small injury, easy operation, less complications, and satisfactory ankle function.

Effect of erector spinae plane block and serratus anterior plane block on acute pain after thoracoscopic surgery 

TAO Tao, ZHOU Quan, TIAN Yu, ZHU Chen

Chinese Journal of Clinical Anatomy. 2019, 37(3):  340-343.  doi:10.13418/j.issn.1001-165x.2019.03.020

Abstract ( 788 )  

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Objective　To retrospectively analyze the effect of erector spinae plane block and serratus anterior plane block on acute pain after single-port thoracoscopic surgery.    Methods　Eighty-seven patients were selected, who underwent selective thoracoscopic surgery under total intravenous general anesthesia in our hospital from January to December 2018. Twenty-nine patients who only accepted total intravenous general anesthesia were assigned to the control group. The 30 patients who accepted total intravenous general anesthesia (TIVA) combined with erector spinae plane block (ESPB) were assigned to the ESPB group. Twenty-eight patients who accepted TIVA combined with serratus anterior plane block (SAPB) were assigned to SAPB group. All patients accepted patient controlled intravenous analgesia (PCIA) for postoperative analgesia. Heart rate, blood pressure, and pulse oximetry were routinely monitored during anesthesia. VAS scores were obtained before surgery, 2 h, 8 h, 12 h, 24 h, and 48 h after surgery. Opioids consumption during the operation and PCIA were also recorded. Additionally, postoperative complications such as nausea and vomiting, urinary retention, itching and respiratory depression during 48 h after surgery were also recorded.  Results　VAS scores in the ESPB and SAPB group were significantly lower than those in the control group at 2, 8 and 12 h postoperatively. And the ESPB group was lower than SAPB group (P<0.05). Compared with the control group, the opioids consumption during the operation and PCIA of ESPB and SAPB group were significantly decreased and the ESPB group decreased more than the SAPB group (P<0.05).　Conclusion　In the perioperative analgesia of thoracoscopic surgery, ultrasound-guided ESPB has better analgesic effect than SAPB, reducing perioperative opioid consumption. 

Application of the vacuum infusion technique in bone specimens’ preservation

LI Qing-yun, ZHAO Zi-rui, WEN Chu-qi, Wang Sen, Sadam-Yusan, PAN Ai-hua

Chinese Journal of Clinical Anatomy. 2019, 37(3):  344-346.  doi:10.13418/j.issn.1001-165x.2019.03.021

Abstract ( 537 )  

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Objective　This study aims to increase the accessibility and the life spans of bone specimens and to overcome the shortcomings of the polyurethane resin painting method that is widely used in bone specimen preservation.　Methods　Bone specimens of a male donor were first dried, and then immersed into the HZ-806A/HZ-806B two-component transparent epoxy resin for vacuum infusion. Then, the specimens were put into a mixed solution with a ethanol to glycerol ratio of 2:1 in weight for solidifying for 12 hours. After that, all specimens were moved into anhydrous ethanol to remove the glycerol component and then dried in the air. Last, the changes of the compact bone and the spongy bone were evaluated comprehensively with the aspects of appearance, anatomical features and physical properties.　Results　The cured transparent epoxy resin filled the space around bone trabecula in the spongy bone, and formed a hard, glossy, and transparent film on the surface of the bones, improving the hardness, toughness, safety, and color of the bone specimens. According to the statistical results, the average gaining weight rate of all specimens was 80.3%.　Conclusion　The vacuum infusion technique has a prominent advantage in bone processing, especially for the brittle bones that are hard to be utilized. Hopefully, this method will serve as a new common technical means for skeleton preservation.

Research progression of the treatment of pelvic and acetabular fractures with 3D printing technique

HUANG Fu-ming, FAN Shi-cai

Chinese Journal of Clinical Anatomy. 2019, 37(3):  347-350.  doi:10.13418/j.issn.1001-165x.2019.03.022

Abstract ( 304 )  

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Application of computer-aided design 3D printing patient specific instruments in total knee arthroplasty

WEN Wen-xian, YANG Shuai , ZHANG Guang-ming

Chinese Journal of Clinical Anatomy. 2019, 37(3):  351-352.  doi:10.13418/j.issn.1001-165x.2019.03.023

Abstract ( 265 )  

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Morphological changes and research progress on skeletal aging in orbital region and midfacial region

FENG Wen-jie, LUO Sheng-kang

Chinese Journal of Clinical Anatomy. 2019, 37(3):  353-356.  doi:10.13418/j.issn.1001-165x.2019.03.024

Abstract ( 583 )  

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The clinical significance of the posterior humeral circumflex artery variantions

PENG Hong-xiang, ZHAO Liang-yu

Chinese Journal of Clinical Anatomy. 2019, 37(3):  357-359.  doi:10.13418/j.issn.1001-165x.2019.03.025

Abstract ( 705 )  

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The incomplete duplication of right kidney and ureter with right sigmoid colon: a case report

LI Yong, FENG Li, ZHANG Xing-hua, DENG Wen-da

Chinese Journal of Clinical Anatomy. 2019, 37(3):  303.  doi: 10.13418/j.issn.1001-165x.2019.03.026

Abstract ( 331 )  

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