Table of Content

25 March 2020 Volume 38 Issue 2

  

Basic research on privileged sites and special types of perforator flap

ZHENG He-ping

Chinese Journal of Clinical Anatomy. 2020, 38(2):  121-122.  doi:10.13418/j.issn.1001-165x.2020.02.001

Abstract ( 363 )  

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Anatomical study of the buccal mucosal flap based on the facial artery perforator for reconstruction of lacrimal duct

WEI Xu-dong, LIN Neng-ben, LI Xiao-jing, NING Jin-long

Chinese Journal of Clinical Anatomy. 2020, 38(2):  123-126.  doi: 10.13418/j.issn.1001-165x.2020.02.002

Abstract ( 168 )  

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Objective　To provide anatomical basis for reconstructing the lacrimal duct by the buccal mucosa flap based on the facial artery perforator.　Methods　20 sides of 10 adult head specimens were perfused with red latex and were dissociated to observe the following contents: ①The origin, branches and distribution of the facial artery perforators; ②The origin, branches and distribution of the buccal artery. ③The anastomosis of the facial artery and the buccal artery. In addition, mimic operation design was performed on one side of the fresh specimen.　Results　The blood supply of the buccal mucosa was multi-source, which was mainly composed of the perforating branches from the facial artery, buccal artery and posterior superior alveolar artery. ① The facial artery commonly arose from the external carotid artery, then crossed over the mandibular bone at the front edge of the masseter muscle and arrived at the face, and finally ran obliquely towards the medial canthus to anastomose with the dorsal nasal artery. The facial artery sent out several branches to nourish the neck region and face region on its way. It also sent out 1~3 buccal branches at (1.10 ± 0.31) cm lateral to the angulus oris, innervating the buccal muscle and the front-middle part of mucosa and anastomosing with the buccal branches of buccal artery and the buccal branches of the posterior superior alveolar artery; ②The buccal artery originated from the pterygoid segment of the maxillary artery and ran anteriorly and inferiorly under the deep surface of the temporal muscle. It sent out branches, which distributed at the postero-middle part of the buccal mucosa, and anastomosed with the perforators of the facial artery. When the maxillary artery sent out thin and short buccal branches, the thick posterior superior alveolar artery buccal branches with a 5% occurrence rate  compensated them.　Conclusions　The buccal mucosal flap based on the facial artery perforator is abundant in blood supply and may become a supplement for the reconstruction of the lacrimal duct.

Anatomical basis of the dorsal perforating extended flap based on the palmar artery at the site between the thumb and the index finger 

WANG Tian-quan, HU De-qing, LIN Hai-qing, WEN Fu-li, XUE Lai-en

Chinese Journal of Clinical Anatomy. 2020, 38(2):  127-130.  doi:10.13418/j.issn.1001-165x.2020.02.003

Abstract ( 627 )  

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Objective　To explore the morphological characteristics of the dorsal perforators from the palmar artery at the site between the thumb and the index finger, and provide the anatomical basis for the design of the dorsal perforator flap based on the palmar artery.　Methods　Thirty adult upper limb specimens injected with red latex were dissociated to observe the following contents by means of vascular cast and macro-micro-anatomy: ①The origin, courses and distribution of the dorsal nutrient vessels at the site between the thumb and the index finger; ②The anastomotic characteristics of the dorsal perforators of the palmar artery and the dorsal vessels at the site between the thumb and the index finger. One fresh specimen perfused with red latex was performed as a mimic operation.　Results　The blood supply at the site between the thumb and the index finger was multi-sources, which was provided by the dorsal perforators from the palmar artery (the radial palmar digital artery of the index finger and the ulnar palmar digital artery of the thumb) and the branches from the dorsal artery (the first dorsal metacarpal artery). ①The first dorsal metacarpal artery constantly originated from the radial artery and ran in the first metacarpal bone interval, and finally divided into three terminal branches: radial branch, ulnar branch, and intermediate branch，accompanied with homonymous dorsal digital cutaneous nerve from the superficial branch of radial nerve. ②The palmar artery sent out the radial, ulnar, and intermediate perforators towards the dorsum, which formed constant anastomosis with the branches of the first dorsal metacarpal artery to nourish the dorsal skin.　Conclusions　The dorsal perforator flap based on the palmar artery at the site between the thumb and the index finger possessed cross regional blood supply and could be transposed to repair the defects in the proximal part of the index finger, the thenar region, as well as the thumb.

Anatomical study of the V-Y advancement flap based on the cubital fossa perforators

HU De-qing, ZHOU Xiao, CHEN Peng, ZHANG Wen-ming

Chinese Journal of Clinical Anatomy. 2020, 38(2):  131-134.  doi:10.13418/j.issn.1001-165x.2020.02.004

Abstract ( 607 )  

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Objective　To investigate the morphological characteristics of the cubital fossa perforators, providing anatomical basis for restoring the antecubital defects by using the V-Y advancement flap based on the cubital fossa perforators.　Methods　30 sides of adult cadaveric upper extremities were collected to perform red latex perfusion, macro-micro-anatomy, and mimic operation. The following contents were observed under a surgical magnifier: ①The morphology of the cubital fossa; ②The origin, branches, and distribution of the cubital fossa perforators. ③The anastomosis of the cubital fossa perforators and the peripheral rete  vasculosum.　Results　①The cubital fossa was a triangle lacuna in the anterior aspect of the elbow, which was a passing portal for antebrachial vessels and nerves. ②The blood supply for the skin of the cubital fossa was multi-source, which was commonly composed of the brachial artery and the perforators from the branches of the brachial artery. The perforators had a large variation and could be classified into three types according to the number and outer diameter: A. Thick and concentrated type (13/30, accounting for 43.33%): this type had 1 perforator (inferior cubital artery) with an average outer diameter of 0.6~1.2 mm. B. Tiny and dispersive type (11/30, accounting for 36.67%): this type had 3~4 perforators with an average outer diameter of 0.3~0.6 mm; C. Moderate and balanced type (6/30, accounting for 20%): this type had 2 perforators with an average outer diameter of 0.4~0.7 mm; ③ The perforators punctured out of the deep fascia along either side of the cutaneous antebrachial lateralis nerve or cephalic vein towards the antecubital skin, which also anastomosed with each other and with adjacent vessels to form the fascial vascular network of cubital fossa.　Conclusions　The V-Y advancement flap based on the cubital fossa perforators could become a good supplement for restoring the antecubital defects.

Anatomical study of the semimembranosus popliteal perforator flap

HU De-qing, ZHOU Xiao, CHEN Peng, ZHANG Wen-ming

Chinese Journal of Clinical Anatomy. 2020, 38(2):  135-137.  doi:10.13418/j.issn.1001-165x.2020.02.005

Abstract ( 568 )  

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Objective　To explore the anatomical characteristics of the semimembranosus popliteal perforators, providing morphological basis for the reconstruction of soft tissue defects around the knee joint. Methods　After 30 sides of adult lower extremity specimens were perfused with red latex,  the following contents were observed emphatically under a surgical magnifier：①The origin, courses, branches, and distribution of the nutrient vessels of the semimembranosus muscle. ②The anastomosis characteristics of semimembranosus popliteal perforators and adjacent perforators.　Results　The semimembranosus popliteal perforators, with an outer diameter of (0.7±0.3)mm and a length of (1.1±0.4)cm on average, commonly originated from the semimembranosus muscular branch at 13.5cm proximal to the tibial condyle, and then punctured out of the deep fascia towards the subcutaneous plane, and finally sent out numerous tiny vessels to form anastomosis with the direct cutaneous perforators of the popliteal artery as well as the medial popliteal cutaneous arteries.　Conclusions　The flap pedicled with the semimembranosus popliteal perforators could become a supplement for repairing the soft tissue defects around the knee joint in the form of transposition or V-Y advancement.

Anatomical study of the axillary hair-bearing perforator flap

QI Rui-lin, LIN Hai-qing, XUE Lai-en, XIONG Zhi-gang

Chinese Journal of Clinical Anatomy. 2020, 38(2):  138-141.  doi: 10.13418/j.issn.1001-165x.2020.02.006

Abstract ( 86 )  

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Objective　To investigate the anatomical characteristics of the axillary fossa perforator, providing the hair-bearing perforator flap for reconstruction of the mons pubis defects.　Methods　30 sides of adult cadaveric specimens were managed by methods of red latex perfusion, macro-micro-anatomy. The following contents were observed emphatically: ①The origin, branches, and anastomosis of the axillary fossa perforators; ②The outer diameter and length of the axillary fossa perforators.　Results　There were three types of perforating vessels in the axillary region: the first cutaneous perforator of the thoracodorsal artery (occurrence rate: 96.7%), the first cutaneous perforator of the lateral thoracic artery (occurrence rate: 90%), and the direct perforator of the axillary artery (occurrence rate:93.3%), with an average original outer diameter of (1.2±0.3) mm, (1.2±0.2) mm, and (1.4±0.3) mm, respectively.　Conclusions　Due to the rich blood supply and constant anatomy, there was at least one cutaneous perforator to be taken as the vascular pedicle for the design of a hair-bearing perforator flap in this axillary region, which could be a supplementary choice for repairing the hairy skin defects caused by tumor radical resection, burns, as well as trauma and other reasons.

Clinical anatomy of the pubic hair-bearing perforator flap

LIN Hai-qing, QI Rui-lin, XUE Lai-en, WEN Fu-li, XIONG Zhi-gang

Chinese Journal of Clinical Anatomy. 2020, 38(2):  142-145.  doi:10.13418/j.issn.1001-165x.2020.02.007

Abstract ( 522 )  

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Objective　To investigate the anatomical characteristics of the perforating vessels in the pubic area, providing anatomical basis for reconstruction of soft tissue defects in the maxillofacial hairy region.　Methods　30 sides of adult cadaveric specimens (18 sides of male, 12 sides of female) were fixed by 10% formaldehyde conventionally, followed by managements of red latex artery perfusion, microscopic anatomy, and mimic operation. The following contents were observed: ①The origin, course, branch, and distribution of the perforating vessels in the pubic area; ②The anastomosis of the perforators in bilateral pubic area.　Results　The skin blood supply of the pubic region was mainly provided by the superficial external pubic artery, which originated from the femoral artery, and then bifurcated into the superior branch and the inferior branch when arriving at the terminal segment of the great saphenous vein. The superior branch crossed over the inguinal ligament and entered into the pubic area, and finally anastomosed with the contralateral homonymous artery near the anterior midline. Along the way, it sent out cutaneous branches to nourish most of the hairy skin in the pubic area. The inferior branch entered into the pubic proparea horizontally and sent out branches to nourish the medial-superior thigh, the pubic proparea and the scrotum (labium). The average starting outer diameter of the superior branch and the inferior branch were (1.2±0.2) mm and (1.1±0.3) mm, respectively.　Conclusions　The pubic area was abundant and reliable in blood supply, which allowed to design a hair-bearing perforator flap based on the superficial external pubic artery for reconstruction of skin and soft tissue defects in the maxillofacial hairy region.

Design and clinical application of anterior malleolus perforating extended flap

WANG Zheng-li, ZHANG Tian-hao, WANG Zhi-jiang, LIN Jian

Chinese Journal of Clinical Anatomy. 2020, 38(2):  146-149.  doi:10.13418/j.issn.1001-165x.2020.02.008

Abstract ( 616 )  

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Objective　To investigate the anatomical basis and clinical efficacy of the anterior malleolar perforator flaps, so as to provide a supplementary choice for repairing the soft tissue defects of ankle and foot.　Methods　15 cases of foot and ankle defects were repaired to use the anterior malleolar perforator flaps, which were designed based on the anatomical study of the anterior malleolar perforator flaps, the size and shape of the wound defects. The size of the flaps ranged from 4.0 cm×3.5 cm to 15.0 cm×6.0 cm.　Results　All the flaps survived successfully except for 1 case which appeared necrosis at the distal edge of flap and healed after dressing change. After a follow-up of 3 to 24 months, the flaps presented an excellent appearance and color and the donor sites healed without any ulcer, meanwhile, the function of weight-bearing walking was good.　Conclusions 　Four types of perforator flaps or a perforating extended flap could be designed based on the anterior malleolar perforating vessels which were constant and reliable in blood supply．The anterior malleolar perforator flaps might become a desirable choice for the repair of soft tissue defects in ankle and foot.

Clinical application of the first metatarsal proximal perforator-based neurocutaneous vascular flap

ZHANG Fei, LIN Jian, HONG Xu, LIN Hai-qing, XUE Lai-en, ZHENG He-ping

Chinese Journal of Clinical Anatomy. 2020, 38(2):  150-152.  doi:10.13418/j.issn.1001-165x.2020.02.009

Abstract ( 544 )  

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Objective　To explore the clinical efficacy of the first metatarsal proximal perforator-based neurocutaneous vascular flap for repairing the forefoot soft-tissue defects.　Methods　From March 2014 to November 2019, eight patients with forefoot defects were reconstructed by the first metatarsal proximal perforator-based neurocutaneous vascular flaps with an average size from 6.0 cm×4.9 cm to 3.0 cm×2.1 cm.　Results　All flaps survived completely and the donor sites healed uneventfully. After a follow-up of 3 to 12 months, the flaps presented an excellent texture, a fine elasticity, and a similar skin color. And the patients were satisfied with both the functions and appearances of the donor and recipient regions.　Conclusions　Due to the good and reliable blood supply and the simple and practical surgical procedure, the first metatarsal proximal perforator-based neurocutaneous vascular flap might become a new choice for the repair of forefoot soft-tissue defects.

Clinical application of posterior interosseous artery bilobate flap in repairing hand skin defect

ZENG De-qing, JIANG Ji-yong, WANG Qing-hong, YU Chun-bin, ZHONG Shao-kai, LU Wen-jing, LI Pei, WANG Hai-wen, GU Rong

Chinese Journal of Clinical Anatomy. 2020, 38(2):  153-156.  doi:10.13418/j.issn.1001-165x.2020.02.010

Abstract ( 560 )  

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Objective　To investigate the clinical effects of posterior interosseous artery bilobate flap on repairing multiple or large skin and soft tissue defects of the hand.　Methods　4 cases of multiple skin and soft tissue defects and 5 cases of large area skin and soft tissue defects, who were treated with forearm posterior interosseous artery bilobate flap transformation from March 2011 to December 2018, were selected. All patients' wounds were accompanied by deep tissue exposure. The cutting area of flap was 4.5 cm× 5.5 cm ~ 7.0 cm× 9.0 cm in size and the donor area was directly stitched together.　Results　All flaps survived successfully. Four patients were followed up for 2 months to 2 years, with an average of 10 months.  Among them, 2 patients had overstaffed flap and underwent flap plasty half a year after operation. The flap had a good texture and the skin color was similar to the recipient area. The two-point discrimination perception of the  flap was 11~20 mm, with an average of 14 mm. The wrist joint function was not affected.　Conclusions　The application of posterior interosseous artery bilobate flap in repairing hand skin defects has the advantages of no damage to forearm main blood vessels, constant vascular anatomy, simple and convenient cutting, high survival rate, direct suture of part of donor site, similar color and texture compared with recipient site, good late function, which was an ideal method to repair hand skin defects.

Anatomical study and significance of the middle temporal vein in Chinese population

SONG Li-ling, SONG Hui-min, SUN Ya-zhen, HAN Ke-xin, LV Hai-lin, LUO Peng, XU Yun

Chinese Journal of Clinical Anatomy. 2020, 38(2):  157-159.  doi:10.13418/j.issn.1001-165x.2020.02.011

Abstract ( 1612 )  

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Objective　To study the anatomical characteristics and mark of the middle temporal vein(MTV), providing anatomical basis for clinical application.　Methods　Twenty-six（ 12 cases on the left , 14 cases on the right ）human head specimens perfused with 10% formalin solution were collected, and the middle temporal vein and its tributary were dissected. The distribution of the MTV was observed. The distance from the trunk of the MTV to each anatomical landmark and pipe diameter were measured. The number of tributaries was accounted. The difference between the left side and right side was compared.　Results　All specimens had middle temporal veins, with an average trunk diameter of 2.91 mm (0.72~5.88 mm), had 0~7 tributaries , with an average tributary diameter of 2.05 mm (0.54~5.30 mm). There were 2 levels of tributary in 1 case (accounting for 3.8 %). The locations of the confluence points that the trunk merging into the superficial temporal vein were not exactly the same. The high confluence points were located at the root of the zygomatic arch in 11 cases (accounting for 42.3% ) and the low were at the lower edge of the zygomatic arch 9.02~21.00 mm.  Trunk had three types according to the distribution: ① 14 cases of classic type (accounting for 53.8%) ② 8 cases of split aggregation type (accounting for 30.8%) ③ 4 cases of right-angled type (accounting for 15.4%). The average vertical distance from the turning point to the interior edge of the tragus was 18.69 mm. The mean distance of the left side from the trunk to the midpoint of zygomatic arch, the junction of the orbital outer edge and the zygomatic arch, the outer canthus, and the outer end of eyebrow were (17.23±7.29)、(18.82±9.00)、(21.14±6.96)、(9.62±8.87) mm respectively and the right of those  were (17.28±5.74)、(18.34±7.63)、(19.40±6.98)、(8.17±5.53) mm respectively. The corresponding mean diameter of the vein in the left were (3.75±1.63)、(3.34±1.00)、(3.08±1.18)、(2.81±1.23) mm respectively, the right were (4.29±2.93)、(2.90±1.29)、(2.89±1.20)、(2.57±1.21) mm respectively. There were no statistical difference between the left side and the right side.　Conclusions　The anatomical knowledge of the middle temporal vein is of crucial importance for  reconstructive scalp surgery in the temporal region.

Anatomical basis of the morphology and blood supply of the capitate bone

WU Huan, XU Yong-qing, LUO Hao-tian, FAN Xin-yu, HE Xiao-qing, ZHANG Xu-lin, ZHAO Wan-qiu, XU Yu-jian, YUAN Li-bo

Chinese Journal of Clinical Anatomy. 2020, 38(2):  160-165.  doi:10.13418/j.issn.1001-165x.2020.02.012

Abstract ( 1512 )  

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Objective     To provide the anatomic basis for the clinical treatment of advanced Kienb?ck disease by transposition of the capitate bone through observing the morphology of the capitate bone and blood supply pattern and exploring the mechanism of avascular necrosis of the capitate bone.  Methods 　Twelve fresh wrist joint specimens were selected, gelatin-lead oxide solution was perfused from the ulnar artery or radial artery. After scanned by Micro-CT, the image was reconstructed by Mimics software to observe the morphology of the capitate bone and the main blood supply source. The length, width, thickness of the capitate bone and lunate bone and diameter, arc length, arc height of the proximal joint surface were measured. The number and distribution of the capitate bone nourished blood vessels were recorded, and the relevant data were statistically analyzed. 　Results　(1) There were 9 cases of F-shaped capitate bone (accounting for 75%), and 3 cases of S-shaped (accounting for 25%); (2) Blood supply of capitate bone originated from the volar surface and the dorsal surface, with the dorsal surface mainly; (3) Compared the length, width, thickness, the diameter, arc length and arc height of the capitate bone and the lunate bone, there were  significant correlation among them; (4) The nourishing vessels of the capitate bone were distributed at 2.2mm from the base, the number of nourishing vascular foramina on the distal pole was more than that of the proximal pole, the difference was statistically significant (P<0.05).　Conclusions　The proximal capitate bone is mainly dominated by the distal retrograde blood supply, which is the main cause of avascular necrosis in the capitate bone. It is feasible to treat  the advanced Kienb?ck disease by transposition of the capitate bone.

Feasibility study of axial laminar screw fixation in children aged 1~6 years

LI Kun, LI Zhi-jun, ZHANG Shao-jie, WANG Xing, LI Xiao-he, GAO Shang, CHEN Jie, HE Yu-jie

Chinese Journal of Clinical Anatomy. 2020, 38(2):  166-170.  doi:10.13418/j.issn.1001-165x.2020.02.013

Abstract ( 488 )  

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Objective　To investigate the feasibility of axial lamina fixation with 3.5mm screw in children aged from 1 to 6 years.　Methods　The original CT data of 45 children aged from 1 to 6 years old were collected into three groups of A, B and C. The age difference of children in each group was within 2 years old . The CT data were 3D- reconstructed to measure the following parameters: the width of upper edge, middle edge, lower edge of the lamina, the height and length of the lamina, the obliquity and the inclination of the lamina.　Results　With the increasing of age, the indexes of lamina were on the rise. The main factors limiting axial lamina screw placement were lamina midline width (LWM) and distance from the entering point to the lamina outer edge (ELE). The LWM  of the A group, the B group and the C group was (4.69±0.45) mm, (7.13±1.61)  mm; (7.72±1.28) mm ,respectively. The ELE of the A group, the B group and the C group was (15.44±6.98) mm, (23.67±1.86) mm, (27.75±2.39) mm, respectively. In the simulation of lamina screw placement, the entering point of the A group, the B group and the C group was the junction of the right and left branches of the ipsilateral spinous process, the middle edge of spinous process branch on the opposite side of vertebral plate where the screw was located,  the upper edge of spinous process branch on the opposite side of the vertebral plate where the screw was located, respectively.　Conclusions　It is feasible to insert 3.5 mm screw in the axial lamina of children aged 1 to 6 years, but the screw placement method should be different according to the age.

A morphological classification of adult lumbar vertebral endplates at coronal plane

XU Yan-xiao, ZHANG Lei , QI Ji, ZHANG Nan, WU Kai, LI Yi-kai

Chinese Journal of Clinical Anatomy. 2020, 38(2):  171-175.  doi:10.13418/j.issn.1001-165x.2020.02.014

Abstract ( 899 )  

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Objective　To explore anatomic features of adult lumber vertebral endplantes under CT imaging, and  provide anatomical evidence for the design of intervertebral fusion and the complications of disc arthroplasty surgery.　Methods　The CT data of 62 non-spinal disorders patients with 310 lumbar vertebrae from L1 to L5 were measured at the upper endplates and lower endplates separately. The posterior endplates of lumbar vertebral at coronal plane were classified into 3 types: type I concave; type Ⅱ flat; type Ⅲ convex. The following data were measured: (1) Vertical distances from middle line of the endplate to left pedicle of the upper and lower endplates, to midpoint of the connecting endplate  (LLU, LLL); (2) Vertical distances from middle line of the endplate to right pedicle of the upper and lower endplates, to midpoint the connecting endplate ( LRu, LRL) (3) Vertical distances from middle line of the endplate to the midpoint of the of the posterior upper and lower endplates at coronal plane (LMu, LML). 　Results　Type I endplates had the highest proportion from L1~4 at the upper and lower endplates. At L1, L2, L3, L4, type I endplate accounted for 93.75%, 77.27%, 58.33%, 66.67% of upper endplate respectively, and 80%, 68.18%, 54.17%, 55.56% of lower endplate respectively. Type I and type Ⅲ were the main types of upper endplate at L5, accounting for 35.48%, 35.48%. Type Ⅲ was the main type of lower endplate at L5 , accounting for 61.29% . Sex difference of LLU、LRU、LMU of the upper endplates at L2 was statistically significant(P<0.05). Sex difference of LLL、LRL of the lower endplates at L3 was all statistically significant(P<0.05).　Conclusions　The mainly types of upper and lower endplates at L1~4 are type I, while the types of upper endplate at L5 are type I and type Ⅱ, the type of lower endplate at L5 is Type III. The research on morphological classification and measurement of upper and lower endplates of lumbar vertebral will be beneficial to the improvement of future design of the artificial lumbar disc prosthesis.

Spastin promotes the formation of dendritic field in hippocampal neurons

ZHANG Jia-qi, CHEN Li, LI Jiong, LI Su-mei, ZHANG Ji-feng, TENG Ji-jun, GUO Guo-qing

Chinese Journal of Clinical Anatomy. 2020, 38(2):  176-182.  doi:10.13418/j.issn.1001-165x.2020.02.015

Abstract ( 616 )  

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Objective　To investigate the effect of microtubule-severing protein Spastin on the formation of dendritic field in hippocampal neurons.　Methods　Spastin was transfected into hippocampal neurons and the α-amino-3-hydroxyl-5-methyl-4-isoxazole propionic acid (AMPA) receptors on dendrites were detected by immunofluorescence. Whole-cell patch clamp was used to detect miniature excitatory postsynaptic currents (mEPSCs).　Results　Overexpression of Spastin promoted dendritic outgrowth and branch formation, while knockdown of Spastin inhibited dendritic outgrowth and formation of new branches. The results showed that Spastin significantly promoted the formation of and complexity of dendritic field compared with the control group (P<0.05). Sholl analysis results showed that Spastin increased the complexity of dendrites (P<0.05). Immunofluorescence results showed that overexpression of Spastin promoted the expression of AMPA receptor GluA2 subunit in dendrites, which was significantly different from the control group (P<0.05) , while knockdown of Spastin inhibited the expression of GluA2 in dendrites (P<0.05). Whole-cell patch clamp detection showed that overexpression of Spastin increased the amplitude and frequency of mEPSCs, however, knockdown of Spastin significantly decreased the amplitude and frequency of mEPSC (P<0.05).　Conclusions　Spastin promotes the formation of neuronal dendrites that are the functional dendrites.

Expression of dopamine D1 and D2 receptor in the special visceral motor nuclei of rat and its effect on the level of BDNF

ZHOU Li, Li Yong, YANG Yan-li, RAN Xue-rui, WANG Zhi-yong

Chinese Journal of Clinical Anatomy. 2020, 38(2):  183-188.  doi:10.13418/j.issn.1001-165x.2020.02.016

Abstract ( 535 )  

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Objective　To investigate the expression and function of dopamine D1 receptor (DRD1) and D2 receptor (DRD2) in the trigeminal motor nucleus, the facial nucleus, ambiguous nucleus, accessory nucleus of rat.　Methods　The expression and distribution characteristics of DRD1 and DRD2 in the above 4 nuclei were detected by double staining immunofluorescence. SD rats were randomly divided into three groups: a control group (C), a DRD1 and DRD2 agonist rotigotine group (Roti) and a rotigotine plus DRD2 inhibitor haloperidol group (Roti+halo), each group had 6 rats. The protein expression changes of BDNF and TrkB in trigeminal motor nucleus and the facial nerve were detected by Western blot.　Results　There were large numbers of DRD1 and DRD2 positive cells in the cholinergic neurons of trigeminal motor nucleus, facial nucleus, ambiguous nucleus and accessory nucleus. Compared with the C group, the expression of BDNF in the trigeminal motor nucleus and facial nucleus increased in Roti group (P<0.05). The expression of BDNF in the facial nucleus decreased in the Roti + halo group when compared with the Roti group (P<0.05). There was no statistical difference in the expression of TrkB among three groups (P>0.05).    Conclusions DRD1 and DRD2 are abundantly expressed in the cholinergic neurons of the above 4 nuclei. Rotigotine may induce BDNF expression in the cholinergic neurons through activating DRD1 and DRD2 dimers.

Effects of Astragaloside IV on sepsis myocardiopathy and peroxisomal proliferate activation receptor alpha in mice induced by lipopolysaccharide

NIE Qu, LI Meng-fei, WANG Hong-xin

Chinese Journal of Clinical Anatomy. 2020, 38(2):  189-193.  doi:10.13418/j.issn.1001-165x.2020.02.017

Abstract ( 458 )  

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Objective  To investigate the effects of Astragaloside IV (ASIV) on myocardial myocardiopathy and peroxisomal proliferate activation receptor α (PPARα) in mice induced by lipopolysaccharide (LPS).　Methods　50 healthy male C57BL/6J mice were randomly divided into 5 groups, each group of 10 mice, which were divided into a blank control group, a lipopolysaccharide model group and three astragaloside IV (20, 40, 80 mg/kg/d) groups. Astragaloside IV was administered to the ASIV groups for 7 days, and then the model group was given LPS (10 mg/kg) to establish an acute endotoxin damage model. After 8 h, ultrasound was used to observe the mouse heart function index: ejection fraction (EF), shortening fraction (FS), left ventricular diastolic inner diameter (LVIDd), and left ventricular end-systolic diameter (LVIDs); HE staining was used to observe the morphological changes of the heart tissue of mice; Enzyme linked immunosorbent assay (ELISA) was used to detect tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and free fatty acid (FFA); High performance liquid chromatography (HPLC) was used to detect the content of adenosine triphosphate (ATP), adenosine diphosphate(ADP) and adenosine monophosphate (AMP); Western Blot was used to detect the protein expression levels of PPARα and ATP5D in myocardial tissues. 　Results　Compared with the model group, the increasing of the cardiac function index EF, FS, LVIDd and LVIDs of the ASIV groups improved the infiltration of inflammatory cells and the deformation of myocardial fibers, decreased the content of TNF-α, IL-1β, IL-6, FFA, and increased the ratio of ATP/AMP and ADP/AMP ; increased the protein expressions of PPARα and ATP5D.　Conclusions　Astragaloside IV may be used to improve the energy metabolism of myocardial injury induced by lipopolysaccharide by PPARα, which can protect the cardiomyopathy of sepsis.

Effect of knockdown splicing factor Prp17 on liver morphology and liver function in mice

MA Wen-jie, HUANG Zi-jin, DOU Jian-ping, MA Chun-mei, LIU Ai-jun, WANG Jia-you

Chinese Journal of Clinical Anatomy. 2020, 38(2):  194-197.  doi:10.13418/j.issn.1001-165x.2020.02.018

Abstract ( 471 )  

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Objective   To investigate the effects of knockdown splicing factor Prp17 on liver morphology and liver function in mice.    Methods   The knockdown splicing factor Prp17 adenovirus (Ad-shPrp17) was constructed. C57BL/6 mice were randomly divided into a control group and an Ad-shPrp17 group with 8 mice in each group. The Ad-shPrp17 group was injected with Ad-shPrp17 through medial canthus vein. After 10 days, mouse serum and liver tissue were collected. Pathological changes of liver were observed by hematoxylin-eosin staining. The activities of serum aspartate transaminase (AST) and alanine transaminase (ALT) were determined by enzyme method. Gene expression was analyzed by fluorescence quantitative polymerase chain reaction.   Results   Compared with the control group, the Ad-shPrp17 group had the following changes: (1) Liver index and the quality of liver  significantly increased (P<0.01); (2) with scattered and swollen hepatocytes, loose cytoplasm, the liver cells changed from polygonal to round. The cytoplasm was transparent and ballooning changed, and some cells were necrotic; (3) The enzyme activities of serum ALT and AST were significantly increased (P<0.01); (4) The expression of liver tissue TNF-α and IL1-β increased (P<0.05).    Conclusions    Knockdown of splicing factor Prp17 could cause pathological changes and function damage in the liver tissue of mice, and its mechanism may be related to the induction of hepatic inflammatory response. This study provides a new therapeutic target and theoretical basis for the prevention and treatment of liver diseases.

The clinical effects analysis of OLIF and CBT screw for the treatment of lumbar degenerative diseases

ZHANG Shi-hao, TAN Liang, LIN Yun-zhi, WANG Hong, FANG Guo-fang, SANG Hong-xun

Chinese Journal of Clinical Anatomy. 2020, 38(2):  198-201.  doi:10.13418/j.issn.1001-165x.2020.02.019

Abstract ( 640 )  

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Objective　To investigate the clinical effects of oblique lateral interbody fusion (OLIF) combined with cortical bone trajectory (CBT) screws internal fixation in the treatment of lumbar degenerative diseases.　Methods　32 cases with lumbar degenerative diseases were treated with OLIF and CBT screws fixation from April 2016 to April 2018. A retrospective analysis was performed to observe the operation time, intraoperative blood loss, complications, intervertebral height, intervertebral fusion time. The visual analogue scale (VAS), low back pain in patients with Oswestry disability index (ODI) were used to evaluate the clinical effect.　Results　All cases were followed up for 1-2 years, with an average of 1 year. There were 25 cases of single segment, 5 cases of two segments, 2 were adjacent segment disease after lumbar degeneration surgery, 13 male and 19 female in the 32 patients. There were statistical differences in the height of intervertebral recovery, lumbar anterior angle and lateral curvature correction angle between after operation and those of before operation (P<0.05).The intervertebral fusion time was 3.2±1.3 months, and the VAS score of lumbar and leg pain decreased from the preoperative average score (6.5±2.8) to (2.5±1.7) post-operation, (P<0.05).The ODI index decreased from (48.7±19.7) % pre-operation to (15.2±9.6) % post-operation (P<0.05).　Conclusions　OLIF combined with CBT internal fixation for the treatment of lumbar degenerative diseases is effective, with minimally invasive and few complications. It has significant clinical effect for the treatment for osteoporosis and adjacent segment disease surgery, and it is worthy in clinical application.

RhBMP-2-loaded calcium phosphate cement scaffold combined with autogenous bone grafting in the treatment of limbs nonunion 

WU Hao-jun, Tan Rong-xiong, HE Yan-xia, CHEN Hang, LIU Yan-Zhi, LIN Han, WEI Bo, ZHENG Yue-yu

Chinese Journal of Clinical Anatomy. 2020, 38(2):  202-207.  doi:10.13418/j.issn.1001-165x.2020.02.020

Abstract ( 545 )  

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Objective　To investigate the clinical effect of recombinant human bone morphogenetic protein 2(CPC/rhBMP-2)-loaded calcium phosphate cement scaffold combined with autogenous bone graft in the treatment of non-infectious atrophy type limbs nonunion.　Methods　A total of 16 patients (12 males, 4 females; aged from 16ys to 67ys, mean age: 37.06±16.31 ys) with limbs nonunion after surgical treatment of fractures from September 2013 to September  2017 were analyzed retrospectively. Bone nonunion part were  lower limbs (tibia 5 cases, femur 3 cases, calcaneus 1 case, fibula 1 case) and upper limbs (radius 3 cases, clavicle 1 case, scaphoid 1 case). All patients were treated with CPC/rhBMP-2 scaffold combined with autogenous bone grafting in the center of bone defect. Follow-up patients were treated with X-ray to observe the fractures healing after operation and record the complication till fractures healed. Upper extremity dysfunction assessment scale (DASH), lower extremity function scale (LEFS) and SF-12 quality of life scale were used to evaluate the effect pre- and post-treatment.　Results　Mean follow-up period was 16.93±4.06 months (ranged from 12 to 26 months). X-ray film showed that all fractures were healed, healing time was 3~10 months (mean 5.43±2.25 months). There were statistical difference between preoperative and postoperative DASH, LEFS and SF-12 scale (P<0.05).　Conclusions　CPC/rhBMP-2 combined with autogenous bone graft are effective and safe in the treatment of non-infectious atrophy type limbs nonunion.

Analysis of the effect of femoral head replacement with cutting off femoral quadratus muscle by posterior external approach

ZHANG Xiao-lu, FANG Kai-bin, WU Shi-qiang, CAI Li-quan, KE Qing-feng

Chinese Journal of Clinical Anatomy. 2020, 38(2):  208-211.  doi:10.13418/j.issn.1001-165x.2020.02.021

Abstract ( 589 )  

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Objective　To explore the short-term clinical effects of femoral head replacement by modified posterolateral approach and traditional posterolateral approach.　Methods　A total of 60 patients who underwent unilateral artificial femoral head replacement were collected, of which 20 underwent a modified posterolateral approach with cutting off the quadratus femoris (improved group) and 40 underwent a conventional posterolateral approach (traditional group).The operation time, the blood loss volume, haemoglobin difference pre- and post-operation VAS scores and Harris scores, postoperative complications and first landing time were compared between the two groups.　Results　All 60 patients successfully completed the operation. Compared with the traditional group, the improved group had less intraoperative blood loss, earlier first landing time after operation, longer operation time, less hemoglobin difference, higher hip Harris scores 2 weeks after operation, lower VAS scores 24 hours after operation. Two groups were Ⅰ-stage healing of incision, 1 patients in the traditional group occurred prosthesis dislocation after operation,  no dislocation occurred again after 1 month by manualreduction and immobilization. There were no statistical differences in Harris score between the two groups (P>0.05). There were no complications or prosthesis loosening in both  groups during the last follow-up.　Conclusions　The modified posterolateral approach with cutting off the quadratus femoris has the advantages of less perioperative bleeding, less postoperative pain and faster postoperative recovery, but its long-term effect remains to be further observed.

Influence of the sellar floor fenestration on the endonasal transsphenoidal surgery for pituitary adenoma under the microscope

QIN Yong, WEI Liang-feng, DING Chen-yu, XIAO De-yong, YUAN Bang-qing, LIN Kun-zhe, WANG Shou-sen

Chinese Journal of Clinical Anatomy. 2020, 38(2):  212-216.  doi:10.13418/j.issn.1001-165x.2020.02.022

Abstract ( 823 )  

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Objective　To explore the influence of the sellar floor fenestration on the microscopic endonasal transsphenoidal surgery for pituitary adenoma.　Methods　51 patients (including 22 cases of male and 29 cases of female，aged from 19 to 75) of pituitary adenoma patients who undergone microscopic endonasal transsphenoidal surgery at the 900th Hospital of the Joint Logistics Team from March 2014 to March 2015 were included in this retrospective analysis. Paranasal sinus CT and pituitary MRI scan were done for each patient before and after operation. Image fusion and reconstruction were done by Mimics15.0 software. The area of sellar floor fenestration and the vertical distance from the highest point of fenestration to planum sphenoidale were observed and measured. The relationships between them and the extent of tumor resection, intraoperative cerebrospinal fluid leakage, postoperative diabetes insipidus were analyzed retrospectively.　Results　The area of sellar floor fenestration in the total removal group was smaller than that of the incomplete resection group, while the ratio of sellar floor fenestration area to the largest tumor area in the total removal group was larger than that of the incomplete resection group. The vertical distance from the highest point of fenestration to planum sphenoidale in the intraoperative cerebrospinal fluid leakage group was shorter than that of the without intraoperative cerebrospinal fluid leakage group. The difference among of them was statistically significant (P<0.05). Logistic regression analysis showed that the ratio of sellar floor fenestration area to the largest tumor area and tumor invasion were independent predictive factors that influenced the extent of pituitary adenoma resection (P<0.05).  in There were no statistical difference on the area of sellar floor fenestration between the diabetes insipidus group and without diabetes insipidus group (P>0.05).　Conclusions　The relative insufficient of the sellar floor fenestration is one of the most important reasons for residual tumor. The higher position of the sellar floor fenestration, the more possible leakage of cerebrospinal fluid. The occurrence of postoperative diabetes insipidus were not associated with the size area of sellar floor fenestration.

Surgical treatment analysis for cervical vertigo induced by cervical spondylotic myelopathy and/or cervical spondylotic radiculopathy 

LI Rui-feng, YU Bao-long, ZHANG Pei, WU Yi-ming, HE Yong-xiong , LI Wen-xuan

Chinese Journal of Clinical Anatomy. 2020, 38(2):  217-220.  doi:10.13418/j.issn.1001-165x.2020.02.023

Abstract ( 523 )  

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Objective　To analyze the therapeutic effect of different surgical intervention on patients who suffered from vertigo induced by cervical spondylotic myelopathy and/or radiculopathy retrospectively. Methods 　62 patients diagnosed with cervical vertigo induced by cervical spondylotic myelopathy and/or radiculopathy were analyzed. Posterior cervical open-door laminoplasty was performed by 34 patients (LAM group),  anterior  cervical discectomy and fusion was performed by the rest 28 patients (ACDF group). The Committee on Hearing and Equilibrium(CHE) standards were used to record the scores of patients before and after operation, to analyze the improvement of cervical vertigo after two different surgical methods, and compare the incidence of cervical vertigo in different lesions segments．Results　In the LAM group, vertigo symptoms in 32 cases improved significantly after operation, including 25 cases completely disappeared, but the symptoms of other 2 cases had no significant remission．The remission rate of vertigo symptom was 94.11%. In the ACDF group, vertigo symptoms in 27 cases improved significantly after operation, including 25 cases completely disappeared, but the symptoms of other 1 cases had no significant remission．The remission rate of vertigo symptom was 96.42%. There were no statistical difference in incidence of vertigo when degeneration occurred in segments of  C3/4，C4/5，C5/6，C6/7 in ACDF group.　Conclusions　Surgical treatment is effective in improving the vertigo induced by cervical spondylotic myelopathy and/or radiculopathy，and there is no statistical difference in the remission rate of cervical vertigo between the two surgical methods.

Analysis of the curative effect of olecroanon osteotomy on treating of C-type intercondylar fracture of humerus

WANG Tie-nan, QIN Song, SU Yun, LI Bo-rui, WANG Jian-chuan, WANG Zhong-pu

Chinese Journal of Clinical Anatomy. 2020, 38(2):  221-224.  doi:10.13418/j.issn.1001-165x.2020.02.024

Abstract ( 465 )  

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Objective　To investigate the clinical efficacy of olecroanon osteotomy in the treatment of C-type intercondylar fracture of humerus.    Methods　50 cases of humerus intercondylar fracture with treatment of olecroanon osteotomy approach were collected from June 2015 to June 2018 (male 23, and female 27). The average time from trauma to surgery was 3 days. According to the injuries caused by different accidents, 17 cases were traffic accident, 25 cases were fall off accidents, and 8 cases were fall from accidents. According to the fracture type, 12 cases of C1 fracture, 28 cases of C2 fracture and 10 cases of C3 fracture. According to the mechanism of fracture injury, 34 cases were straightened and 16 cases were buckled. The Cassebaum Score system was used to evaluate the elbow joint function during the follow-up after operation.   Results    All patients were followed up for 12 to 18 months, with an average of 14.7 months. No displacement of bone mass or failure of internal fixation occurred in all cases, and bony healing was observed at the site of olecranon osteotomy. Evaluation of elbow joint function as follow: excellent in 25 cases, good in 18 cases, fair in 5 cases, poor in 2 cases. Excellence rate was 86%. Conclusions   The treatment of C-type intercondylar fracture of humerus by olecroanon osteotomy is satisfactory.

Suprapubic hernia combined with right oblique inguinal hernia: a case report and literature review

ZHANG Yang, HE Ju

Chinese Journal of Clinical Anatomy. 2020, 38(2):  225-226.  doi:10.13418/j.issn.1001-165x.2020.02.025

Abstract ( 355 )  

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Dorsal hand anatomy based rejuvenation injection

LIAO Zhi-feng, HONG Wei-jin, LUO Cheng-en, LI Ji-ming, LUO Sheng-kang

Chinese Journal of Clinical Anatomy. 2020, 38(2):  227-230.  doi:10.13418/j.issn.1001-165x.2020.02.026

Abstract ( 586 )  

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Research progress on vasospasm mechanism and anti-vasospasm drugs after flap transplantation

MA Qi-ming, ZHUANG Yue-hong

Chinese Journal of Clinical Anatomy. 2020, 38(2):  231-234.  doi:10.13418/j.issn.1001-165x.2020.02.027

Abstract ( 654 )  

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Relationship between endoplasmic reticulum stress protein expression of adipocytes and obesity

LUO Ming, YU Wei-qiang

Chinese Journal of Clinical Anatomy. 2020, 38(2):  235-238.  doi:10.13418/j.issn.1001-165x.2020.02.028

Abstract ( 315 )  

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One case of variation of left median nerve 

WANG Hong-bin, SUN Feng-gang, LI Feng-juan, ZHANG Chun-ju, WANG Hui, DUN Ai-she

Chinese Journal of Clinical Anatomy. 2020, 38(2):  122.  doi:10.13418/j.issn.1001-165x.2020.02.030

Abstract ( 377 )  

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Variation of 4-headed biceps brachii muscle: a case report

YU Rui, LIU Ya-qi, SHAO Qian-qian, LI Sen, KONG Chao, MA Chun-ming

Chinese Journal of Clinical Anatomy. 2020, 38(2):  170.  doi:10.13418/j.issn.1001-165x.2020.02.031

Abstract ( 569 )  

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Anatomic variation of  left tendon calcaneus: one case report

LIU Wei, HE Sheng-jiang, ZHANG Cui-ying

Chinese Journal of Clinical Anatomy. 2020, 38(2):  238.  doi:10.13418/j.issn.1001-165x.2020.02.032

Abstract ( 484 )  

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Iliac vein variation: two cases report

XU Yun, JIANG Kui

Chinese Journal of Clinical Anatomy. 2020, 38(2):  239.  doi:10.13418/j.issn.1001-165x.2020.02.029

Abstract ( 339 )  

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