Table of Content

25 July 2021 Volume 39 Issue 4

  

Anatomical observation of the extraforaminal ligaments of the cervical spine 

Gao Qiang, Fan Lei, Li Xiaobin, Cai Teng, Zhao Jianjun, Zhao Qinghao, Liu Tao

Chinese Journal of Clinical Anatomy. 2021, 39(4):  375-378.  doi:10.13418/j.issn.1001-165x.2021.04.001

Abstract ( 643 )   PDF (546KB) ( 82 )  

References | Related Articles | Metrics

Objective　To describe the extraforaminal ligaments in the exit regions of the C2~7 intervertebral foramina and to discuss their possible clinical significance.　Methods　A total of 100 C2~7 intervertebral foramina from 10 adult cadavers were anatomically observed. All the ligaments that appeared were identified. The number, morphology, distribution, starting and ending position of the ligaments were observed and recorded. The length, width and thickness of each ligament were measured by vernier calipers. Results　There were 252 extraforaminal ligaments in the 100 intervertebral foramina. The extraforaminal ligaments could be divided into  radioactive ligaments (236pcs, accounting for 93.7%) and  transforaminal ligaments (16pcs, accounting for 6.3%). Radioactive ligaments, which connected the nerve root to the surrounding structures, could be divided into superior ligaments (accounting for 25.0%), inferior ligaments (accounting for 60.2%), anterior ligaments (accounting for 6.3%) and posterior ligaments (accounting for 8.5%). The transforaminal ligaments were perpendicular to the nerve root and straddled the nerve root. The transforaminal ligaments were the most common in C4~5 ligaments. The average length of the transforaminal ligaments at C4~5 intervertebral foramina was (8.12±1.38) mm (6.28~9.93 mm), and the thickest was 1.04 mm. There was one transforaminal ligament at most per cervical foramina.　Conclusions　The extraforaminal ligaments is a normal physiological structure of intervertebral foramen and may be related to the occurrence of C5 nerve palsy after cervical decompression surgery. After cervical decompression surgery, the transforaminal ligaments may be one of the potential causes of nerve root entrapment and nerve injury. The radioactive ligament could limit the displacement of spinal nerves and may cause nerve injury by traction.

Morphological characteristics of the vertebral artery and the first cervical nerve through dura meter and its relation to occipital pain in hypertension  

Du Xinru, Kong Xiangyu, Guo Sen , Wang Jiajia

Chinese Journal of Clinical Anatomy. 2021, 39(4):  379-383.  doi:10.13418/j.issn.1001-165x.2021.04.002

Abstract ( 379 )   PDF (5015KB) ( 157 )  

References | Related Articles | Metrics

Objective　To observe the morphological characteristics and adjacent structures of the vertebral artery and the first cervical nerve through the dura meter, and to explore the mechanism of hypertension combined with occipitocervical pain.   Methods    Eighteen cranial-neck specimens were dissected and exposed to observe the position of the vertebral artery and adjacent structures, relationship between the first cervical nerve and vertebral artery.　Results　The vertebral artery passed through the dura mater in the posterior part of the lateral atlanto-occipital joint, forming a round hole with smooth edge. Diameter of the hole was 6.5~9.0 mm. The dura mater and the adventitia of the vertebral artery were connected by fibrous connective tissue. The anterior and posterior roots of C1 nerve originated from the spinal cord and ran laterally to the medial side of the vertebral artery and were accompanied by the dural foramen below it (100%), among which 12 cases (accounting for 66.7%) were attached to the artery wall. Four patients (accounting for 22.2%) had nerve insertion into arterial wall. Dural organizers were found in 2 cases (accounting for 11.1%). After exiting the foramen, the C1 nerve root passed the vertebral artery and the vertebral artery sulcus.　Conclusions　The position of vertebral artery is fixed, the hole edge is density. The position limits the expansion of vertebral artery, which is helpful to maintain vertebral artery cervical activity. When systemic blood pressure fluctuates, in order to maintain the stability of circulating hemodynamics, vertebral artery diameter does not change significantly. However, elevated blood pressure may press C1 cervical nerve root into the dural edge. The pulsation of the vertebral artery stimulates the C1 cervical nerve root, leading to vertebrooccipital muscle spasm and occipital neck pain. This may be the morphological basis of hypertension with occipitocervical symptoms. 

Anatomical study and clinical significance of the middle axillary approach in the treatment of T₂~T₅ vertebral lesions

Hou Jun, Shi Dongdong, Pan Qing, Chen Changcheng, Chen Qianfen

Chinese Journal of Clinical Anatomy. 2021, 39(4):  384-388.  doi:10.13418/j.issn.1001-165x.2021.04.003

Abstract ( 806 )   PDF (2352KB) ( 122 )  

References | Related Articles | Metrics

Objective　To study the anatomical relationship between thoracic  vertebral body (T2~T5) and adjacent tissue structure, and to explore the feasibility of treating the T2~T5 vertebral body lesion through the middle axillary approach.　Methods　Ten (20 sides) formalin-treated cadaveric specimens with intact thoracic and upper limbs  were selected to simulate T2~T5 vertebral surgery through the left and right mid-axillary thoracic approaches, respectively, and then dissected layer by layer to the lateral front of the thoracic spine. The length of the skin incision, the longitudinal width of the rib fracture were observed.  The upper and lower ends of the opening, the upper edge of the aortic arch, the highest point of the sacral arch, the position of the vertebral body of the thoracic duct, and the distance between the thoracic sympathetic trunk and the anterior edge of the costal joint were extended to simulate the operation of T3 vertebral body resection + rib bone graft + plate screw internal fixation.　Results　The length of the mid-axillary skin incision was (11.63 ±0.50) cm, and the width of the third rib was (7.04±0.47) cm. The upper and lower ends of the brace were flat on the 2nd and 5th thoracic vertebrae. The upper edge of the aortic arch flat T3 was 70%, the highest point of the venous arch flat T4 was 60%, and the thoracic duct crossing T5 from the front was 70%. The distance from the sympathetic trunk to the leading edge of the first rib joint was (6.84±0.55) mm, (6.99±0.51) mm, (6.98±0.56) mm, (7.07±0.47) mm, respectively. The simulated surgical field can exposed the T2~T5 vertebra. The adjacent structures were relatively fixed, which can safely and effectively complete the surgical operation of removing the bone graft and internal fixation and reconstructing the stability of the thoracic spine. Conclusions　The middle axillary approach is a treatment for T2~T5 vertebral lesions, which has the advantages of good visual field, less trauma, and high safety.

Anatomical study and clinical application of supraclavicular endoscopic surgery for thoracic outlet syndrome

Wei Ruihong, Zhuang Yongqing, Liu Yingnan, Wen Guifen, Ke Yanna, Liu Zhidong, Chen Chun-ling, Huang Jietao, Liu Zhaokang, Xu Tao, Lao Jie

Chinese Journal of Clinical Anatomy. 2021, 39(4):  388-391.  doi:10.13418/j.issn.1001-165x.2021.04.004

Abstract ( 375 )   PDF (4703KB) ( 77 )  

References | Related Articles | Metrics

Objective　To report the anatomical study and clinical effect of supraclavicular endoscopic surgery for thoracic outlet syndrome.　Methods　Adult specimens were selected to study anatomically the structures of the lateral cervical region and the anterior cervical region, and the supraclavicular approach was selected for endoscopic simulation operation to determine the optimal approach point. According to the results of anatomical study, endoscopic supraclavicular approach was applied in the treatment of thoracic outlet syndrome.　Results　Anatomic study showed that the best approach of endoscopic surgery was  the intersection point between the sternocleidomastoid muscle and 60% of the total length of the sternocleidomastoid muscle and the posterior margin of the sternocleidomastoid muscle when the head was slightly inclined to the opposite side at 60 °. The transverse cervical artery was the anatomic specific marker of endoscopic operation. Five patients underwent endoscopic supraclavicular approach surgery clinically. The mean follow-up time was 25 months (12~36 months). According to Roos criteria, 4 cases were excellent and 1 case was good.　Conclusions　Endoscopic surgery via supraclavicular approach for thoracic outlet syndrome has its anatomical basis, and its clinical application is safe and feasible. It can effectively relieve the compression of brachial plexus in thoracic outlet syndrome with satisfactory effect.

Localization of the centers of intramuscular nerve dense regions of the adult teres major muscle and its significance in blocking spasticity

Luo Huaixiang, Ji Songling, Yang Shengbo

Chinese Journal of Clinical Anatomy. 2021, 39(4):  392-395.  doi:10.13418/j.issn.1001-165x.2021.04.005

Abstract ( 427 )   PDF (3494KB) ( 29 )  

References | Related Articles | Metrics

Objective　To localize the centers of intramuscular nerve dense region (CINDR) of teres major muscle accurately. 　Methods　Twenty-four adult cadavers were collected. The curved lines close to skin surface connecting the superior angle of scapula and the acromion, and the inferior angle of scapula were designed as the horizontal (H) and longitudinal (L) reference lines, respectively. A modified Sihler's staining was used to show the intramuscular nerve dense region of one side teres major muscle. The corresponding position of the intramuscular nerve dense region of the other side muscle was anatomically exposed. And the CINDR was labeled with barium sulfate, and its body surface projection points（P and P'） of CINDR on the back and chest were determined by spiral computed tomography. The position of intersections（PH and PL） of point P vertical with H and L lines, and the depth of CINDR were determined by the Syngo system. 　Results　There was only one intramuscular nerve dense region in teres major muscle. The PH of CINDR was located at (86.71±0.85) % of line H and the PL was at (72.07±1.08) % of line L. The depth of CINDR was at (40.06±2.44) % of line P-P'. 　Conclusions　These results should be used as a guidance for intramuscular injection of botulinum toxin A to block the spasticity of teres major muscle.

Anatomical basis of hypothenar skin flap based on descending branches of supracarpal cutaneous branch of the ulnar artery 

Xu Dan, Liu Peng, Zheng Xuefeng, Cao Min, Ding Zihai, Ai Xuguang

Chinese Journal of Clinical Anatomy. 2021, 39(4):  396-399.  doi:10.13418/j.issn.1001-165x.2021.04.006

Abstract ( 589 )   PDF (2232KB) ( 123 )  

References | Related Articles | Metrics

Objective     To provide the clinical anatomical basis for repairing the palm skin defect with the hypothenar skin flap of the descending branches of supracarpal cutaneous branch of the ulnar artery. Methods    From May, 2018 to May, 2019, a total of 42 side upper extremities were used in the research. Twenty-eight side through brachial artery were perfused with red latex for anatomy, 14 side through brachial artery were perfused with ABS and eroded to be vascular cast mold. The branch, course, distribution, communication, outer diameter and anastomosis of the descending supracarpal cutaneous branch of the ulnar artery were anatomically observed and measured.    Results    A line from lentiform bone to the ring, webbing of the little finger was drawn and the line was divided into 3 equal sections. The descending branches of supracarpal cutaneous branch of the ulnar artery arised 14.5 branches, including 6.8 cutaneous branches and 7.7 communicating branches in the distal, middle and proximal 1/3 segments. The cutaneous branches anastomosed with each other to form 1-2 grade cutaneous branch chain in the superficial fascia of hypothenar. The length of cutaneous branches was (1.80±0.60) cm and the diameter of cutaneous branches was (0.23±0.10) mm. The communicating branches was anastomosis with deep branch of ulnar artery, the ulnar margin of superficial palmar arch, the common palmar digital artery or ulnar volar artery of little finger, respectively. The length of communicating branches was (1.60±0.50) cm and the diameter was (0.16±0.06) mm. There was one or two large communicating branches in the proximal and distal 1/3 segments, which can be used as an ideal flap vascular pedicle.   Conclusions     The hypothenar flap is an ideal selection to repair the small tissue defect of palm skin, for it has a constant position of the descending supracarpal cutaneous branch of the ulnar artery in the hypothenar skin flap, with abundant endothelium branch chains, and its skin structure is the homology with the center of the palm.

Research on age-related  parameters of cervical spinal stenosis in asymptomatic adults 

Hu Liu, Lv Yongman, Lin Yang

Chinese Journal of Clinical Anatomy. 2021, 39(4):  400-404.  doi:10.13418/j.issn.1001-165x.2021.04.007

Abstract ( 390 )   PDF (2253KB) ( 22 )  

References | Related Articles | Metrics

Objective　To explore the correlation between age-related changes and parameters of cervical spinal stenosis in asymptomatic adults on lateral cervical spine radiographs.　Methods　One hundred asymptomatic cervical spinal adults were divided into three groups according to the age at the initial examination: group 1 (20~39 years old), group 2 (40~59 years old) and the group 3 (over 60 years old). The standard cervical lateral X-ray was performed in 2011 and 2017 respectively. Parameters of cervical spinal stenosis were measured: sagittal diameter of spinal canal, middle sagittal diameter of vertebral body, sagittal diameter of degenerative vertebral body, cervical spinal canal ratio and effective cervical spinal canal ratio. The correlation between the cervical spinal canal ratio, effective cervical spinal canal ratio and age was analyzed. The differences between the results of two examinations of all parameters in each group were compared.　Results　There was a negative correlation between cervical spinal canal ratio, effective cervical spinal canal ration and age. The comparison of all parameters between two examinations: the sagittal diameter of spinal canal was statistically different only in C3 segment in group 3. There was statistical difference in the sagittal diameter of vertebral body in C5 segment of group 2 and C6 segment of group 3. There was statistical difference in the sagittal diameter of degenerative vertebral body in C5 segment in group 1, C3~C7 segment in group 2 and C4~C6 segment in group 3. There was statistical difference in the cervical spinal canal ratio of C5 segment in group 1, C3~C5 segment in group 2 and C3~C7 segment in group 3. There was statistical difference in the effective cervical spinal canal ratio of C5 segment in group 1, C3~C7 segment in group 2 and 3, meanwhile there was no significant difference in the rest.　Conclusions　Cervical spinal canal ratio and effective cervical spinal canal ratio in adults are related to age, and their changes are obvious with age in people over 60. Effective cervical spinal canal ratio is more sensitive to the progression of cervical spinal stenosis.

Diffusion tensor tractography imaging observation and clinical application of the anterior cruciate ligament

Wang Changqing, Yang Rongli, Fu Shengqi

Chinese Journal of Clinical Anatomy. 2021, 39(4):  405-409.  doi:10.13418/j.issn.1001-165x.2021.04.008

Abstract ( 527 )   PDF (1958KB) ( 23 )  

References | Related Articles | Metrics

Objective　To provide image data for grading diagnosis in the different degree of anterior cruciate ligament injury.   Methods   One hundred normal knee joint and one hundred unilateral anterior cruciate ligament laceration in the Affiliated Hospital of Xinxiang Medical University were selected by diffusion tensor imaging scanning, and divided into I grade, Ⅱ grade, Ⅲ grade and Ⅳ grade according to the damage degree. At the workstation, the regions of interest of the anterior cruciate ligament and its injury were divided, the tractography images were generated and the fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of the regions of interest were measured. The FA values and ADC values were compared in different position and different degree damage position of the anterior cruciate ligament.    Results    There were significant differences in the FA values and ADC values of the anterior cruciate ligament among the upper ends, upper-middle position, middle position, lower-middle position and lower ends (P<0.05), the FA values was negatively correlated with the decreasing of anterior cruciate ligament from top to bottom, while the ADC values was positively correlated with the increasing of anterior cruciate ligament. There was no significant difference in the FA values and ADC values between the upper ends and upper-middle position of the groups (P>0.05), and it was significant difference in the FA values and ADC values between the other position (P<0.05). There were significant differences in the FA values and ADC values of the anterior cruciate ligament injure at I grade, II grade, III grade and IV grade (P<0.05), the FA values decreased with the increasing of damage degree, while the ADC values increased. There was no significant difference in the FA values and ADC values between the I grade and II grade (P>0.05), and it was significant differences in the FA values and ADC values between the other damage grades (P<0.05).    Conclusions    The FA values and ADC values of anterior cruciate ligament are closely related to the damage location and damage degree. Diffusion tensor tractography imaging can provide an objective imaging diagnosis basis for the changes of the microstructure of anterior cruciate ligament injury.

Three dimensional CT study of sphenoid sinus in patients with pituitary adenoma

Qin Yong, Zhao Lin, Wei Liangfeng, Wang Shousen

Chinese Journal of Clinical Anatomy. 2021, 39(4):  410-414.  doi:10.13418/j.issn.1001-165x.2021.04.009

Abstract ( 580 )   PDF (2934KB) ( 12 )  

References | Related Articles | Metrics

Objective 　To investigate the anatomic changes of sphenoid sinus and the significance in patients with pituitary adenoma in transsphenoidal surgery by 3D CT.　Methods　The imaging data of 51 patients with pituitary adenoma in our hospital from March 2014 to March 2015 were collected. Before the operation, the CT images of the paranasal sinuses were input into the computer, and the separation of the sphenoid sinuses was reconstructed by using the software of mimics15.0. The number, shape and deviation of the sphenoid sinuses were observed and recorded, and they were compared with those of during the operation. The gasification types of the sphenoid sinuses, the internal carotid protrusion and fissuring and the incidence of Onodi cell chamber were observed.　Results　Among the 51 cases, the sphenoid sinus presented anterior sellar type in 3 cases, semi sellar type in 12 cases, sellar type in 18 cases and sella occipital type in 18 cases. The sphenoid sinus had no septum in 1 case, 1 mediastinum in 36 cases, 2 mediastinum in 11 cases, 3 mediastinum in 2 cases. The tumor was filled with the sinus cavity and the number of septum could not be determined in 1 case. There were 2 cases of transverse septum and 1 case of oblique septum. The anterior edge of the septum was the middle in 19 cases left in 14 cases on the, right in 16 cases. The anterior edge of the septum was damaged by tumor and could be judged in 1 case. In 5 cases, the posterior margin of 7 sides of sphenoid sinus was attached to the carina of internal carotid artery. There were 12 cases of bilateral internal carotid artery carina, 2 cases of unilateral internal carotid artery carina and 5 cases of internal carotid protrusion fissure. Onodi cell chamber was found in 9 sides of 5 cases. In all patients, the bony separation in the sphenoid sinus was consistent with the three-dimensional reconstruction image before operation. The localization of the sellar base was realized quickly and accurately under the guidance of the sphenoid sinus separation.　Conclusions　CT three-dimensional reconstruction technique can display the bony separation in the sphenoid sinus and the protrusion of the lateral wall of the sphenoid sinus well, which is helpful for rapid and accurate localization in transsphenoidal surgery.

The morphological classification and clinical significance of the scapular spine based on CT three-dimensional reconstruction

Yu Hao, Deng Wanqiu, Sang Peng, Liu Yi

Chinese Journal of Clinical Anatomy. 2021, 39(4):  415-419.  doi:10.13418/j.issn.1001-165x.2021.04.010

Abstract ( 543 )   PDF (1760KB) ( 96 )  

References | Related Articles | Metrics

　Objective   To explore morphological classification of scapular spine based on three-dimensional reconstruction of CT and its clinical significance.   Methods   Three hundred and nineteen patients (179 cases of left shoulder and 140 cases of right shoulder) from the department of Radiology in the affiliated Hospital of Zunyi Medical College were scanned by CT, and then the three-dimensional reconstruction and classification of the affected scapular spine were performed. It was assumed that the point of intersection between the medial end of the scapular spine and the medial margin of the scapula was point A. The intersection of the glenoid notch and the superior margin of the scapular spine was point B. The glenoid notch was point C. The medial edge of the acromion was point D. The lateral edge of the acromion was point E. The inner 1/3 point of AB was point F. The inner 1/3 point of AC was point G. The outer 1/3 point of AB was point H, the outer 1/3 point of AC was point I, the midpoint of FG was point J, the midpoint of HI was point K, the midpoint of BC was point L. Research parameters were the following: the distance between  point A and point B, point A and point C, point A and point D, point A and point E, point B and point C, point H and point I, point F and point G, and the thickness of B, H, F, L, K, J, E, I, G.    Results    The shape of the inferior scapular spine reconstructed by CT can be divided into 6 types: large fusiform-type, small fusiform-type, wooden club-type, thick rod-type, S-type and slender rod-type. The length of AE, BC, AC and AD in large fusiform-type, wooden club-type and thick rod-type was longer than that of small fusiform-type, S-type and slender rod-type. The length of AB in large fusiform-type was longer than that of wooden club-type and slender rod-type (P<0.05). The height of FG in large fusiform-type was higher than that in small fusiform-type. The height of HI in large fusiform-type was higher than that of all other types (P<0.05). The thickness of B, C, H, K, I, F, J and Gin large fusiform-type and thick rod-type were thicker than those of slender rod -type and small fusiform-type (P<0.05).   Conclusions    The scapular spine can be divided into 6 types based on the CT three-dimensional reconstruction: large fusiform-type, small fusiform-type, wooden club-type, thick rod-type, S-type and slender rod-type. Different morphological types of scapular spine provide anatomical basis for clinicians to choose internal fixation and operation methods.

Mechanical stress promotes ASCs proliferation via negative regulation of Lamin A/C expression in expanded prefabricated adipose tissue 

Ren Jing, Wan Lingling, Lu Feng, Chen Xihang

Chinese Journal of Clinical Anatomy. 2021, 39(4):  420-425.  doi:10.13418/j.issn.1001-165x.2021.04.011

Abstract ( 412 )   PDF (5565KB) ( 97 )  

References | Related Articles | Metrics

Objective　To explore the regulatory effect of Lamin A/C on the mechanical sensitivity of adipose-derived stromal cells (ASCs) proliferation and the mechanism of the stress induced fat regeneration. Methods　A rat model of EPAT vacuum aspiration was established. Specimen were collected and prepared at 1, 4, 8 weeks after operation. And the expression of Lamins A/C were detected by Western blot and immunochemistry to analyze the correlation between the protein expression of Lamins A/C and the stress induced fat regeneration. The overexpression of Lamins A/C lentiviral vectors was constructed in vitro and transfected with ASCs. Static stretching of ASCs was performed in vitro, and the proliferation degree of ASCs was detected by Western blot and immunofluorescence to clarify the regulatory effect of Lamin A/C on the proliferation of ASCs.　Results　In vivo experiments showed that the proliferation of ASCs in EPAT of rats increased, meanwhile, the expression level of Lamin A/C in EPAT decreased significantly. There was no statistical difference in the expression of Lamin B1 and the expression of Lamin B2.  In vitro experiments showed that overexpression of Lamin A/C could inhibit significantly the regulatory effect of static mechanical stress on the proliferation of ASCs in vitro.   Conclusions　Lamin A/C is involved in the process of stress induced fat regeneration via negatively regulating the proliferation of ASCs. 

Effects of hydrogen sulfide on the autophagy and apoptosis induced by oxygen-glucose deprivation-reoxygenation in rat neuron

Jiang Wenwu, Hong Yue, Wu Lixiang, Deng Lvhong

Chinese Journal of Clinical Anatomy. 2021, 39(4):  426-430.  doi:10.13418/j.issn.1001-165x.2021.04.012

Abstract ( 334 )   PDF (3333KB) ( 32 )  

References | Related Articles | Metrics

Objective　To investigate the effects of exogenous hydrogen sulfide (H2S) on autophagy and injury induced by oxygen glucose deprivation/reoxygenation (OGD/R) in neurons, and to clarify the molecular mechanism of H2S attenuating cerebral ischemia-reperfusion injury in rats.　Methods　Rat neuronal PC12 cells were used as the research object. Classical OGD/R was used to induce cell damage. Sodium thiosulfate (NaHS), a donor of H2S, was used to observe the effect of H2S on OGD/R-induced mTOR, AMPK and its phosphorylated AMPK. In order to clarify the role of AMPK in the regulation of autophagy in PC12 cells by H2S, AMPK overexpression plasmid was used to observe the effect of H2S on the damage of PC12 cells.　Results　The OGD/R-treated PC12 cells had decreased mTOR phosphorylation level and enhanced AMPK activity, and NaHS pretreatment partially reversed the above changes. The overexpression of AMPK can abolish the inhibitory effect of NaHS on OGD/R-induced autophagy and cell damage. Conclusions　H2S can inhibit the autophagy of brain neurons during ischemia-reperfusion by inhibiting the activation of AMPK, and finally reduce neuronal damage.

The expression of NHE1 and apoptosis related protein in brain tissue of patients with lateral temporal lobe epilepsy

Wu Xuling, Dong Lian, Peng Shuang, Ye Lan, Xu Zucai, Feng Zhanhui

Chinese Journal of Clinical Anatomy. 2021, 39(4):  431-436.  doi:10.13418/j.issn.1001-165x.2021.04.013

Abstract ( 204 )   PDF (3651KB) ( 66 )  

References | Related Articles | Metrics

Objective　To detect the expression of Na+/H+ exchanger-1 (NHE1) and apoptosis related protein in brain tissue of patients with lateral temporal lobe epilepsy after operation and explore the pathogenic mechanism preliminarily.　Methods　Sixteen samples from patients with lateral temporal lobe epilepsy were collected as an epilepsy group, 10 samples from patients with temporal lobe tumor and cerebral hemorrhage as a control group. The pathological changes of brain tissue were observed by HE staining. The expression of NHE1 were further detected by immunohistochemistry and immunofluorescence. Western blot and other method was used to semi-quantitatively analyze the expression characteristics of NHE1, Bcl-2 and Bax. The data were collected and analyzed by SPSS 24.0 software.　Results　HE staining showed that neurons decreased, phagocytosis increased and microglia was hyperactive in the temporal lobe of the epilepsy  group. However, there was no similar expression in the control group. Immunofluorescence and immunohistochemical staining showed that NHE1 was located on neurons. NHE1 staining in the epilepsy group was significantly higher than that in the control group (P<0.05). The expression of NHE1 protein in the epilepsy group was significantly higher than that in the control group (P<0.05). The results of Bcl-2 and Bax showed that the expression of Bcl-2 in the epilepsy group was significantly lower than that in the control group (P<0.05), and the expression of Bax was significantly higher than that in the control group (P<0.05).　Conclusions　NHE1 is closely related to the formation and development of lateral temporal lobe epilepsy. The possible mechanism is closely related the increasing of NHE1 and neuron apoptosis.

Protective effect of carnosine on H9C2 cardiomyocyte injury induced by high glucose and its underlying mechanism

Zhang Danni, Wang Hongxin

Chinese Journal of Clinical Anatomy. 2021, 39(4):  437-442.  doi:10.13418/j.issn.1001-165x.2021.04.014

Abstract ( 318 )   PDF (2103KB) ( 31 )  

References | Related Articles | Metrics

Objective　To study the protective effect of carnosine on H9C2 cardiomyocyte induced by high glucose and its mechanism.　Methods　High glucose culture medium containing 50 mmol/L glucose was used to establish a high glucose injury model, 5 and 15 mmol/L carnosine was given to protect H9C2 cells. MTT assay was used to detect the viability of H9C2 cells in each group. ELISA was used to determine the concentration of IL-1β, IL-6 and TNF-α inflammatory factors in culture medium. SOD, MDA, AST and LDH activities in cells were detected by kit. Active oxygen content in cells was determined by ethidium dihydrochloride. The expression of bax, bcl-2, p65 and IκB-α protein in cells was determined by Western-blot.　Results　Carnosine pretreatment could significantly increase cell viability, intracellular reactive oxygen species content decreased, SOD activity increased, AST and LDH activity decreased, MDA content decreased. Inflammatory factors in culture medium decreased significantly, p65 protein level in nucleus significantly decreased, and IκB-α protein level in cytoplasm increased，the expression of bax, the ratio of bax to bcl-2 increased and the differences was dose-dependent.　Conclusions　Carnosine can alleviate the injury of H9C2 myocardial cells induced by high glucose and reduce the inflammatory reaction of cells. Its mechanism may be related to ROS/NF-κB signaling pathway.

Finite element model construction and analysis of mild adolescent idiopathic scoliosis in adolescents

Wu Xiaowei, Li Jianyi, Du Bingran, Yang Qiaohua, Fan Tiancheng, Li Lutao

Chinese Journal of Clinical Anatomy. 2021, 39(4):  443-448.  doi:10.13418/j.issn.1001-165x.2021.04.015

Abstract ( 340 )   PDF (5403KB) ( 71 )  

References | Related Articles | Metrics

Objective　To establish a finite element model of mild adolescent idiopathic scoliosis(AIS) patients, to verify the model, and to perform finite element analysis.　Methods　A finite element model of the mild AIS patient from the sixth cervical vertebrae to the fifth lumbar vertebrae was constructed. The model from two aspects of geometry and mechanics was verified. The stress changes of each vertebral body were simulated under movements of forward flexion, backward extension, left flexion, right flexion, left rotation and right rotation.　Results　A finite element model of the mild AIS patient has been established. The total number of nodes and total elements were 2561811 and 1547806, respectively. The validity of the model has been verified. The stress changes of the vertebral body in the most obvious deformity was opposite to that in the static state when simulating backward extension and rotation.　Conclusions　The finite element model of mild AIS is effective and can be further used for the research on the disease.

Significance of the anterior longitudinal ligament for the extreme lateral interbody fusion approach in lumbar spine

Wang Le, Zeng Yuwei, Liu Song, Zhang Qingshun, Liang Daxuan, Hu Wei, Wu Zenghui

Chinese Journal of Clinical Anatomy. 2021, 39(4):  449-453.  doi:10.13418/j.issn.1001-165x.2021.04.016

Abstract ( 259 )   PDF (2225KB) ( 13 )  

References | Related Articles | Metrics

Objective　To investigate the accuracy of the cage placement in the extreme lateral interbody fusion (XLIF) approach with reference to the lateral boundary of the anterior longitudinal ligament in lumbar spine.　Methods　Sixty-six patients admitted to the Department of Spine Surgery, the Third Affiliated Hospital of Guangzhou Medical University from January 2019 to February 2021 were prospectively collected. All the patients were undergone the XLIF surgery in the lumbar spine. Thirty-three cases were randomly assigned into a regular decision group, and the placement of cage was determined by the intraoperative C-arm images. Another thirty-three cases were into the improved decision group, and the placement of cage was also determined by the intraoperative C-arm images. Meanwhile, the cage should be placed closely against the lateral boundary of the anterior longitudinal ligament. The basic clinical characteristics and the location of cage in each lumbar segment were compared between the two groups, and the occurrence of perioperative complications in both groups were also recorded.　Results　A total of 114 lumbar segments were treated by XLIF approach, and there were no significant differences in the baseline characteristic between the two groups (P>0.05). The cages in the improved decision group were significantly more centrally located than that in the regular decision group (P<0.00). Although the perioperative complications, including weakness of iliopsoas muscle and anterolateral thigh numbness, were recorded in both groups, no other neurological complications, no major vascular injuries, and nobowel perforations occurred in either group. There was only one case required a second surgical neural decompression due to the backward position of the cage in the regular decision group.　Conclusions　The junction between the lateral part of the anterior longitudinal ligament and lumbar annulus can be determined as the anterior boundary of the cage placement, which can improve the accuracy of the cage placement and effectively prevent the cage placement from deviating to the anterior or posterior, which has important guiding significance in the clinical application of XLIF. 

Computerized navigation system assisted the placement of the cannulated screw and internal fixation for the treatment of femoral neck fractures

Wu Mingjie, Zhuang Weida, Zheng Jie, Li Xiuwang, Chen Min, Fan Xiaohai, Wu Jiachang, Sang Hongxun

Chinese Journal of Clinical Anatomy. 2021, 39(4):  454-459.  doi:10.13418/j.issn.1001-165x.2021.04.017

Abstract ( 336 )   PDF (4816KB) ( 164 )  

References | Related Articles | Metrics

Objective　To evaluate the clinical effects of computerized navigation system assisted the placement of the cannulated screw and internal fixation for the treatment of femoral neck fractures.　Methods　Fifty-nine patients diagnosed with femoral neck fracture and treated with cannulated screw internal fixation from January 2017 to July 2020 were selected. All the patients were divided into a navigation group (n=29) and a non-navigation group (n=30) according to whether using Medtronic computer surgical navigation system (S7) or not. The intraoperative blood loss, times of intraoperative fluoroscopy, times of guide needle drilling, total operation time, persons’ movement frequency during operation of the two groups were compared. The average angles of any two screws and the dispersion degree of the two screws with the farthest distance in the femoral neck on the postoperative anteroposterior and lateral X-ray films of the two groups were recorded and compared.　Results　Compared with non-navigation group, there were less intraoperative blood loss, shorter total operation time, less usages of intraoperative fluoroscopy, fewer guide needle drilling and less persons’ movement frequency during operation of the navigation group. There were statistical significances in intraoperative blood loss, total operation time, usages of intraoperative fluoroscopy, guide needle drilling and persons’ movement frequency during operation between the two groups (P<0.05). The average angles of any two screws and the dispersion degree of the two screws with the farthest distance in the femoral neck on the postoperative anteroposterior and lateral X-ray films of the navigation group were better than those in the non-navigation group (P<0.05). There were statistical significances in the above two indexes between the two groups.　Conclusions 　It is safe and accurate to insert cannulated screws for the treatment of femoral neck fracture with the aid of the computer navigation system. It is worthy of promotion and practice.  

Analysis of tibial osteotomy in varus knee patients with lateral collateral ligament relaxation during TKA

Dai Zhangsheng, Lin Xiaocong, Fang Kaibin, Shi Shaojian

Chinese Journal of Clinical Anatomy. 2021, 39(4):  460-464.  doi:10.13418/j.issn.1001-165x.2021.04.018

Abstract ( 305 )   PDF (1104KB) ( 80 )  

References | Related Articles | Metrics

Objective　To investigate whether osteotomy of varus knee patients with lateral collateral ligament relaxation is affected.　Methods　Ninety-two patients with varus knee joint replacement went to our hospital from 2016 to 2018 were selected, among which 25 patients with lateral collateral ligament relaxation were as an observation group and the rest were as a control group. Both groups were treated with equal osteotomy. The osteotomy of the distal femoral condyle, the posterior femoral condyle and the lateral tibial plateau were measured during the operation. Anatomic tibiofemoral angle (ATFA), patellar tilt angle (PTA) and posterior condylar offset (PCO) were measured during the follow-up. The joint function was evaluated by the American Knee association score (AKS), the American Special Surgery Hospital (HSS) score and joint mobility.　Results　There was no significant difference in the osteotomy of the distal femoral condyle between the two groups (P>0.05). The osteotomy of the lateral tibial plateau in the observation group was lower than that in the control group (P<0.05). There was no statistical difference in ATFA, PTA, PCO, AKS, HSS and knee activity at 6 weeks, 6 months and 12 months after operation between the two groups (P>0.05).　Conclusions　The patients with varus knee combined with lateral collateral ligament relaxation had less osteotomy volume of the lateral tibial plateau .

Clinical observation of reconstruction of C2 muscle ligamentous complex with open-door laminoplasty for the treatment of OPLL involving C2

Ge Nunnun, Fan Chenghu, Qi Bingxian, Tang Zhonghai, Lu Kai

Chinese Journal of Clinical Anatomy. 2021, 39(4):  465-468.  doi:10.13418/j.issn.1001-165x.2021.04.019

Abstract ( 244 )   PDF (2124KB) ( 51 )  

References | Related Articles | Metrics

Objective　To observe the clinical effect of reconstruction of C2 muscle ligamentous complex with open-door laminoplasty for the treatment of OPLL  (ossification of posterior longitudinal ligament) involving C2.　Methods　From March 2016 to June 2018，a retrospective study was performed on 19 patients in our hospital who were treated with reconstruction of C2 muscle ligamentous complex with open-door laminoplasty for the treatment of OPLL involving C2. The JOA Score and VAS Score were used to assess clinical efficacy.　Results　All 19 cases were followed up for 3~31 months. Most of the patients with numbness, weakness of the limbs, walking instability symptoms had been well improved. Two patients had axial symptoms after operation, and one patient occurred C5 nerve root palsy. But the symptoms were relieved after symptomatic treatment. The preoperative JOA score was (8.26±1.63) points, (14.19±3.27) points at the postoperative follow-up. There was statistical difference in JOA score between preoperative and the final follow-up (P<0.05). The preoperative VAS score was (6.85±0.91) points, and (1.06±0.89) points at the postoperative follow-up.  There was statistical difference in VAS score between preoperative and the final follow-up (P<0.05). The efficacy was judged by JOA scoring criteria: excellent in 11 cases, good in 5 cases, and general in 3 cases. The postoperative neurological improvement rate was (78.96±12.83) % at the last follow-up.　Conclusions　Reconstruction of C2 muscle ligamentous complex with open-door laminoplasty for the treatment of OPLL involving C2 is less difficult to operate, with few complications, and significant short-term efficacy.

Application of neuroendoscopy in extended transnasal approach for craniopharyngiomas surgery

Cai Meiqin, Luo Lun, He Haiyong, Zheng Wenhan, Zhang Baoyu, Li Wensheng, Guo Ying

Chinese Journal of Clinical Anatomy. 2021, 39(4):  469-472.  doi:10.13418/j.issn.1001-165x.2021.04.020

Abstract ( 326 )   PDF (3618KB) ( 74 )  

References | Related Articles | Metrics

Objective To evaluate the efficacy and safety of neuroendoscopic extended transnasal approach for selected craniopharyngiomas. Methods The clinical data of 16 patients underwent neuroendoscopic extended transnasal resection of craniopharyngiomas from June 2015 to December 2019 were analyzed retrospectively. Results All the tumors were removed under direct visualization. Gross-total resection was performed in 14 patients (accounting for 87.5%) and subtotal-resection in 2 patients (accounting for 12.5%). Among the 12 patients with preoperative visual impairment, the postoperative visual acuity improved in 10 patients (accounting for 83.3%) and remained unchanged in 2 patients (accounting for 16.7%). Postoperative hypopituitarism occurred in 9 cases (accounting for 56.3%) , diabetes insipidus occurred in 6 cases (accounting for 37.5%).  There were 4 cases (accounting for 25%) of hyposmia, 2 cases of CSF leakage (accounting for 12.5%) and 2 cases of obesity (accounting for 12.5%), and 1 case of meningitis (accounting for 6.3%), 1 case of hydrocephalus (accounting for 6.3%) and 1 case of memory deterioration (accounting for 6.3%) occurred postoperatively. There were tumor no recurrence after 2-59 months follow- up . Conclusions The surgical resection of craniopharyngiomas by extended neuroendoscopic transnasal approach has the advantages of excellent direct visualization of the tumors, high total resection rate and high visual improvement. CSF leakage and hyposmia were the major disadvantages of this approach, so the reconstruction of skull base and the protection of nasal mucosa should be paid more attention  during the surgery.

Analysis of the clinical characteristics and postoperative efficacy of fungal sphenoid sinusitis

Xie Kaipeng, Kang Yuanchun, Liu Haibin, Zhou Liufeng, Peng Hu, Ji Zhenhua, Cheng Yin, Yang Zixuan, Chen Jinxuan, Zhang Guomin, Wu Xiaoqin

Chinese Journal of Clinical Anatomy. 2021, 39(4):  473-476.  doi:10.13418/j.issn.1001-165x.2021.04.021

Abstract ( 940 )   PDF (1645KB) ( 297 )  

References | Related Articles | Metrics

Objective 　To explore the clinical and imaging characteristics of fungal sphenoid sinusitis and to evaluate the clinical effect of nasal endoscopy surgery.　Methods　The clinical data of 67 patients admitted to the department of Otonolaryngosis Head and Neck Surgery of the following hospitals from January 2008 to January 2018 were retrospectively analyzed (the PLA Joint Service Protection Force 909 Hospital, Longhai City First Hospital and the Affiliated to the Naval Military Medical University). The clinical and imaging characteristics of the 67 patients with fungal sphenoid sinus invasion and sphenoid sinus were summarized. All patients received endoscopic sphenoid sinus opening and lesions removal surgery,  and were followed up for 6 months to 12 months to evaluate the surgical efficacy. Visual analog scale (VAS) was used for subjective disease assessment, while the Lund-Kennedy scoring was used for objective disease. The differences between preoperative and postoperative 3, 6 and 12 months were compared.　Results　All 67 cases were cured by one operation, and none of them had serious complications after surgery. The VAS score was (8.34±1.36) preoperatively, but decreased continuously. The VAS score of 3, 6, 12 months after surgery were (2.45±1.06) points, (1.65±1.24) points, (1.21±0.66), respectively. Lund-Kennedy's score was (8.42±1.16)  before surgery, but decreased to (2.56±0.86), (1.74±1.16), (1.15±0.76) at 3, 6, 12 months after surgery, respectively. There were statistical differences in the VAS score and Lund-Kennedy's score before and after surgery (P<0.001).　Conclusions　The main symptoms of fungal sphenoid sinusitis is headache without any regularity.  Endoscopic examination showed mucosal edema in the sphenoidal crypt, and there are caseous and mucinous secretions at the sinus orifice. CT images are characterized by uneven soft tissue density shadow in the sphenoidal sinus cavity, with high-density plaque-like calcification shadow, and thickening of the bone in sinus wall. According to different ranges of lesions, it is a simple, safe and effective method to treat fungal sphenoid sinusitis with the whole hemp nasal endoscopy and nasal endoscopy-assisted surgical treatment.

Clinical study of orthodontic microimplant nail to suppress maxillary supra-erupted molar 

Lai Lingzhi, Wu Xinfan, Chen Kong, Liang Zhichao, Xu Huiyong , Guo Wei

Chinese Journal of Clinical Anatomy. 2021, 39(4):  477-479.  doi:10.13418/j.issn.1001-165x.2021.04.022

Abstract ( 486 )   PDF (1775KB) ( 144 )  

References | Related Articles | Metrics

Objective    To investigate the clinical effects of orthodontic microimplant nail  to suppress maxillary supra-erupted molar.   Methods   Twenty-five patients needed to depress and elongate molar (subsequent implantation and restoration) were selected. Mirco-implant nails were used to bone the over-long molars on palatal and buccal sides. Lateral cephalograms were taken at the beginning and the end of the treatment for cephalometric analysis and comparison.   Results    The supra-erupted molars of 25 patients were all successfully intruded with the average suppression depth of (2.52±0.76) mm, and the average duration of treatment was (5.7±2.8) months.   Conclusions     It is a simple and effective orthodontic method to lower the supra-erupted molar with a micro-implant nail, which can provide a position for the implanted restoration of long-term missing teeth.

Application of 3D printing technology in doctor-patient communication for rapid treatment of intertrochanteric fracture of femur in elderly patients

Liang Guoguang, Fu Maoqing, Liu Yongming, Huang Guanjiu, Tang Liying, Xu Yafei

Chinese Journal of Clinical Anatomy. 2021, 39(4):  480-483.  doi:10.13418/j.issn.1001-165x.2021.04.023

Abstract ( 163 )   PDF (2498KB) ( 12 )  

References | Related Articles | Metrics

Objective　To explore the clinical effects of 3D printing technology in the rapid treatment of intertrochanteric fracture in elderly patients.　Methods　Thirty patients treated with PFNA (Proximal Femoral Nail Antirotation) surgery were involved in our hospital from July 2018 to April 2019. After signing the informed consent, the patients were randomly divided into an experimental group and a control group, with 15 cases in each group.  3D printing technology was used to communicate before operation for the experimental group, while routine pre-operative communication method was used for the control group. After that, the information from the questionnaire of doctor-patient communication before and after operation were collected for the two groups. At the same time, the operation timing (days between admission and operation), operation time and bleeding volume were recorded and analyzed statistically.　Results　The application of 3D printing technology in the communication between doctors and patients before operation had obvious advantages in the understanding and recognition of patients' condition, operation program and nursing plan. Then patients' satisfaction was higher. At the same time, the experimental group also had better performance in operation timing (2.92±1.16) d, while the operation timing of the control group was (4.36±2.10) d (P<0.05).　Conclusions　3D printing technology has a significant effect on doctor-patient communication in the rapid treatment of intertrochanteric fracture of the femur in the elderly, which can shorten the preoperative interval and improve the patient satisfaction.

A meta-analysis of Masquelet technique versus bone transport in lower extremity bone defect reconstruction

Wen Hongjie, Chen Zhong, Yang Huagang, Li Junnan, Xu Yongqing

Chinese Journal of Clinical Anatomy. 2021, 39(4):  484-491.  doi:10.13418/j.issn.1001-165x.2021.04.024

Abstract ( 190 )   PDF (8082KB) ( 4 )  

References | Related Articles | Metrics

Objective　To compare the efficacy and safety between Masquelet technique and bone transport in lower extremity bone defect reconstruction.　Methods　PubMed, EMBASE, CNKI, Wanfang, CBM and Weipu databases were searched. Chinese and English literatures on Masquelet technique and bone transport in the treatment of lower limb bone defect published in official journals from January 1950 to October 2019 were collected. The quality of the included literatures was strictly evaluated, and relevant data were extracted. The data were statistically analyzed by RevMan 5.3 software.  Results  A total of seven studies involving 325 patients were included. There were no significant difference in Paley bone healing (RR=0.99, 95% CI:0.85,1.15, P=0.93), the rate of good and excellent limb function (RR=1.23, 95% CI: 0.90, 1.67, P=0.19), the Iowa knee score (SMD=0.45, 95% CI: -0.05, 0.94, P=0.08), and the Iowa ankle score (SMD=0.10, 95% CI: -0.39, 0.59, P=0.69) between the Masquelet group and bone transport group. Compared with the bone transport group, there was a lower incidence of complications (RR＝0.55, 95% CI: 0.38，0.79, P＝0.001), a higher infection control rate (RR=1.15, 95% CI:1.03,1.30,P=0.02), fewer surgeries (SMD=-0.47,95% CI:-0.81,-0.14,P=0.005), and a shorter healing time (SMD=-1.19, 95% CI:2.15,0.22,P=0.02), higher postoperative SF-36 score (SMD=2.33, 95% CI: 1.81, 2.85, P<0.01) in the Masquelet group.  Conclusions   Compared with bone transport technique, Masquelet technique may have more advantages in the incidence of complications, infection control rate, number of surgeries, healing time, and postoperative SF-36 score in repairing of bone defects of lower extremity. However, there is no difference in Paley bone healing score, limb function score, Iowa knee and ankle joint score. Further research is required and future studies should include assessments of outcome at long-term follow-up.

Advances in diagnosis and treatment of children with lower cervical fixation

Zhou Jianqiang, Zhang Shaojie, Li Zhijun

Chinese Journal of Clinical Anatomy. 2021, 39(4):  492-495.  doi:10.13418/j.issn.1001-165x.2021.04.025

Abstract ( 250 )   PDF (1693KB) ( 73 )  

References | Related Articles | Metrics

Morphological variation of coracoid process and the related diseases

Hu Jian, Liu Bingli, Yu Baoqing

Chinese Journal of Clinical Anatomy. 2021, 39(4):  496-500.  doi:10.13418/j.issn.1001-165x.2021.04.026

Abstract ( 613 )   PDF (1808KB) ( 370 )  

References | Related Articles | Metrics

Variation of vertebral artery and posterior cerebral artery and posterior communicating artery: a case report

Qin Sijia, Su Junlong, Yan Xizhang, Lou Ming, Yang Jiping

Chinese Journal of Clinical Anatomy. 2021, 39(4):  383.  doi:10.13418/j.issn.1001-165x.2021.04.027

Abstract ( 454 )   PDF (1276KB) ( 43 )  

References | Related Articles | Metrics

Variation of bilateral proper hepatic artery: a case report

Li Sihan, Cao Shan, Cui Jinrong, Pang Yifei, Wu Youlong, Xue Yaxiong, Zhang Fengxian, Liu Huanyu, Qin Xiangzheng, Quan Guihong

Chinese Journal of Clinical Anatomy. 2021, 39(4):  500.  doi:10.13418/j.issn.1001-165x.2021.04.028

Abstract ( 295 )   PDF (918KB) ( 52 )  

References | Related Articles | Metrics

The variation of superior vena cava and its branches: a case report

Yang Jiping, Li Haoxu

Chinese Journal of Clinical Anatomy. 2021, 39(4):  501. 

Abstract ( 653 )   PDF (1724KB) ( 323 )  

References | Related Articles | Metrics