Table of Content

25 November 2020 Volume 38 Issue 6

  

Applied anatomical relationship between cerebellar artery and trigeminal nerve root

TIAN Wei-dong, PENG Long-feng, ZHU Shao-lei, WANG Xiao-wen

Chinese Journal of Clinical Anatomy. 2020, 38(6):  625-628.  doi:10.13418/j.issn.1001-165x.2020.06.001

Abstract ( 3068 )  

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Objective　To observe the anatomy of the Chinese cadaver specimens, the initial position of the cerebellar artery, the characteristics of the course and the adjacent relationship between the cerebellar artery and the trigeminal nerve roots, providing anatomical basis for the trigeminal microvascular decompression operation.　Methods　Twelve adult cadaveric specimens fixed in formalin were collected, the superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery and trigeminal nerve were dissected   microscopically. At the same time, the location of the relevant arteries, nerves, and walking characteristics were observed, and the outer diameter of the initial segment of the artery and its closest distance to the trigeminal nerve root were measured.　Results　A total of 27 superior cerebellar arteries were found in 12 cadaveric heads, 2 of which compressed trigeminal nerve roots, 5 of which branches contacted with nerve roots, and the closest distance between the remaining non-contacted and the trigeminal nerves was (3.87±1.58) mm（0.55~6.30 mm）. There were 23 cases of anterior inferior cerebellar arteries, 1 of them compressed nerve root, 2 of them contacted with nerve roots, and the nearest distance with trigeminal nerve roots was (4.67±1.77) mm（2.65~9.50 mm). Twenty-one posterior inferior cerebellar arteries were found, and the closest distance to the trigeminal nerve root was (17.12±3.86) mm (10.45~25.70 mm), and there was no contact or compression between the arteries and nerve roots.　Conclusions　The superior cerebellar arteries are closely related to the trigeminal nerve roots and often contact with the roots and compresses them, which is the main anatomical basis for the occurrence of trigeminal neuralgia. The anterior inferior cerebellar artery is slightly apart from the trigeminal nerve, and can also contact with the trigeminal nerve or compress the nerve, which is one of the anatomical foundation of trigeminal neuralgia.

Investigation on the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the anatomical study

SHENG Min-feng, JIANG Lei, LI Xin, ZHANG Yi, CHEN Yan-ming, WANG Zhong-yong, LV Xuan, CHEN Gang

Chinese Journal of Clinical Anatomy. 2020, 38(6):  629-634.  doi:10.13418/j.issn.1001-165x.2020.06.002

Abstract ( 743 )  

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Objective　To explore the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the skull anatomical landmarks in order to provide the evidence for safe, accurate and fast clinical craniotomy.　Methods 　From April 2016 to June 2019, 15 skull specimens and 8 cadaver head specimens were applied. The anatomical landmarks as followed were identfied on skull specimens: the top point of the digastric groove, mastoidale, asterion and keypoint (corresponding extracracranial point of the transverse-sigmoid sinus junction). The relationship between anatomical markers of skull specimens was studied to develop the craniotomy of suboccipital retrosigmoid approach. 28 patients were performed the craniotomy in the clinical surgery by evaluating relevant indicators to evaluate the feastibility of craniotomy.　Results　(1) Anatomical study and cadaveric test: the distance from keypoint to the top point of the digastric groove was (16.79±3.50) mm (left）and (14.82±2.96) mm (right）；the distance from keypoint to asterion was (19.53±3.84) mm（left）and (22.59±4.08) mm (right）; the distance from keypoint to mastoidale was (33.98±3.87) mm (left) and (32.78±3.29) mm (right). The value of the left distance from keypoint to asterion was smaller than the right side (P=0.020). 8 cadaveric heads specimens were verified the simulate craniotomy of suboccipital retrosigmoid approach. No venous sinus injury was found. (2) Clinical application: 28 patients were performed the craniotomy of suboccipital retrosigmoid approach. Operative area was exposed clearly in 23 patients. No venous sinus rupture occurred. The average craniotomy time was (23.1±2.2) min. The size of bone flap was 1.8 cm×2.0 cm. The diameter of bone window was 2.0~2.5 cm. Bone flap was replaced during the operation.　Conclusions　In order to precisely locate the keypoint in the craniotomy of suboccipital retrosigmoid approach, the center of the burr hole can be exact oriented according to 14 mm (left)/ 12 mm (right) vertically above the top point of mastoid groove based on the line between the supraorbital margin and the upper edge of the external auditory canal. This method can insure safe, accurate and rapid craniotomy with a good vision and avoiding the injury of venous sinus.

Anatomical observation on vertebral artery-dura mater arterial ductal ligament and its clinical significance

KONG Xiang-yu, DU Xin-ru, LIU Hong-wei , WANG Jia-jia

Chinese Journal of Clinical Anatomy. 2020, 38(6):  635-638.  doi:10.13418/j.issn.1001-165x.2020.06.003

Abstract ( 1053 )  

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Objective　 To explore the fibrous connection structures between third section (V3 segment) of vertebral artery and dura mater sac as well as the surrounding bony structures of the occipital bone and also to explore the functional significance and discuss the clinical significance in hemorrhage caused by the vertebral artery rupture in operation.　Methods　Sixteen head linking neck specimens (32 sides) were selected for this investigation. The soft tissues surrounding the V3 segment of vertebral artery and the correlative connecting structure were separated. The vertebral artery-dura mater arterial ductal ligament were found and identified, their morphology and anatomical characteristics were observed. Choosing the typical vertebral artery-dura mater arterial ductal ligament to be cut into slices and stained by HE, and observed and photographed microscopically.　Results　Eleven (accounting for 43.7%) pieces of vertebral artery-dura mater arterial ductal ligament were founded among 32 sides of 16 head linking neck specimens. The longest length was 9.25 mm，the shortest was only 4.76mm. The average caliber and length were (1.16±0.15) mm and (7.39±1.33) mm respectively. The vertebral artery-dura mater arterial ductal ligament located deep to the dura meter, originated from the V3v sections and inserted either into the dura mater or into the bony structure by bifurcated several branches. The observation under light microscope showed that the histological characteristics were centrally hollow or tubular figuration, their lumen was connected with vertebral artery.　Conclusions　Vertebral artery-dura mater arterial ductal ligament is an arterial ligament connected between the V3 segment of vertebral artery and dura mater or basal part of the occipital bone. It is presented as a round tubular ligamental structure formed by occluded arterial branch arising from V3 segment of vertebral artery, it may have stationary function for V3v sections and have close relations with negative pressure formation in the cranial cavity.

The remnant circumferential cortex in pertrochanteric femoral fractures: CT image study and clinical implications

WEI Zhen, XIONG Wen-feng, ZHANG Shi-min

Chinese Journal of Clinical Anatomy. 2020, 38(6):  639-645. 

Abstract ( 632 )  

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Objective　To investigate the morphological features of circumferential proximal cortex in pertrochanteric fractures by CT-images，and providing structural basis and anatomical reference for the cortical support reduction in pertrochanteric fractures.　Methods　Eighty cases of AO/OTA 31-A1 and A2 pertrochanteric fractures were enrolled in this study. The CT scans of the cases were collected and the 3D-CT images were reconstructed by using the Mimics software. Fractures were reconstructed and simulated by 3D-CT. With the angle between the femoral shaft axis and the head-neck axis maintained at 130 degrees, the circumference of remnant circumferential cortex, width of its anterior part, lateral part, posterior part, and angle of the line between anterior and posterior broken-ends were measured.　Results　Twenty-one cases belong to type A1, the average circumferential cortex length was 88.7 mm; anterior, lateral and posterior circumferential cortex widths were 36.9 mm, 36.9 mm and 27.3 mm, respectively; and broken-ends line angle was 16.2°. 59 cases in type A2, the average circumferential cortex length was 60.0 mm; anterior, lateral and posterior circumferential cortex widths were 32.3 mm, 27.4 mm and 9.2 mm, respectively; and broken-ends line angle was 40.2°. The length of circumferential cortex in type A1 was significantly longer than that in A2 (P<0.01). On the whole, the posterior cortex had the largest variation, while anterior cortex was much more stable and showed the lowest variation (C.V were 75.5% and 20.0%).　Conclusions　There are significant differences between type A1 and A2 in circumferential cortical morphology of the proximal femur. The posterior cortex width is small and highly variable. While the anterior cortex width is much more longer and basically stable, which could be used as the main structure for the cortical support reduction.

CT localization study of brachial plexus branches and its clinical significance in Bristow-Latarjet

TAN Zhi-chao, YUAN Sheng-chao, LIN Fu-chun, DU Er-zhu, GUO Jin-hua, YANG Chun

Chinese Journal of Clinical Anatomy. 2020, 38(6):  646-651.  doi:10.13418/j.issn.1001-165x.2020.06.005

Abstract ( 591 )  

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Objective　To study the CT localization of the brachial plexus in front of the subscapularis muscle and to improve the knowledge of the safe range of Bristow-Latarjet surgical procedures. Methods　A total of 16 shoulder cadaver specimens were selected from Guangdong Medical University. Sixteen shoulder specimens were dissected and the position and stroke of the brachial plexus (musculocutaneous nerve, axillary nerve, radial nerve) trunk in front of the subscapularis muscle were marked using the development line. The distance between the musculocutaneous nerves to the anterior edge of the scapular glenoid (at the 2~5 o'clock position of the internal rotation 45° position, the neutral position and the external rotation 45° position) as well as its angular regularity with the line connecting the anterior and posterior margin of thescapular glenoid was measured at the CT level. The resulting data was processed and analyzed statistically.　Results 　(1) The brachial plexus was in front of the subscapularis muscle and the arrangement of the nerves from the inside to the outside was: the axillary nerve, the radial nerve and the musculocutaneous nerve. (2)The data of musculocutaneous nerve measured in three positions on CT horizontal position were compared among groups: angle comparison showed that there were significant differences between the internal rotation position and neutral position and external rotation position at 2~5 o'clock (all P<0.05). Distance comparison showed that there were significant differences between the external rotation position and neutral position at 2 o'clock and between the internal rotation position (all P<0.05). There was no statistical difference between the neutral position and the internal rotation position (P=0.15). There was statistical difference between the internal rotation position and the neutral position and the external rotation position at 3~5 o'clock (P<0.05). There was no significant difference between the 5 o'clock position and the neutral position (P=0.07). Intra-group comparison: the angle of 2 o'clock position of internal rotation was significantly different from that of 3~5 o'clock position (all P<0.05), and there was no significant difference between the two positions of 3~5 o'clock (all P>0.05). Pearson's analysis showed that the height of the pelvis HL was negatively correlated with the angle of 2-point position of the internal rotation position, positively correlated with the angle of 3-point position, negatively correlated with the distance of 2 o'clock position of the internal rotation position and positively correlated with the distance of 3~5 o'clock position.　Conclusions　The safe range of the musculocutaneous nerve at the internal rotation 45° position of the shoulder joint is significantly larger than that at the neutral position and the external rotation 45°position. Operation at the internal rotation position is recommended. 

Application of Mimics software to construct 3D visual anatomy of hamate bone

WEI Ming-jie, XU Yong-qing, LUO Hao-tian, WU Yi-peng, WANG Yi, ZHANG Xu-lin, WU Huan, XU Yu-jian, YUAN Li-bo

Chinese Journal of Clinical Anatomy. 2020, 38(6):  652-656.  doi:10.13418/j.issn.1001-165x.2020.06.006

Abstract ( 582 )  

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Objective　To analyze the morphology of the hook bone and its intravascular bone shape by using the mimics software 3D visualization , which provided an anatomical basis for the treatment of hook fracture and its related surgery.　Methods　Twelve cases of fresh upper limb specimens were selected. After perfusion, Micro-CT scan was performed. The data were imported into Mimics software to reconstruct the hooked bone and its blood supply.　Results　The hooked bone had 3 non-articular surfaces. The dorsal and volar surfaces were triangular, and the lateral side of the palm extended laterally to the volar side to form a hooked bone hook. The hooked bone hook was divided into a top side, a middle side and a base side. The distal joint surface of the hooked bone and the base of the 4th and 5th metacarpal bones formed the carpometacarpal joint, the radial side and the head bone formed a joint, and the ulnar side and the triangular bone formed a joint. The non-articular surface on the dorsal side was branched into a number of nourishing blood vessels into the bone of the hook bone by the micro-arterial network, and the hooked bone blood supply supplied in all directions. In the volar side of the non-articular surface hooked bone, which was, the 1-2 root nourishing blood vessels of the basal part of the hooked bone hook branched into the bone directly, and travelled to the hooked bone body and the hooked bone hook respectively. Part of the specimen had a nourishing blood vessel on the ulnar side of the base of the hooked bone, thereby entering the bone and branching into the hooked bone. There were separate small blood vessels at the tip of the hooked bone that entering and branching within the bone. The iliac bone branch of the humerus at the base of the hooked bone was consistent with the intravascular branch of the trophoblastic nucleus from the dorsal side of the hook bone and the hook of the hook.　Conclusions　The blood supply in the hook bone is rich, and ischemic necrosis is difficult to occur. The conservative treatment of nonunion of hook-and-loop fractures may be caused by the type of fracture and the degree of displacement.

Study on validity of 3D surface structured light scanner for measuring hand morphology

YU Fang, CHENG Zhi-quan, TANG Ju-yu, SUI Xin-lei, CAO Zhe-ming, PAN Ding, LI Hui

Chinese Journal of Clinical Anatomy. 2020, 38(6):  657-660.  doi:10.13418/j.issn.1001-165x.2020.06.007

Abstract ( 413 )  

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Objective　To develop a 3D hand scanning system based on structural light and to evaluate the validity of hand morphological modes.　Methods　By scanning the left hand of 5 volunteers with the self-designed 3D scanning system of structural light, the 3D images on the volar side and the dorsal side were spliced, encapsulated, filled and smoothed. Then the fingers’ length, joint circumference and width of 3D models of the hand were measured, and the measured results were compared with those obtained by the direct measurement method.　Results　The scanning time of 3D scanning system for structural light was 1 second, and the shape of the 3D hand models was realistic and the skin texture was fine. Among of the 28 measurement indexes, the difference between the dorsal length of the index and long fingers and the DIP joint circumference of the index finger were statistically significant (but all were less than 2.0 mm), and the difference between other measurement indexes was not statistically significant (all were within 1.0 mm).　Conclusions　The self-made 3D scanning system of structural light can reconstruct the soft tissue models of the hand quickly, and the 3D hand morphological models have high validity.

Effects of severed hepatic branch of vagus nerve on blood glucose and lipid levels and its relationship with mTOR expression level in rats

CAO Na, CHENG Zi-juan, LI Zhao-rui, LIU Man-jun, ZHU Lin, XIA Chun-bo

Chinese Journal of Clinical Anatomy. 2020, 38(6):  661-667.  doi:10.13418/j.issn.1001-165x.2020.06.008

Abstract ( 510 )  

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Objective　To investigate the effect of cutting vagus nerve hepatic branch on blood glucose and lipid levels and its relationship with mTOR expression level in rats, to provide experimental evidence for the study of neuromodulation mechanism of glycolipid metabolism.　Methods　Rat model of hepatic branch of vagus nerve transection was established by surgical method (n=15), and the sham operation group (n=15) with vagus hepatic branch exploration and the control group without any treatment (n=15) were set up. The levels of blood glucose, blood lipid, insulin and cortisol, glycogen content in liver and skeletal muscle and the expression of mTOR were measured every two weeks after operation.     Results    Compared with the control group, two weeks after operation, the blood glucose level of the experimental group decreased, the content of liver glycogen increased and the level of insulin increased (P<0.05). Six weeks after operation, the level of blood glucose increased, the content of glycogen in liver and skeletal muscle decreased, the level of triglyceride increased, the level of HDL decreased, and the expression of mTOR in liver and skeletal muscle increased (P<0.05). There was no significant difference between the sham group and the control group at each time point (P>0.05).    Conclusions   The transetion of rat vagus nerve hepatic branch can lead to abnormal glucose and lipid metabolism and glycogen content, which may be related to the changes in insulin level and increased expression of mTOR in liver and skeletal muscle.

Bone marrow mesenchymal stem cells transplantation attenuates type 1 diabetes mellitus by immune suppressing T cells

YU Jia-shan, YANG Wen-jiang, PENG Li-juan, GAO Jie, LI Hong, SU Min, HU Rong

Chinese Journal of Clinical Anatomy. 2020, 38(6):  668-673.  doi:10.13418/j.issn.1001-165x.2020.06.009

Abstract ( 503 )  

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Objective　To investigate the effects and mechanism of bone marrow mesenchymal stem cells (BMSCs) transplantation on Type 1 diabetes mellitus (T1DM) mice.　Methods　Isolation, culture and identification of BMSCs were performed. BMSCs supernatant was used to be the conditioned medium after third passage (P3), co-cultured with 2 weeks NOD splenocytes, and the proliferation and activation of CD4+ and CD8+T cells were detected by FACS. Two weeks female NOD mice were randomly divided into three groups: a BMSCs group, a PBS group and a control group (6 mice in each group). Mice in the control group were killed at 2 weeks. 100 μl (2×107 cells) BMSCs or equal volume PBS was injected intraperitoneally at 12 weeks in the BMSCs group and the PBS group respectively, then the mice were monitored for blood glucose and body weight till 26 weeks. Inflammatory cells infiltration of pancreases was detected by H&E, immunohistochemical and immunofluorescent staining. The splenocytes were extracted to observe the proliferation and activation of CD4+ and CD8+T cells by FACS.　Results　BMSCs were successfully isolated and cultured. BMSCs conditioned medium inhibited the proliferation and activation of CD4+ and CD8+T cells (P<0.05). Mice body weight of BMSCs group was higher than that of PBS group (P<0.05), the incidence rate of diabetes and inflammatory infiltration decreased (P<0.05) as well as the proliferation and activation of CD4+ and CD8+ T cells in the spleen (P<0.05).　Conclusions　BMSCs transplantation may attenuate T1DM by immune suppressing T cells.

Effect of TRPC6 inhibitor SAR7334 on biological behavior of cervical cancer 

JIAN Meng-chan, FAN Li, WU Yun, SHI Dan-dan, LU Min, LIU Rui, HE Xi-ju

Chinese Journal of Clinical Anatomy. 2020, 38(6):  674-679.  doi:10.13418/j.issn.1001-165x.2020.06.010

Abstract ( 397 )  

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Objective　To investigate the expression of TRPC6 in cervical cancer and the effect of its inhibitor SAR7334 on the proliferation and migration of Siha （Human cervical squamous cell carcinoma cell）.　Methods　Eleven cases of cervical squamic carcinoma diagnosed in People’s hospital of Shiyan from September 2017 to September 2019 were selected as the experimental group. Normal cervical tissue of the same patient was used as the control group. Western-blot and immunofluorescence were used to detect the expression of TRPC6; Siha cells were treated with 20, 100, 1000 nmol/L SAR7334, cell proliferation and apoptosis were detected by CCK8 method and Hoechst staining. Cell migration was detected by scratch test and Transwell test. After TRPC6 channel was blocked, the change of autophagy in Siha cells was detected by immunoblotting.　Results　The expression of TRPC6 protein in cervical cancer tissues was significantly higher than that of normal tissues. Compared with the control group, after blocking TRPC6 with 100 nmol/L SAR7334, the proliferation and migration of Siha cells reduced, the scratch healing rate reduced, and the apoptosis rate increased (P<0.05). After the TRPC6 channel was blocked, the autophagy of Siha cell weakened.　Conclusions　The expression of TRPC6 is up-regulated in cervical cancer, and its inhibitor SAR7334 may inhibit the proliferation and migration of cervical cancer Siha cells by affecting cell autophagy.

Expression of protein kinase WEE1 in gastric cancer tissue and its clinical significance

LI Jing, JIN Yu, LI Qi-yang, XU Ying-zhuo, LIU Chao, XIAO Jian-ying

Chinese Journal of Clinical Anatomy. 2020, 38(6):  680-684.  doi:10.13418/j.issn.1001-165x.2020.06.011

Abstract ( 440 )  

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Objective　To investigate the expression of protein kinase WEE1 in gastric cancer tissues and the association between its protein expression and clinical indicators of patients with gastric cancer, and to clarify its role in the occurrence and development of gastric cancer.　Methods　The Oncomine database was used to analyze the differential expression of WEE1 in gastric adenocarcinoma and gastric mucosa. Tissue microarray and immunohistochemistry were used to detect the expression of WEE1 protein using 100 cases of gastric adenocarcinoma and 80 cases of adjacent tissues. The proportion of staining in immunohistochemistry and the degree of staining were semi-quantitatively analyzed, and the correlation between semi-quantitative analysis and clinical indexes of gastric cancer patients was relevance analyzed. Furthermore, reverse transcription (RT)-polymerase chain reaction (PCR) and Western blotting were used to detect the mRNA and protein expression of WEE1 in gastric cancer cells and gastric mucosa cells.　Results　The positive rate of WEE1 in gastric cancer tissues was 86%, of which 14 cases were low expression and 86 cases were high expression of the 100 patients. Oncomine database analysis showed that the expression of WEE1 mRNA in mixed gastric adenocarcinoma was higher than that in gastric mucosa (P<0.01). The results of immunohistochemistry, RT-PCR and Western blotting showed that the expression of WEE1 in gastric cancer tissues was significantly higher than that in adjacent tissues (P<0.01). Moreover, the immunohistochemistry showed that the protein expression of WEE1 increased with the increasing clinical stage of gastric cancer (P<0.01). 　Conclusions  Protein kinase WEE1 is highly expressed in gastric cancer tissues, suggesting that it may act as one of the therapeutic targets of gastric cancer.

The effect of atorvastatin on the collateral vessel growth in hypercholesterolemia rats

TANG Yin-juan, LUO Hua, ZHU Guo-fu, CAI Wei-jun, LUO Ming-ying

Chinese Journal of Clinical Anatomy. 2020, 38(6):  685-690.  doi:10.13418/j.issn.1001-165x.2020.06.012

Abstract ( 338 )  

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Objective To investigate the effect of atorvastatin on the collateral vessel growth in hypercholesterolemia rats.　Methods　Twenty-eight adult SD rats were given a high-fat diet for 8 weeks, to establish a model of collateral vessel growth induced by ligature of femoral artery in hypercholesterolemia rats hind limb. Rats were randomly divided into a ligation-only group (L group), a hypercholesterolemia + ligation group (HL group), and an atorvastatin (0.3mg/kg/2w, intraperitoneal injection) + hypercholesterolemia + ligation group (AL group). After a 7-day survival, the effects of atorvastatin on collateral vessel growth and the change of the expression pattern of important cytokines were detected by angiography, HE staining, and confocal immunofluorescence.　Results　Compared with the L group, the number of collateral vessels in the HL group reduced, and the collateral vessels growth was impaired, showing that the intimal hyperplasia was manifested and the tunica media was significantly thickened, resulting in narrowing of the vascular lumen, and cell proliferation of the vascular wall and decreasing of the adventitia inflammatory cells. Compared with the HL group, after the application of atorvastatin in the AL group, the growth of collateral vessels significantly improved, and developed into collateral vessels with a larger lumen. The cell proliferation of vascular wall, the adventitia inflammatory cells, and the number of visible collateral vessels all increased. There were statistical significance among the number of collateral vessels, cross sectional area of collateral vessels and the immunofluorescence intensity difference (P<0.05).  Conclusions　Hypercholestero- lemia impairs the growth of collateral vessels in the rat hind limbs. Atorvastatin can improve the proliferation of vascular wall cells and the increasing of adventitia macrophage cells, resulting in promoting and restoring the growth of collateral vessels.

Regulation of SOX9 by HOXD13 may be related to the occurrence of congenital foot malformation

WANG Zheng-dong, YAN Nan, LIU Li-ying, LI Shu, CHEN Yao, KONG Si-hui, LI Pei-yuan, JIN Chun-lian

Chinese Journal of Clinical Anatomy. 2020, 38(6):  691-696.  doi:10.13418/j.issn.1001-165x.2020.06.013

Abstract ( 381 )  

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Objective　To study the molecular mechanism of HOXD13 and SOX9 genes in the occurrence of foot soft tissue malformation of idiopathic congenital talipes equinovarus (ICTEV).　Methods  3 HOXD13 binding sites upstream of 5 'of SOX9 gene were predicted by the software, and luciferase activity of serial truncated and mutant vector in promoter region of SOX9 gene was detected. The binding effect of HOXD13 to the 3 sites of SOX9 gene promoter was verified by ChIP in vivo. The expression levels of HOXD13 and SOX9 were detected by qRT-PCR.　Results　A negative regulatory region between -1158 to -770 bp (site 1) and -512 to -368 bp (site 3) in the upstream of SOX9 gene 5' was found by the Luciferase. Between -770 and -512bp (locus 2) was a positive regulatory region. ChIP results showed that HOXD13 could bind to SOX9 locus 3.The mRNA expression of SOX9 gene was up-regulated by interference of HOXD13 expression.　Conclusions　The expression of SOX9 gene was up-regulated by HOXD13 in combination with the negative regulation region of SOX9 gene 5' upstream. The interference of HOXD13 up-regulated SOX9 gene expression may be related to the occurrence of soft tissue contracture on the ankle of foot.

Study on the accuracy of three dimensional reconstruction and three dimensional printing technique in the measurement of pelvic three dimensional features

ZHANG Yong , ZHANG Yan-ru , YANG Yun-feng , LU Yan , TONG Zhao-hui

Chinese Journal of Clinical Anatomy. 2020, 38(6):  697-702.  doi:10.13418/j.issn.1001-165x.2020.06.014

Abstract ( 410 )  

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Objective　To evaluate the differences among the 3D measurement results of the cadaver pelvis, its digital 3D reconstruction model and 3D printing models. 　Methods 　A middle-aged male pelvic specimen was selected and a total of 14 feature points were selected and fixed on the surface of the pelvic specimen according to the physiological structure characteristics of the pelvis. The 1mm CT scan was performed on this pelvic specimen with fixed feature points. The Delta Medical Studio (DMS) was used to reconstruct the scanned image and record the 3D coordinates of the feature points. The 3D reconstruction model was printed by the 3D printing equipment (Melt deposiition modeling, FDM and Stereo Lithography Appearance, SLA), and the 3D coordinates of the recorded feature points were measured by a CMM. The distances and the angles among the feature points of the cadaver specimen, the digital model and the 3D printing solid models were calculated through the recorded 3D coordinates. The errors of the three groups of data were analyzed from the perspectives of maximum error, average error and t-value verification.　Results   The mean distance and angle measurement errors of the digital 3D reconstruction pelvic model were about 0.5mm and 0.35 degree, respectively. The mean distance error of the 3D printing models was about 0.8 ~ 1.1mm, and the mean angle error was about 0.4~0.5 degree.　Conclusions　The 3D reconstruction model and the 3D printing models are reliable for the preoperative reference of the pelvis in terms of the accuracy of feature measurement. The 3D reconstruction model or the 3D printing model can be selected as the reference object for the preoperative planning of the pelvis according to the actual needs.

Surgical essentials and early clinical effects of biportal endoscopic lumbar intervertebral fusion in the treatment of degenerative lumbar disease

LIANG Chang-xiang, ZHENG Xiao-qing, XIAO Dan, HUANG Yong-xiong, LIANG Guo-yan, CHEN Chong, YIN Dong, CHANG Yun-bing

Chinese Journal of Clinical Anatomy. 2020, 38(6):  703-708.  doi:10.13418/j.issn.1001-165x.2020.06.015

Abstract ( 540 )  

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Objective　To introduce and discuss surgical highlights and advantages of BELIF (Biportal Endoscopic Lumbar Intervertebral Fusion), its short-term clinical therapeutic efficacy and potential surgical complications.　Methods　BELIF surgery was performed on 54 patients (Male: 24 cases, female: 30 cases, age: 38~79 years old) and they were followed-up at least 3 months. The VAS and ODI scores were recorded before and afer surgery. The total operation time and microscopic operation time，the perioperative complications of the patients and the perioperative bleeding volume were recorded and calculated. The percentage of bone graft area in the total intervertebral disc area was measured.    Results   The VAS score of low back pain improved from (6.13±0.64) before operation to (2.21±1.04) the last follow-up (P<0.05). The ODI score improved from (46.54±13.75) before operation to (14.78±9.23) (P<0.05). The average operation time was 164 min and the average endoscopic time was 102 min. The average bleeding volume was (156±31) ml. The average area of bone graft was (48.5±9.4)%. There was no serious complications.   Conclusions    BELIF is a minimally invasive, safe and efficient lumbar fusion surgery with good short-term clinical effect and few complications.

Comparison of the clinical application of percutaneous endoscopic TESSY and BESI technology in L5~S1 disc herniation 

XUE Hou-jun, PAN Lei, HUANG Jie-bin, LEI Yu, WANG Shi-cheng, CHEN Wei-xiong

Chinese Journal of Clinical Anatomy. 2020, 38(6):  709-714.  doi:10.13418/j.issn.1001-165x.2020.06.016

Abstract ( 368 )  

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Objective　To compare the clinical application of percutaneous endoscopic BEIS and TESSY technology in L5~S1 disc herniation and to evaluate its clinical value.　Methods　Sixty patients with L5-S1 disc herniation treated by Foshan Sixth People's Hospital from January 2018 to June 2019 were collected and were randomly divided into the following two groups: a BEIS technology group (observation group) and a TESSY technology group (control group), each with 30 cases, and were followed up for 6~18 months. The gender, age, time of operation, number of X-ray machines in C-arm during operation, postoperative complications and surgical results were compared between the two groups to evaluate the therapeutic effect and clinical value of different techniques.　Results　Sixty patients were followed up for 12 months on average, there were no statistical difference in gender, age of the two groups  (P>0.05). Compared with the TESSY group, the BEIS group had shorter operation time and fewer C-arm fluoroscopy, with statistically significant difference (P<0.05). During the 6 months after surgery follow-up and the last time follow-up, there were no statistical difference in the VAS and ODI scores of the two groups (P>0.05) . There was one case of postoperative recurrence in each of the two groups, both recovered well after the second open operation, and there was no statistical difference in the incidence of postoperative complications (P>0.05).　Conclusions　Percutaneous endoscopic BEIS and TESSY are safe, effective and minimally invasive treatments for L5~S1 disc herniation and BEIS is easier to master. BEIS technology have certain advantages in the operation time and intraoperative perspective on treatment of the L5~S1 disc herniation.

Endoscopic treatment the diseases of anterior medial and inferior wall of maxillary sinus by prelacimal recess approach

WU Xiao-qin , KANG Yuan-chun, ZHOU Liu-feng, LIU Hai-bin, YANG Zi-xuan, PENG Hu, JI Zhen-hua, CHENG Yin, ZHANG Guo-min, CHEN Jin-huang, XIE Kai-peng

Chinese Journal of Clinical Anatomy. 2020, 38(6):  715-718.  doi:10.13418/j.issn.1001-165x.2020.06.017

Abstract ( 552 )  

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Objective　To investigate the clinical effect of the treatment on the diseases of anterior medial and inferior wall of maxillary sinus by endoscopic prelacimal recess approach.　Methods　The clinical data of 67 patients with various maxillary sinus lesions treated by crypt in the treatment of various maxillary sinus lesions were analyzed retrospectively in the three hospitals from January 2008 to January 2018.　Results　Twenty cases of lower wall cysts in the upper jaw sinus, 6 cases of lower wall polyps in the upper jaw sinus, 2 cases of internal epithelial papilloma, 23 cases of fungal globular sinusitis, 13 cases of allergic reactive fungal sinusitis, 1 case of chronic aggressive fungal sinusitis. All patients were followed-up regularly after surgery for more than half a year without relapse.　Conclusions　The prelacrimal recess approach under nasal endoscope can fully expose the maxillary sinus cavity and completely remove the lesions in the maxillary sinus. The operation is convenient and can effectively treat various benign lesions of the maxillary sinus, such as obvious prelacrimal recess and alveolar recess, it can be used as the first choice of surgical approach for maxillary sinus anterior medial inferior wall lesions.

Clinical effect of tonsillotomy in children with obstructive sleep apnea hypopnea syndrome

ZENG Xian­ping, CHEN Xiao­ming, ZHANG Hong­tao, CAO Chen, GUO Xue­xue, LI Qian­ying, CHEN He­xin, ZHENG Ying

Chinese Journal of Clinical Anatomy. 2020, 38(6):  719-722.  doi:10.13418/j.issn.1001-165x.2020.06.018

Abstract ( 340 )  

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Objective　To explore the potential benefits of partial tonsillectomy in the treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS).　Methods　From August 2016 to January 2019, 138 patients of tonsil hypertrophy combined with adenoid hypertrophy were treated with partial tonsillectomy(TT group, 69 cases) and total tonsillectomy (TE group, 69 cases). The pain index (PI), intraoperative blood loss (IBL), time of operation (TO) ，the number of  postoperative bleeding people (POB) , number of postoperative fever people (PF),  number of upper respiratory infections people within 1 year after operation  (URIs), hospital-length of stay (HLOS), apnea hyponea index  within 2 months after surgery and the amount of time taken to resume a “normal” diet (POFT) between the two groups were compared. 　Results　In patients of the TE group, the average IBL was significantly more than that of the TT group，and the TO was also extended accordingly, while postoperative fever is rare. Due to the more frequently use of bipolar electrocoagulation, the PI of the TE group was also significantly higher than that in the TT group [(5.9 ±0.5) vs (3.1±0.4)].  The PF in the TT group was significantly more than that in the TE group, while the HLOS in the TT group was shorter than that in the TE group [(4.8±2.3) d vs (6.4±1.8) d]. In the TT group, the amount of time taken to resume a “normal” diet was slightly shorter than that in the TE group, but apnea hyponea index  of both groups was significantly lower than that before operation.　Conclusions　The partial tonsillectomy with the advantage of less IBL, low chance of intraoperative bleeding, remission of obstructive sleep apner hypopnea for children, is worth to promote in the clinical application.  

Clinical value of Tardus Parvus waveform and contrast-enhanced ultrasound microperfusion quantitative technique in hepatic artery stenosis after liver transplantation

ZHAO Ning-bo, FENG Wen-xia, DENG Fen, DONG Chang-feng, ZHOU Peng, GONG Xue-hao

Chinese Journal of Clinical Anatomy. 2020, 38(6):  723-727.  doi:10.13418/j.issn.1001-165x.2020.06.019

Abstract ( 429 )  

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Objective   To explore the clinical value of Tardus Parvus waveform and contrast-enhanced ultrasound (CEUS) microperfusion quantitative technique in hepatic artery stenosis after liver transplantation.   Methods　Sixty cases of liver transplantation patients of hepatic artery doppler ultrasound, ultrasonic imaging and CTA/DSA examination data were collected separately. The systolic peak of hepatic artery doppler ultrasound blood flow velocity (PSV), end-diastolic velocity (EDV), resistance index (RI), acceleration time (SAT) were recorded. Tardus Parvus waveform of the diagnostic criteria were RI < 0.5 and SAT > 0.8 s. Contrast-enhanced ultrasound was used to record quantitative parameters such as marginal region of liver and central region basic identity (BI), arrival time (AT), peak intensity (PI), time to peak (TTP), absolute value of difference in real enhancement identity (REI) between the central region and the marginal region. Patients were divided into two groups according to the standard of hepatic artery stenosis rate ≥ 50% diagnosed by CTA or DSA: a hepatic artery stenosis group and a non-stenosis group.  Results   Doppler ultrasound in the hepatic artery stenosis group showed positive Tardus Parvus waveform (P<0.05). Compared with the non-stenosis group, absolute value of difference in REI between the central region and the marginal region reduced (P<0.05), and TTP in the central region prolonged (P<0.05).  Conclusions   Tardus Parvus waveform and contrast-enhanced microperfusion quantitative technique have a certain value in the diagnosis of hepatic artery stenosis after liver transplantation. 

Analysis of surgical factors of failure of PFNA after intertrochanteric fracture

NIU Guo-qing, WU Feng, PENG Zhi-hao, LU Guo-liang, HUO Zhi-qian

Chinese Journal of Clinical Anatomy. 2020, 38(6):  728-734.  doi:10.13418/j.issn.1001-165x.2020.06.020

Abstract ( 561 )  

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Objective　To investigate the operative factors of failure in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA).　Methods　The material of patients with intertrochanteric fracture who accepted fixation with PFNA were conducted from September 2015 to September 2018 in our hospital and were analyzed retrospectively. Patients who failed in PFNA fixation were 24. Preoperative lateral wall fracture, postoperative reduction mass of medial femoral trochanteric cortex, region of spiral blade located on X-ray film, and the tip-apex distance (TAD) were observed through the X-ray film of preoperative, postoperative and internal fixation failure.　Results　In the 24 cases who failed in PFNA fixation, 13 cases (accounting for 54%) had lateral wall fractures before operation, 5 cases had dangerous lateral wall fractures, and 6 cases had no lateral wall fractures. While there were 16 cases (accounting for 67%) of medial cortical reduction negative support, 6 cases of positive support and 2 cases of neutral support. At the same time, there were 16 cases (accounting for 67%) with TAD>25 mm, 6 cases with TAD between 10mm~25mm, 2 cases with TAD<10 mm. In the region of spiral blade located on the positive X-ray film, there were 19 cases (accounting for 79%) located on the upper side, 3 cases in the middle-lower side and 2 cases in the lower side. In addition, in the lateral X-ray film, there were 17 cases (accounting for 71%) located in the front side, 5 cases in the back side, and 2 cases in the middle side.　Conclusions　The risk of internal fixation increase when there were lateral wall fractures before operation, poor medial cortex reduction, oversize TAD and poor location of spiral blade on the X-ray film in the femoral intertrochanteric fracture fixed with PFNA.

Giant hydronephrosis and bladder stone in one female patient

TU He-ping, WANG Kai-bao, LIU Guang-yi, ZHONG Hui, ZHANG Ji-qing

Chinese Journal of Clinical Anatomy. 2020, 38(6):  735-736.  doi:10.13418/j.issn.1001-165x.2020.06.021

Abstract ( 405 )  

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Perfusion and anatomy of cerebral blood vessels in SD rats

WANG Wei, MU Shu-wen, SHANG Ming-chao, WANG Shou-sen

Chinese Journal of Clinical Anatomy. 2020, 38(6):  737-738.  doi:10.13418/j.issn.1001-165x.2020.06.022

Abstract ( 400 )  

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The concept of lateral femoral wall thickness and its clinical value

WEI Zhen, ZHANG Kai, ZHANG Shi-min

Chinese Journal of Clinical Anatomy. 2020, 38(6):  739-742.  doi:10.13418/j.issn.1001-165x.2020.06.023

Abstract ( 567 )  

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Research progress of the anatomical characteristics and clinical significance of the accessory renal artery

HAN Shuai-hong, JIA Jie-dong, ZHANG Bin, WANG Dong-wen

Chinese Journal of Clinical Anatomy. 2020, 38(6):  743-744.  doi:10.13418/j.issn.1001-165x.2020.06.024

Abstract ( 618 )  

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Application progress of topology optimization design combined with 3D printing technology in medical metal implants

WEN Xiang-yuan, ZHENG Qiu-bao, ZHAN Xiao-rui, WANG Hua, FAN Shi-cai

Chinese Journal of Clinical Anatomy. 2020, 38(6):  745-748.  doi:10.13418/j.issn.1001-165x.2020.06.025

Abstract ( 201 )  

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Variation of right hapatic artery and accessory hepatic duct: one case report

WANG Ya-jie, MA Jian-jun, ZHANG Ge-ge, YANG Biao, ZHU Xing-qiang, BAI Yun-zheng, HUANG Zi-rui, ZHAO Xuan-jie

Chinese Journal of Clinical Anatomy. 2020, 38(6):  645.  doi:10.13418/j.issn.1001-165x.2020.06.026

Abstract ( 488 )  

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Variation of hepatic duct and cystic artery: a case report

HE Yue, SHAN Zeng-qiang, HUANG De-huan, LIANG-Jin-bao, SUN Cheng

Chinese Journal of Clinical Anatomy. 2020, 38(6):  734.  doi:10.13418/j.issn.1001-165x.2020.06.027

Abstract ( 294 )  

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Variation of the left vertebra arteries: one case report

GU Kai-li , FANG Rui-xian, XIA-Zi-yi, LIU Shan-shan, MAO Shu-lian, QIN Xiang-zheng, QUAN Gui-hong, LIU Huan-yu, PIAO Cheng-zhe

Chinese Journal of Clinical Anatomy. 2020, 38(6):  742.  doi:10.13418/j.issn.1001-165x.2020.06.028

Abstract ( 583 )  

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