Table of Content

25 March 2021 Volume 39 Issue 2

  

Morphological classification of the lateral ankle ligaments and clinical significance

Zhou Yunfeng, Xu Dazheng, Chen Zhong, Yao Huosheng, Zhang Congda, Li Weiping, Shen Huiyong, Song Bin

Chinese Journal of Clinical Anatomy. 2021, 39(2):  121-125.  doi:10.13418/j.issn.1001-165x.2021.02.001

Abstract ( 1546 )   PDF (3912KB) ( 127 )  

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Objective　To study the morphological characteristics of lateral ankle ligaments and to explore their clinical significance.　Methods　Dissection was performed on 43 ankle specimens. Bundle number, route, origin and insertion for each lateral ankle ligament, and fibrous relationship near their attachments were observed and recorded.　Results　Anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) were dissected in all specimens. According to the number of ATFL bundles, the single bundle, double bundles and three bundles were defined as typeⅠ, typeⅡ and typeⅢ, accounting for 27.9%, 65.1 % and 7%, respectively. Based on the surface-deep position of the insertions of ATFL and CFL fibers at the fibula, they were divided into the following type: superficial type (8 cases, accounting for 18.6%), parallel type (19 cases, accounting for 44.2%), deep type (9 cases, accounting for 20.9%) and mixed type (7 cases, accounting for 16.3%). According to the superior-inferior attachment of ATFL-CFL, the insertion was divided into the following type: total type (5 cases, accounting for 9.3%), superior type (15 cases, accounting for 34.9%) and inferior type (24 cases, accounting for 55.8%). In 7 specimens, ATFL and CFL inserted on fibula with a complex structure, accounting for 16.3% of the total sample size. Lateral talocalcaneal ligament (LTCL) was present in 46.5% (20/43) specimens: type A 25.6%, type B 20.9%. LTCL was absent in the remaining 23 cases (53.5%).　Conclusions　The lateral ankle ligaments in Chinese specimens has some morphological variability. Morphological study would be helpful for clinical diagnosis and treatment, and it might provide anatomical basis for further exploration of the function of these ligaments.

Applied anatomy study of zoneⅠ extensor terminal tendon insertion and its adjacent tissues  

Zhao Wentao, Zhao Min

Chinese Journal of Clinical Anatomy. 2021, 39(2):  126-129.  doi:10.13418/j.issn.1001-165x.2021.02.002

Abstract ( 1520 )   PDF (3094KB) ( 70 )  

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Objective　To provide anatomical basis for mini plate internal fixation of bony mallet finger by anatomical study of the zoneⅠ terminal extensor tendon and adjacent tissues.　Methods　Ten adult hand cadavers’ upper limb specimens were dissected and the anatomical relationships between nail matrix, nail root and zoneⅠ terminal extensor tendon were observed. Microscopically, the distance from the terminal extensor tendon to nail root, nail matrix, articular surface were measured. The width of zoneⅠ terminal extensor tendon and the transverse and vertical diameters of phalangette joints were measured.　Results　The proximal margin of the nail root did not completely cover the germinal matrix, and the distance between the zoneⅠ terminal extensor tendon and the germinal matrix was（1.21±0.21）mm.There was a loose connective tissue between them. The width of terminal extensor tendon was（6.27±1.23）mm,  horizontal thickness was (1.02±0.21) mm. The distance between the zoneⅠ terminal extensor tendon and the articular of the distal interphalanx was （1.22±0.21）mm. The transverse diameter of the distal phalanx articular surface was (8.00±2.21)  mm, the longitudinal diameter was （6.22±1.21）mm. ZoneⅠ terminal extensor tendon was closely connected to the dorsal articular capsule of distal interphalangeal joint.　Conclusions　The longitudinal dorsal median skin incision on the distal phalangeal bone can fully reveal the tissue structure around zoneⅠ terminal extensor tendon. In fixing the avulsed fracture fragment of the distal phalanx, the plate is partially overlapped with the nail matrix, and the nail root and nail matrix need to be partially incised. The terminal extensor tendon is closely linked to the dorsal capsule of distal interphalangeal joint, where the zoneⅠterminal extensor tendon has a dorsal fibrous cartilage tissue plate, just like the volar plate.

Anatomical study on the branch of pig femoral head retinacular artery

Zhang Xiangnan, Deng Wei, Zhang Songqiang, Li Lei, Zhou Guangliang, Ju Faxin, Ju Wen, Zhou Zhenghu, Li Guanxing, Ju Jihui, Hou Ruixing

Chinese Journal of Clinical Anatomy. 2021, 39(2):  130-133.  doi:10.13418/j.issn.1001-165x.2021.02.003

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Objective　To explore the number, distribution and outer diameter of retinacular artery branch of pig femoral head and its significance.　Methods　Thirty-nine isolated pig femoral head specimens with peri-hip vessels were dissected, the retinacular artery were separated, and microperfusion was performed with 30% barium sulfate suspension. The shape, number, distribution and outer diameter of the retinacular artery's entry branch were observed. The distribution of the arterial head was recorded according to the time points. The micrometer was used to measure the external diameter of the retinacular artery branch. The position of the thickest branch of the retinacular artery in each group were measured statistically.　Results　There were（6.10±1.32） arteries in the pig femoral head, which were mainly divided into three groups: a posterosuperior group, a posteroinferior group and an anterior retinacular artery group. The clock points of the thickest branch head of each group of retinacular artery were （11:22~01:29），（06:36~08:15），（02:01~03:59）o'clock, respectively. The diameters of the three groups were（0.37±0.11），（0.52±0.11），（0.35±0.09）mm, respectively.　Conclusions　The number and location of the pig femoral head inlet arteries are relatively constant. The average diameter of the thickest branch of the pig femoral head inlet arteries is（0.52±0.11）mm, which origining from the posteroinferior retinacular artery group  and is an important blood supply source for pig femoral head.

Anatomical research on the morphology and blood supply of the trapezium bone and trapezoid bone

Wang Yakang, Xu Yongqing, Yuan Libo, Zhang Xulin, Xu Yujian , Luo Haotian, Wei Mingjie

Chinese Journal of Clinical Anatomy. 2021, 39(2):  134-139.  doi: 10.13418/j.issn.1001-165x.2021.02.004

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Objective　To observe the morphology and blood supply pattern of the trapezium bone and trapezoid bone, and provide reasonable anatomical basis for the clinical application.　Methods　Twelve wrist specimens were perfused with a mixture of lead oxide and gelatin powder into the main arteries of the wrist. After the perfusion, the Micro-CT scan was performed. The scanning data were imported into the software of Mimics for three-dimensional reconstruction. The morphology of the trapezium bone and trapezoid bone was observed, the number and location of the nutrient foramens were recorded, and the anastomosis and course of the blood vessels in the bone were analyzed.　Results 　(1)The trapezium bone had a relatively constant number of nutrient foramen distributed on the three non-articular surfaces, which was (2.66±0.49) foramen on the radial side, (2.75±0.62) foramen on the dorsal side, and (2.33±0.65) foramen on the volar side, there were no statistical difference in the number of nutrient foramen among the three non-articular sides. The nourishing blood vessels branched out after penetrating into the bone and widely anastomosed with each other. About 70% of the blood supply in the bone came from the dorsal side, while 30% came from the volar and radial sides. (2) The trapezoid bone had a relatively constant number of nutrient foramen distributed on the two non-articular surfaces, (2.75±0.45) foramen on the dorsal side, and (2.42±0.51) foramen on the volar side, there were no statistical difference in the number of nutrient foramens between the two non-articular sides. The nourishing blood vessels branched out after penetrating into the bone, but its intraosseous blood vessel branch anastomosis was not as rich as that of the trapezium bone. About 70% of the blood supply in the bone came from the dorsal side, and 30% came from the volar side.　Conclusions　(1) The trapezium bone is rich in nourishing blood vessels from inside and outside the bone, which may be the reason why the incidence of the trapezium bone avascular necrosis is lower than other carpal bones. (2) The nourishing blood vessels outside the trapezoid bone are relatively abundant, but the intraosseous vascular anastomosis is not as rich as the large bone, this may be the main reason why the trapezoid bone are more prone to non-traumatic ischemic osteonecrosis than the trapezium bone.

Study on the relationship between cerebellum development and gestational age in neonatal infants 

Liu Ruike, Li Guifang, Du Xueqian, Chen Shuai

Chinese Journal of Clinical Anatomy. 2021, 39(2):  140-144.  doi:10.13418/j.issn.1001-165x.2021.02.005

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Objective　To analyze cerebellum development with gestational age and to evaluate clinical early cerebellum development,  by means of cranial ultrasound to measure the neonatal cerebellum for gestational age of 25 to 41 weeks on the day of birth.　Methods 　Three hundred and eighteen eligible cranial ultrasound images of neonates of appropriate for gestational age from 25 to 41 weeks were selected. Transverse cerebellar diameter, vermis height, vermis diameter, vermis circumference and vermis area were measured for statistical analysis.　Results　Transverse cerebellar diameter formed a linear equation with the gestational age, which was Y=0.1036X+0.1929 (R2=0.727，P<0.001). Vermis height formed a linear equation with the gestational age, which was Y=0.069X-0.3156 (R2=0.823，P<0.001). Vermis diameter formed a linear equation with the gestational age, which was Y=0.0509X-0.5798 (R2=0.735，P<0.001). Vermis circumference formed a linear equation with the gestational age, which was Y=0.2811X-1.5932 (R2=0.782，P<0.001). Vermis area formed a linear equation with the gestational age, which was Y=0.2283X-4.4559 (R2=0.817，P<0.001). The vermis height had the strongest positive correlation with the gestational age (r=0.907，P<0.001). Conclusions   The results of this study provide that the cerebellar extrauterine reference range among transverse cerebellar diameter, vermis height, vermis diameter, vermis circumference, vermis area of neonates of appropriate for gestational age and gestational age, which is helpful for clinical diagnosis and evaluation of cerebellum growth and development of newborns.

Anatomical study on CT images of peripancreatic fascia and interfascia and its clinical significance

Zhou Xiaobo, Xu Gangchao, Liu Qiang

Chinese Journal of Clinical Anatomy. 2021, 39(2):  145-147.  doi:10.13418/j.issn.1001-165x.2021.02.006

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Objective　To explore the correlation between peripancreatic fascia, fascia space in abdominal CT images and peripancreatic fascia in fresh adult cadaver specimens and to provide guidance for minimally invasive pancreatic surgery.　Methods　One hundred and fifty-six patients with acute pancreatitis in Huidong County People's Hospital were selected in this study. The characteristics of the peripancreatic CT scan images of their abdomen were summarized. At the same time, 5 fresh adult cadaver specimens provided by the department of anatomy at Southern Medical University were selected for dissection to explore the corresponding relationship between abdominal CT images of peripancreatic fascia and fascia space and the cadaver specimens.　Results 　The anterior fascia and posterior fascia of pancreas and anterior renal fascia could be observed simultaneously in a small number of patients with acute pancreatitis on abdominal CT scan image and fresh adult cadaver specimens. The prepancreatic space was between the pancreatic parenchyma and the anterior pancreatic fascia.  The retropancreatic   space was between the pancreatic parenchyma and the posterior pancreatic fascia. The retropancreatic fusion fascia space was between the posterior pancreatic fascia of posterior pancreas and the anterior renal fascia.　Conclusions 　In a few patients with acute pancreatitis, the peripancreatic fascia and fascia space can be observed on the CT scan images, which corresponds to fresh adult cadaver specimens.

Accurate localization and removal of deeply imbedded metallic foreign bodies in human limbs assisted by positioning device

Su Weiwei, He Zaopeng, Zhang Guodong, Li Wei, Xu Jing, Liao Zhengwen, Xie Pusheng, Lin Dongxin, Huang Wenhua

Chinese Journal of Clinical Anatomy. 2021, 39(2):  148-153.  doi:10.13418/j.issn.1001-165x.2021.02.007

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Objective　To explore the application of the new positioning device on the accurate localization and removal surgery of deeply imbedded metallic foreign bodies.　Methods　Ten human limb specimens were used and 65 metal balls with a diameter of 2.0 mm were inserted. This experiment was divided into an experimental group, which was the actual locating result of the 65 cases of foreign bodies, and a control group, which was the theoretical optimal locating result of the 65 cases of foreign bodies. After localization with assistance of the locating device, a thin layer CT scan and 3D reconstruction were performed to measure the positioning deviation distance (D1). The qualified positioning numbers of different accuracy levels was counted. The chi square test was performed to obtain the positioning accuracy of the locating device and the fluoroscopy time (T1) and removal time of the foreign body (T2) were recorded.　Results　All 65 metallic foreign bodies were located and removed precisely, with mean T1: 46.06±18.44 seconds and T2: 177.10±65.87 seconds. The location accuracy of this device was 2.3mm.　Conclusions　With the aid of this positioning device, the precise localization and removal of deeply embedded metallic foreign bodies in human limbs can be achieved.

The role of miR-206 on regulation of ERK1/2 signaling pathway by targeting Cx43 in rabbit steroid-induced avascular necrosis of femoral head model

Xi Yuan, Luo Gaobin, Wei Guiqing, Qin Wentao, Bo Zhandong

Chinese Journal of Clinical Anatomy. 2021, 39(2):  154-160.  doi:10.13418/j.issn.1001-165x.2021.02.008

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Objective　To explore the role of MicroRNA(miR)-206 on regulating of extracellular signal-regulated protein kinase(ERK) 1/2 signaling pathway by targeting connexin(Cx) 43 in rabbit model of steroid-induced avascular necrosis of femoral head.　Methods　Sixty mature rabbits were randomly divided into a model group (n=30) and a control group (n=30). Rabbit model of femoral head necrosis was made with lipopolysaccharide (LPS) and methylprednisolone (MPS). The establishment of the model was determined by MRI and HE staining after modeled 2、8 and 16 weeks. Total RNA and protein were extracted from the femoral head. In situ hybridization and Quantitative Real-time PCR (qPCR) were employed to detect the change of miRNA-206; qPCR, western blot and immunohistochemistry were used to detect the expression of Cx43、ERK1/2 and Runx2.　Results　The model success rate was 70%. In situ hybridization result showed that the miR-206 expressed in rabbit femoral head medullary space, osteoblasts and osteocyte. Compared with the control group, miR-206 expression of the model group up-regulated at 2 weeks, 8 weeks and 16 weeks after modeling, the expression of Cx43 and Runx2 mRNA in the model group down-regulated, the expression of Cx43、ERK1/2 and Runx2 protein in the model group also down-regulated.　Conclusions miR-206 can be involved in the occurrence, development and repair of steroid-induced femoral head necrosis by down-regulating its target protein CX43, inhibiting the ERK1/2 signaling pathway and osteogenic differentiation. 

Role of Nrf2/ARE signaling pathways in reduction of ischemia-reperfusion injury by morphine preconditioning in rats with heart failure induced by doxorubicin hydrochloride

Tan Yongli, Tang Huijie, Tian Yuan

Chinese Journal of Clinical Anatomy. 2021, 39(2):  161-168.  doi:10.13418/j.issn.1001-165x.2021.02.009

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Objective　To investigate the role of the nuclear factor E2 related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway in reduction of myocardial ischemia-reperfusion injury (MIRI) by morphine preconditioning in rats with heart failure induced by doxorubicin hydrochloride.　Methods　The HF model rats were randomly divided into the following 5 groups: a sham group, a model group, a MFC group, a MOA group and an OAD group. The normal group was set at the same time. The HF model rats were ligated at the anterior descending branch of the left coronary artery for 30 minutes and then were perfused for 120 minutes to construct the MIRI model. The MFC group rats were pretreated with morphine before operation. The OAD group rats were pretreated with Nrf2/ARE signaling pathway inhibitor before operation, the MOA group with Nrf2/ARE signaling pathway inhibitor plus morphine.  TUNEL was used to detect the apoptosis rate. Western blot was used to detect the expressions of Nrf2 and HO-1.　Results Compared with the normal group, the apoptosis rate and the expressions of Nrf2 and HO-1 in the model group significantly increased. Compared with the model group, the apoptosis rate of the MFC group significantly reduced, and the expressions of Nrf2 and HO-1 significantly increased. Compared with the MFC group, the apoptosis rate of the MOA group significantly increased, and the expressions of Nrf2 and HO-1 significantly reduced. Compared with the model group, the apoptosis rate of the OAD group significantly increased, and the expressions of Nrf2 and HO-1 significantly increased. There were statistical differences in the expressions of Nrf2, HO-1 and the apoptosis rate among the groups (P<0.05).　Conclusions　In the MIRI rat model induced by HF, morphine preconditioning can obviously activate the Nrf2/ARE pathway and inhibit cell apoptosis.

Effect of E003 on the ultrastructural changes of decidual tissues in RSA model mice 

Long Shenggen, Zhang Zhiqin, Huang Zhihui, Xia Leizhen, Tang Liang, Wu Qiongfang, Huang Ouping

Chinese Journal of Clinical Anatomy. 2021, 39(2):  169-173.  doi:10.13418/j.issn.1001-165x.2021.02.010

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Objective　To observe the ultrastructural changes of decidual tissues in recurrent spontaneous abortion (RSA) model mice after treated with E003.　Methods　The RSA model mice was established, the experiment was divided into the following four groups: a normal pregnancy control group, a RSA model group, a low dose E003 group and a high dose E003 group.  After 14 days of continuous gavage of E003, decidual tissues were taken. Light microscope was used to observe the vascular and cell morphology of decidual tissue, ultrastructure of decidual tissue.　Results　The uterus was dissected to calculate the absorption rate of the embryo. The results showed that the E003 treatment group (low-dose group and high-dose group) had lower embryo absorption rate than that of the RSA model group, and the difference was statistically significant (P<0.05).There was no significant difference in embryo absorption rate between the high-dose E003 group and the normal pregnancy group (P>0.05). Compared with the normal pregnancy group, the number of decidual cells in RSA model group significantly reduced. Compared with the model group, the decidua cells in the low dose group and the high dose group increased in number and were arranged neatly. Under electron microscope, the volume of deciduous cell in the RSA model group decreased compared with the normal pregnancy group, the space of cells was larger, vascular wall was incomplete, vascular endothelial cell structure was incomplete and the nucleus was fusiform. Compared with the model group, the intercellular space and volume of decidual cell volume in the E003 low-dose group increased. The vascular wall was more complete, the vascular endothelial cells were long fusiform, the vascular endothelial cell structure was more complete, and the intercellular space was slightly wider. The decidual cell tissue and blood vessel in the high-dose E003 group was close to the normal pregrancy group.    Conclusions    RSA model mice have the barrier of maternal-fetal interface angiogenesis, and E003 can repair the damaged cell structure in the decidua tissue of RSA model mice, improve the morphology of angiogenesis and organelles, which has a certain therapeutic effect on RSA model mice.

Trichostatin A mediates apoptosis of MDA-MB-231 cells via JNK / MAPK signaling pathway

Zhang Haiyan, Sun Lihui, Pan Hongming, Li Lin, Lian Jie, Yu Jing, Lang Weiya

Chinese Journal of Clinical Anatomy. 2021, 39(2):  174-181.  doi:10.13418/j.issn.1001-165x.2021.02.011

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　Objective　To explore the effect and mechanism of Trichostatin A (TSA) on the cell proliferation and apoptosis of breast cancer MDA-MB-23.　Methods　MTT, plate cloning experiments, flow cytometry were used to detect the effect of TSA on cell biological functions. qPCR and Western blot were applied to detect the effect of TSA on proliferation, apoptosis and MAPK signaling pathway. Mechanisms were detect by JNK pathway inhibitor in treatment.　Results　TSA inhibited the proliferation and apoptosis of breast cancer MDA-MB-231 cells in a dose-dependent manner; TSA could block the cell cycle of breast cancer MDA-MB-231 cells in G1 phase. TSA could upregulate the expression of protein and mRNA on P21, caspase-3, Bax and p-JNK, and down-regulate the expression of protein and mRNA of cyclin D1, Cdk4 and Bcl-2. The inhibition of JNK pathway inhibited the expression of p-JNK and the total apoptosis rate of MDA-MB-231 cells. The expression of Caspase-3, Bax and Bcl-2 decreased.　Conclusions　TSA can induce the apoptosis of MDA-MB-231 cells, the mechanism of which is to regulate the expression of apoptotic protein and induce apoptosis through phosphorylation of JNK in MAPK signaling pathway.

Research on the biocompatibility and biomechanics of citrate-based biodegradable screws 

Yang Cheng , Li Zhen, Liao Jianwen, Fan Shicai, Yang Jian, Bai Xiaochun

Chinese Journal of Clinical Anatomy. 2021, 39(2):  182-186.  doi:10.13418/j.issn.1001-165x.2021.02.012

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weighing, 8-11 kg) were selected to prepare the models (AO classification type: B1) of bilateral lateral femoral condyle fracture. Right fracture was fixed with POC-click-HA absorbable cannulated screws as an experimental group and left fracture with Poly-DL-Lactic acid(PDLLA) screws as a control group. At 4, 8, and 12 weeks after operation, general observation was done, Lane - Sandhu histologic grading, biomechanics were taken for observing fracture healing.　Results　All aniamls survived to the end of the experiment. General observations showed that no fracture displacement occurred and fracture healed at 12 weeks in the two groups. POC - click - HA screws degraded and new bone tissue was found from samples at 12 weeks. According to the Lane - Sandhu histologic grading, , there was no statistical difference between two groups in the screws at 4, 8, and 12 weeks after operation (P>0.05). Biomechanics test showed that the maximum load at the nail-bone interface of the POC-click-HA group was lower than that of the PDLLA group at 4 weeks after operation (P<0.05). While there was no significant difference between the two groups at 8 weeks and 12 weeks (P>0.05). 　Conclusions　Citric acid polymer composite hydroxyapatite (POC-click-HA) screw has good biocompatibility and biomechanics,which can be better utilized for Beagles’ lateral femoral condyle B1 fractures. 

Seabuckthorn polysaccharide alleviates insulin resistance, liver and kidney function damage in diabetic rats by inhibiting PERK/ATF4/CHOP pathway

Yao Lan, Jiang Chengxia, Guo Yanyan, You Chengshan, Li Mei, Ye Xujuan

Chinese Journal of Clinical Anatomy. 2021, 39(2):  187-191.  doi:10.13418/j.issn.1001-165x.2021.02.013187

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Objective　To investigate the effects of seabuckthorn polysaccharide (SP) on insulin resistance, liver and kidney function damage in diabetic rats.　Methods　Rats were randomly divided into the following groups: a control group, a streptozocin  (STZ) group, a rosiglitazone (RSG) group (4 mg.kg-1.d-1) and a low, a medium and a high dose SP group (50, 100, 200 mg.kg-1.d-1). All rats except the control group were established as type II diabetes model. After drug treatment, the body weight, bilateral kidney weight, fasting blood sugar and insulin levels were measured by balance, blood glucose meter and Elisa, and renal hypertrophy index and insulin resistance index were calculated. The levels of HbA1C and adiponectin were detected by Elisa, and the levels of TG, TC, LDL-C, HDL-C, PRO, Scr and BUN were detected by biochemical analyzer. Oil red O and HE staining were used to observe hepatic fat deposition and renal histomorphology. Western Blot was used to detect the activation level of PERK/ATF4/CHOP pathway. Results　Compared with the model group, the body weight, adiponectin and HDL-C content in the medium and high doses of SP group significantly increased (P<0.05). While the blood glucose content, insulin resistance index, kidney hypertrophy index, HbA1C, plasma insulin, the levels of TG, TC, LDL-C, proteinuria, Scr, BUN in the medium and high doses of SP group significantly down-regulated (P<0.05). SP could alleviate liver lipid deposition and kidney damage, and inhibit the activity of PERK/ATF4/CHOP pathway in rats.　Conclusions　Seabucthorn Polysaccharide can alleviate insulin resistance, liver and kidney function damage in diabetic rats, its mechanism may be related to the inhibition of PERK/ATF4/CHOP pathway activity.

Clinical study of minimally invasive percutaneous screw fixation for digital treatment of talar posterior process fractures

Wei Ke, Chen Qiwang, Mao Haijiao

Chinese Journal of Clinical Anatomy. 2021, 39(2):  192-195.  doi:10.13418/j.issn.1001-165x.2021.02.014

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Objective　To investigate the clinical effect of digital technology assisted minimally invasive percutaneous screw fixation in the treatment of talar posterior process fractures.　Methods　A total of 19 patients with talar fracture treated from June 2014 to December 2018 were selected, including 13 males and 6 females, aged from 28 to 57 years, with an average of 37.7 years. The causes of injury were 5 cases of car accident injuries, 11 cases of fall injuries from heights, and 3 cases of sprains. There were 11 cases of talar posterior process fracture, 4 cases of subtalar joint dislocation, 2 cases of ankle fracture, and 2 cases of calcaneus fracture. Digital technology was used to perform precise minimally invasive surgery on the above patients. The AOFAS Ankle Hindfoot Scale and Visual Analogue Score (VAS score) were used to evaluate the function of the affected foot before operation and at the last follow-up.　Results　Nineteen patients were followed up for 9 months to 22 months, with an average of 14.2 months. All patients had no complications such as incision infection, fracture displacement, vascular and nerve injury, and unhealed bone. AOFAS ankle-hindfoot score: preoperative (38.8±12.4) points and postoperative (87.0 ±6.4) points. VAS score: preoperative (4.8±1.2) points and postoperative (1.0±0.7) points. The AOFAS ankle- hindfoot score was excellent in 17 cases of patients and good in 2 cases of patients.　Conclusions　The application of digital technology assisted minimally invasive percutaneous screw fixation in the treatment of talar posterior process fractures can improve the accuracy of surgery, shorten the operation time, and reduce surgical trauma.

Clinical characteristics of dynamic changes of serum creatine kinase in popliteal artery injury in different planes

Mao Jianjie, Gao Jianming

Chinese Journal of Clinical Anatomy. 2021, 39(2):  196-201.  doi:10.13418/j.issn.1001-165x.2021.02.015

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Objective　To investigate the clinical significance about the severity of trauma to the affected limb caused by popliteal artery injury at different levels, to evaluate the role of sural artery in repair of popliteal artery trauma.　Methods　One hundred and three patients with unilateral knee fracture (dislocation) who were admitted to our hospital from January 2010 to December 2019 were collected. Sixty-eight patients with popliteal artery injury were divided into a high group (n=16) and a low group (n=52) according to whether the injury level was higher than the sural artery or not, the remaining 35 patients were in a control group. The CK (creatine kinase) of three groups before operation and 1 day, 3 days, 7days, 15 days after operation were compared and analyzed.　Results　CK value in the high group was significantly higher than that in the low group, while the low group was higher than the control group (F=217.709, P<0.001). There were significant differences in CK value among the three groups at the same time point (before operation, 1 day, 3 days, 7 days 15 days after operation) (P<0.001). There were statistical differences in CK value at each time point in the high group (P<0.05); there were no statistical differences in CK value between before operation and 7 days after operation (P=0.930), 1 day and 3 days after operation (P=0.195) in the low group.　Conclusions　The degree of limb ischemia and injury  in the high group is more serious than that in the low group. The sural artery is the main reason for CK difference at different injury planes of popliteal artery, and it has a compensatory effect.

Repair soft tissue defects of distal termination of leg and around the foot and ankle with perforators positioning technique assisited by color dopplerultrasound

Kang Yongqiang, Rui Yongjun, Wu Yongwei, Ma Yunhong, Liu Jun, Gu Jun, Xu Peng, Lin Fang

Chinese Journal of Clinical Anatomy. 2021, 39(2):  202-206.  doi:10.13418/j.issn.1001-165x.2021.02.016

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Objective　To assess clinical efficacy of perforators positioning technique in perforator pedicled propeller flap of the leg reconstructing soft tissue defects of distal termination of leg and around the foot and ankle. 　Methods　Forty-six patients with soft-tissue defects in distal termination of leg and around the foot and ankle (33 males and 13 females, aged from 27 to 68 years with an average of 48.2 ) were collected to our hospital from January of 2013 to August of 2017 and were analyzed retrospectively. The defect areas was 21 cm×8 cm~8.5 cm×5.5 cm. All the patients underwent secondary repair and the repair time was 5 days~42 days after injury. Preoperative perforator positioning of the flap through the method of color doppler ultrasound(CDS) was performed. Thirty-one cases of posterior tibial artery perforators and 15 cases of radial artery perforators were included. Preoperative color doppler ultrasound was used to locate the perforator branch, and the skin flap was designed according to the perforator branch and the wound surface. The accuracy of perforator branch positioning was verified during the operation. Postoperative survival rate, complications and seven indicators of skin flap were evaluated.　Results　The coincidence rate was 89.1% during the operation. One case had complete necrosis after flap operation and 4 cases of anterolateral thigh perforator flaps distal partial necrosed. Thirty-four patients were sutured directly through donor incision. Twelve donor sites were skin grafted, 2 patients had partial necrosis of skin grafts, and the other donor sites healed well. In this group, one patient did not heal the infected wound around the skin flap after surgery, and two patients had a small part of skin graft necrosis in the donor site. Forty-three patients were followed up ranged 5 to 46 months (average of 14.3 months). According to the evaluation 7 indicators of skin flap function, 14 cases were excellent, 23 cases were good , 3 cases were fair, and 3 cases were poor , with an excellent and good rate of 86.0%.　　Conclusions　The preoperative color Doppler ultrasound localized perforator pedicled propeller flaps have good effect on repairing the wound of the distal leg and around the foot and ankle, with satisfactory appearance and high clinical practicality.

Digital anatomical and clinical study on the reconstruction of scaphoid nonunion with 1，2 intercompartmental supraretinacular artery vascularized graft

Lv Jing, Liu Lihong, WEI Jianwei, Dong Zhonggen, Chen Yufei

Chinese Journal of Clinical Anatomy. 2021, 39(2):  207-210.  doi:10.13418/j.issn.1001-165x.2021.02.017

Abstract ( 416 )   PDF (2958KB) ( 43 )  

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Objective　To investigate the feasibility and evaluate the clinical efficacy of reconstructing scaphoid nonunion using a first and second intercompartmental supraretinacular artery (1,2 ICSRA) vascularized graft.　Methods 　The CT data of 47 patients with normal wrist joint were collected, and the distance from the tip of styloid of radius to the distal and proximal poles of the long axis of scaphoid were measured and compared with the length of vascular pedicle of 1,2 ICSRA to analyze the feasibility of 1,2 ICSRA vascularized graft for reconstruction of scaphoid nonunion. Twenty-three patients with scaphoid nonunion were treated with 1,2 ICSRA vascularized graft and Herbert screw internal fixation, and the healing of the fracture of patients were followed up and the postoperative efficacy of patients were evaluated by Cooney wrist score.　Results　The average distance from the tip of styloid radius to the proximal and distal poles of the long axis of scaphoid were (15.66±1.89) mm and (17.07±1.60) mm, respectively, which were much less than the length of vascular pedicle of 1,2 ICSRA. The mean follow-up duration was（51.08±11.30）months after the surgery for 23 cases, and bone union was achieved in all patients. At the last follow-up, the pain of wrist completely disappeared in 21 cases, and 2 cases felt slightly pain when they overworked, but the symptom of these patients were significantly improved. Cooney wrist score improved significantly from (62.39±7.21) points before the operation to（92.39±4.23）points at the last postoperative visit, and the difference was statistically significant (t=17.213，P=0). According to Cooney wrist score, the results were rated as excellent in 20 cases, good in 3 cases.　Conclusions 　1,2 ICSRA vascularized graft can cover any part of scaphoid, so this method is feasible. 1,2 ICSRA vascularized graft is an effective treatment for patients with scaphoid nonunion. 

Clinical application of right posterior mediastinal pleura suspension in the cleaning of group 7 lymph nodes

Bao Feng, Wu Zongyang, Yuan Yunfeng

Chinese Journal of Clinical Anatomy. 2021, 39(2):  211-215.  doi: 10.13418/j.issn.1001-165x.2021.02.018

Abstract ( 337 )   PDF (2993KB) ( 91 )  

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Objective　To analyze the effect of right posterior mediastinal pleura suspension on lymph node dissection, operation time and related complications in group 7 of minimally invasive lung cancer operation.　Methods　A retrospective analysis of 58 patients with right lung cancer treated by thoracoscopic surgery in our hospital from March 2018 to December 2019, among them, 31 patients were treated with right posterior mediastinal pleura suspension to clean the group 7 lymph nodes, and 27 patients were treated with conventional methods to clean the group 7 lymph nodes.　Results　Compared with the routine method group, the number of lymph nodes in the 7th group of mediastinal pleural suspension group increased significantly [(3.35 ± 0.20)piece vs. (2.46±0.47)piece]. There was no significant difference in the time of lymph node dissection [(9.25±3.85) min vs. (9.71±3.21) min], and no significant difference in the related complications, such as air duct injury, esophageal injury and intraoperative drainage.　Conclusions　In the thoracoscopic operation of right lung cancer, the method of posterior mediastinal pleura suspension can clean the group 7 lymph nodes safely and thoroughly without increasing the operation time and perioperative complications.

Imaging anatomical characteristics and clinical manifestations of fungal sinusitis in the first consultation ophthalmology

Zhang Li, Kang Yuanchun, Liu Haibin, Su Zhiqiang, Peng Hu, Hong Xiaodong, Ji Zhenhua, Wang Zhiping, Wu Xiaoqin, Zou Liufeng, Cheng Yin, Yang Zixuan, Chen Jinhuang, Zhang Guomin

Chinese Journal of Clinical Anatomy. 2021, 39(2):  216-219.  doi:10.13418/j.issn.1001-165x.2021.02.019

Abstract ( 381 )   PDF (2265KB) ( 68 )  

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　Objective　To analyze the imaging anatomical and clinical characteristics of fungal sinusitis, which is dominated by eye symptoms.　Methods　Two hundred and eighty-five patients with fungal sinusitis admitted to the department of otolaryngology and neck surgery in three hospitals from January 2008 to January 2018 were selected, and the clinical data of 20 patients in the first consultation ophthalmology were collected, the characteristics and causes of clinical misdiagnosis were analyzed.　Results　The lesions of the 20 cases first consultation ophthalmology were mainly located in sieve sinus (3 cases), sphenoid sinus (2 cases), maxillary sinus combined with ethmoid sinus (3 cases), 8 cases of ethmoid sinus combined with sphenoid sinus, maxillary sinus combined with ethmoid sinus and sphenoid sinus (4 cases). The ocular symptoms mainly included unilateral swelling pain, diminution of vision, vision change, facial pain and headache.　Conclusions　Patients admitted to the department of ophthalmology with unilateral swelling pain and diminution of vision should consider the possibility of fungal sinusitis and then should be transferred to department of otolaryngology for treatment after sinus CT examination.

Clinical comparative study of modified nasal endoscopic dacryocystorhinostomy and modified external nasal approach dacryocystorhinostomy

Zhang Min , Song Daoliang , Han Xuefeng , Wang Shaopeng , Liu Yongliang

Chinese Journal of Clinical Anatomy. 2021, 39(2):  220-223.  doi:10.13418/j.issn.1001-165x.2021.02.020

Abstract ( 272 )   PDF (1148KB) ( 36 )  

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Objective　To compare the clinical effects between modified nasal endoscopic dacryocystorhinostomy and modified external nasal dacryocystorhinostomy.　Methods　Eighty-four patients with chronic dacryocystitis in our hospital from January 2013 to December 2017 were randomly divided into two groups: an observation group (n=44, treated with modified nasal endoscopic dacryocystorhinostomy) and a control group (n=40, treated with modified external nasal dacryocystorhinostomy). The patients were followed up for 12 months to observe the cure rate, effective rate, operation time and the incidence of complications.　Results　In the observation group, the cure rate  was 91.5%, the effective rate was 97.7%, the average operation time was 40 minutes, and the incidence of complications was 2.3%. In the control group, the cure rate was 81%, the effective rate was 90.5%, the average operation time was 60 minutes, and the incidence of complications was 9.5%. There was significant difference in curative effect between the two groups (P<0.05).   Conclusions　Modified nasal endoscopic dacryocystorhinostomy in the treatment of chronic dacryocystitis has the advantages of high clinical effect, short operation time, few complications and high patient satisfaction, which is worth to be promoted.

Comparison of open angle of two different methods to make hinges in cervical expansive laminoplasty

Yu Lanzhe, Cui Shangbin, Wei Fuxin, Wang Le, Liu Shaoyu

Chinese Journal of Clinical Anatomy. 2021, 39(2):  224-227.  doi:10.13418/j.issn.1001-165x.2021.02.021

Abstract ( 262 )   PDF (2395KB) ( 61 )  

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Objective 　To investigate the effects of 20° sharp rongeur or high-speed-micro- drill on the open angle to make hinges in cervical posterior open-door expansive laminoplasty.　Methods 　Patients who received cervical posterior open-door expansive laminoplasty were collected in our hospital and were followed up prospectively. They were divided into 2 following groups according to the instrument of making hinges, which are a 20°sharp rongeur group and a high speed micro-drill group. Cervical vertebra computed tomography (CT) was performed before operation and within 1 week after operation in all patients. The angles between the lamina and the coronal vertebral body on the CT cross-section were measured before and after surgery. Then these data were statistically analyzed.    Results    40 patients were collected in and were followed up, including 23 cases in the rongeur group and 17 cases in the drill group. In the rongeur group, the mean angle between the open segment lamina and the coronal plane before operation was (37.58±4.09)°, while the angle in the drill group was (36.19±3.92)°, which showed no statistical difference between them (P=0.286). And the open angle of the rongeur group after operation was (62.27±3.99)°, while (67.17±3.48)° in drill group, which were significantly different (P<0.001). In addition, there were statistical difference in the lamina expansion angle, preoperative and postoperative open angle ratio, and expansion rate of open angle between these two groups (P<0.01).    Conclusions    Using 20° sharp rongeur to make hinges can control the open angle more precisely and closer to the ideal open angle than using high speed micro-drill.

Clinical experience of modified diorthosis on upper eyelid relaxation for 136 elderly patients 

Fu Furen, Xie Yide

Chinese Journal of Clinical Anatomy. 2021, 39(2):  228-230.  doi:10.13418/j.issn.1001-165x.2021.02.022

Abstract ( 578 )   PDF (1219KB) ( 32 )  

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Objective　To explore the effect of an modified diorthosis on upper eyelid relaxation in old age.　Methods　One hundred and thirty-six cases of patients with the modified diorthosis on upper eyelid relaxation from June 2016 to March 2019 were collected. An incision line ACBDA with the appearance of "dolphin-like" incision was designed. Point A was located at the lower edge of the eyebrows about 0.5~1 cm. Point B was on the extension line of connecting line between the ipsilateral nasal alar and the lateral canthus. A vertical line at lateral canthus angel E and arc line AB was intersecting at point A.  Two equidistant points C and D above and below point O were set. Point B was flexible according to the degree of crow’s feet. The eyebrow and part of the eyebrow body were preserved, and the inner eyebrow tail and the surrounding skin in the ACBDA line were completely resected, the eyebrow fat pad was lifted and fixed, the orbicularis oculi muscle on the lower brow was suspended and fixed, the cosmetic incision was sutured by layers.    Results    No blepharochalasis and crow's-feet occurred within 6 months after follow-up, and the result of operation was satisfactory. There were 46 cases on 6 months to 12 months follow-up, and 4 cases with skin ptosis of lateral canthus and upper eyelid. The remaining surgical results were satisfactory.    Conclusions     The modified diorthosis on the upper eyelid relaxation is simple. It is a good method to correct severe upper eyelid relaxation in the elderly and is worthy of clinical application.

Repair of leg wound with anterior lateral thigh flap with venous arterialization：one case report

Deng Wei, Ju Jihui, Li Lei, Zhou Zhenghu, Li Changsong

Chinese Journal of Clinical Anatomy. 2021, 39(2):  231-232.  doi:10.13418/j.issn.1001-165x.2021.02.023

Abstract ( 248 )   PDF (1118KB) ( 6 )  

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Views merged method of CT venography display the spatial conformation of subdural hematoma and adjacent veins

Xu Weiming, Lin Yuke , Lin Jianbin, Chen Chongze, Wang Wei, Mu Shuwen, Wang Cheng, Wang Shousen

Chinese Journal of Clinical Anatomy. 2021, 39(2):  233-236.  doi:10.13418/j.issn.1001-165x.2021.02.024

Abstract ( 386 )   PDF (3607KB) ( 98 )  

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Research on the methods of the posterior skull surface-embedding by horizontal and coronal incision

Xiao Zhaoming, Xu Guangwei, Li Zeyu, Liu Chang, Wu Kuncheng, Luo Baohua, Liang Haibin, Ma Ziwei, Luo Shiwen, Luo Jianheng  

Chinese Journal of Clinical Anatomy. 2021, 39(2):  237-239.  doi:10.13418/j.issn.1001-165x.2021.02.025

Abstract ( 346 )   PDF (2903KB) ( 8 )  

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Objective　To make the structure of the skull become hard, make the holes, joints and pipes well preserved by using the epoxy resin AB glue to bury the surface of the posterior skull by horizontal and coronal incision, which was the most easily damaged.　Methods　Forty-eight skull specimens were randomly divided into 8 groups. Each group were immersed individually into the epoxy resin AB glue in the organic glass box at different times. When soaking, there were gas discharging from the inside of the specimen for about 1 min.When there was no obvious large bubble, hemostatic forceps was used to clamp the edge of the thick skull wall to take out the skull, and the skull was held for a while above the plexiglass box and was gently shaken. After the flow of glue on the skull surface was basically dry, the skull was placed horizontally on the silicone plate and left it standing for 24 h.    Results    High transparency of the specimens and smooth skull wall can help to identify clearly the specimen structure. The skeleton stress of the fragile parts significantly enhanced. The skeleton , which was easy to fall off, was more closely connected with the skull. There were no obvious blockage and agglomeration on the surface of embedded skull specimens within 60 min after full stirring.   Conclusions    At room temperature, the appropriate time for skull surface embedding was within 60 min after full mixing of epoxy resin AB glue. The skull specimen after surface embedding  can better solve the dilemmas of not being easily damaged and not being touched in the course of experimental teaching.

Application of the P45 sectional plastination technique in applied anatomic study

Sun Shizhu, Yu Shengbo, Sui Hongjin

Chinese Journal of Clinical Anatomy. 2021, 39(2):  240-243.  doi:10.13418/j.issn.1001-165x.2021.02.026

Abstract ( 402 )   PDF (3288KB) ( 87 )  

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Anatomical variation of bilateral talonavicular coalition: a case report and literature review

Li Junhua, Liao Liqing, Li Yikai

Chinese Journal of Clinical Anatomy. 2021, 39(2):  244-245.  doi: 10.13418/j.issn.1001-165x.2021.02.027

Abstract ( 244 )   PDF (1777KB) ( 14 )  

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Abnornal course of median artery and absence of superficial palmar arch and musculi palmaris longus: a case report

Li Kun, Li Zhihong, Gu Jun, Zhang Peng, Lv Yehui

Chinese Journal of Clinical Anatomy. 2021, 39(2):  246.  doi: 10.13418/j.issn.1001-165x.2021.02.028

Abstract ( 270 )   PDF (1714KB) ( 22 )  

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