Chinese Journal of Clinical Anatomy

An anatomical study of the improved screw placement in the mini-plate fixation of lateral mass for cervical open-door laminoplasty operation

Wu Jieshi, Xue Jun, Yuan Fenglai, Zhao Peng, Zhao Quanming, Xu Ruisheng

Chinese Journal of Clinical Anatomy. 2021, 39(5): 503-506. doi:10.13418/j.issn.1001-165x.2021.05.001

Abstract ( 390 )

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Objective　To provide the anatomical basis for a safer screw direction and screw path for cervical microplate side mass fixation screws in cervical open-door laminoplasty operation.　Methods　The points of A and B on the surface of lateral mass for setting cephalic and caudal screws to fix the plate were determined in 50 specimens of C3~C7 vertebra, the length of vertical screw path A1 and B1 and head tilt of 15o A2 and B2 were measured.　Results　The mean value of A1 length in cervical vertebra was C3 (9.4±1.2) mm, C4 (11.7±2.8) mm, C5 (12.9±2.5) mm, C6 (12.0±2.3) mm, C7 (10.4±1.8) mm. The mean value of A2 length was C3 (11.9±1.6) mm, C4 (15.3±1.7) mm, C5 (15.7±1.7) mm, C6 (14.2±1.3) mm and C7 (13.5±1.0) mm, which were all greater than 11 mm. The mean value of B1 length was C3 (4.7±0.6) mm, C4 (5.0±1.1) mm, C5 (5.8±0.9) mm, C6 (5.5±0.6) mm, and C7 (5.3±0.4) mm. The percentage of B1 length less than 5 mm in the C3, C4, C5, C6 and C7 vertebrae was 57%, 46%, 28%, 27% and 35%, respectively. The average length of B2 nail track in all cervical vertebrae specimens C3 was (6.8±0.8) mm, C4 (7.0±2.1) mm, C5 (7.8±1.4) mm, C6 (8.5±0.8) mm, and C7 (7.6±0.6) mm, which was greater than 5 mm.　Conclusions　When the cervical mini-plate is fixed to the lateral mass of cervical spine, in order to avoid screw's over length, it is necessary to set the screw path at the head tilt of 15o. The length of the cephalic screw can be 9 mm, and the caudal one should be 5 mm, which can efficiently avoid screw protruding out facet and hurting the articular cartilage of the cervical spine small joint.

Anatomical basis of a new double-threaded pedicle screw for preventing nerve root injury

Xiao Zhongzhou, Liu Jiaming, Huang Shanhu, Liu Zhili

Chinese Journal of Clinical Anatomy. 2021, 39(5): 507-512. doi:10.13418/j.issn.1001-165x.2021.05.002

Abstract ( 220 )

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Objective　To provide the anatomical basis of a new double- threaded pedicle screw for reducing the incidence of nerve root injury, by measuring the anatomical parameters of thoracic and lumbar vertebrae.　Methods　Two hundred healthy volunteers were included for the thoracic and lumbar spine CT scan. The following parameters were measured on CT films: the segment lengths of pedicle screw entry path (the length of the vertebral body, the pedicle and the lamina), the height of the pedicle isthmus, the pedicle isthmus and the angle of the screw abduction. The mean and standard deviation of each parameter were calculated.　Results　A total of 100 thoracic volunteers with an average age of 31.21 years old and 100 lumbar volunteers with an average age of 31.05 years old were included. Parameters of the thoracic group were as follows: the length of the vertebral body was left (19.09±2.36)mm, right (19.77±2.54) mm, the length of the pedicle was left (7.67±1.19)mm, right (8.17±1.16)mm, the length of the lamina was left (9.94±2.02)mm, right (9.06±1.71)mm, the height of the pedicle isthmus was left (11.76±1.86)mm, right (11.79±2.24)mm, the width of the pedicle isthmus was left (8.44±2.71)mm, right (5.95±1.16)mm, the angle of the screw abduction was left (8.61±2.57)°, right (8.44±2.71)°. Parameters of the lumber group were as follows: the length of the vertebral body was left (26.99±3.37)mm, right (27.06±3.24)mm, the length of the pedicle was left (10.00±1.58)mm, right (10.37±1.53)mm, the length of the lamina was left (12.74±2.16)mm, right (13.96±2.46)mm, the height of the pedicle isthmus was left (14.50±2.83)mm, right (14.05±2.39)mm, the width of the pedicle isthmus was left (9.72±1.59)mm, right (9.45±1.8)mm, the angle of the screw abduction was left(16.16±2.93)°, right (16.31±3.05)°.There was no statistical differences on the length of the vertebral body, pedicle, lamina and the angle of the screw abduction between the thoracic and the lumbar groups at the same segment (P>0.05).There were statistical differences on the pedicle isthmus height from T1 to L5 and pedicle isthmus width between the two groups (P<0.05).　Conclusions　Detailed anatomical measurements of the thoracic and lumbar vertebrae in healthy subjects can provide more accurate basis for the design of a new double-threaded pedicle screw.

Clinical anatomical study on the classification of the superior aspect classification of the greater tuberosity

Zhang Lei, He Xue, Zhou Xin, Xiong Lujing, Zhang Meng-yao

Chinese Journal of Clinical Anatomy. 2021, 39(5): 513-517. doi:10.13418/j.issn.1001-165x.2021.05.003

Abstract ( 702 )

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目的通过对肱骨大结节上面观的形态学分型，探讨其临床意义。方法将296例肩关节CT扫描图像根据大结节上面观形态进行分型，分别测量冈上肌、冈下肌和小圆肌肌腱在大结节上的止点长度，肩胛下肌肌腱在小结节上的止点长度，大结节最高点至肱骨头最高点的距离以及结节间沟的宽度和深度。结果肱骨大结节上面观形态可分为3型：弧形45.60%（135例），平坦形44.26%（131例），丘形10.14%（30例）。弧形的肱骨大结节，其冈上肌肌腱止点长度短于平坦形和丘形；丘形的肱骨大结节，其冈上肌肌腱在大结节上的止点长度、肩胛下肌肌腱在小结节上的止点长度、结节间沟的宽度和深度均短于弧形和平坦形；丘形的大结节最高点至肱骨头最高点的距离大于弧形和平坦形，差异均有统计学意义（P＜0.05），其他解剖学形态差异无统计学意义（P>0.05）。结论不同分型的肱骨大结节上面观对临床肱骨大结节相关疾病诊治有一定的指导意义。

Microsurgical anatomy study of perioral island flap on vessel casting

Xu Dan, Ding Ran, Sha Ming, Zheng Xuefeng, Ding Zihai, Liu Peng, Ai Xuguang

Chinese Journal of Clinical Anatomy. 2021, 39(5): 518-523. doi:10.13418/j.issn.1001-165x.2021.05.004

Abstract ( 473 )

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Objective　To provide more accurate anatomical data for perioral island flap.　Methods　Sixty-three cast specimens were utilized to observe the origin, distribution, variation and arterial architecture characteristics of the perioral artery.　Results　The mainly blood supply of perioral region came from the superior labial artery, inferior labial artery, labiomental artery and submental artery ascending branch. The superior labial artery mainly originated from facial artery superior (68.25%) or inferior (22.22%) to corner the mouth, the distribution of them were symmetrical (51.59%) or asymmetrical (46.83%), occasionally absence (1.59%). Inferior labial artery mainly originated from facial artery superior to border of mandible (43.65%) or inferior to corner the mouth (28.89%), and formed one branch of facial artery (61.90%) or the final branch (25.40%). The distribution of them were symmetrical (44.44%) or asymmetrical (47.62%), sometimes absence (7.94%). The upper and lower labial arteries anastomosed with each other on both sides, forming an arterial circle around oral fissure, nourishing the oral fissure, nasal region and chin regions. The labiomental artery originated from the facial artery near the mandibular margin, which was mainly 1 branch (about 55%) or absent (about 30%) on each side, but also was 2 branches (about 10%) or 3 branches (about 5%). The submental artery sent out 2~12 ascending branches in the middle submental region, and formed the labiomental vascular plexus with the descending branches of the inferior labial artery and the labiomental artery, nourishing the skin of mental region.　Conclusions　There are many blood supply sources and abundant anastomosis in perioral area, forming an arterial circle and network around the mouth. However, the variation of origin and distribution of the perioral artery are frequent, and the form of artery construction is uncertain. Therefore, it is essential to perform preoperative ultrasonographic exploration before cutting the perioral island flap.

A modified percutaneous approach for treating maxillary neuralgia through external opening of paracentesis

Chen Liangyu, Dai Luohuan, Qiao Pudan, Liu Donghua, Liu Dalin, Zhao Yuqi, Deng Chunlei, Deng Guang-qi

Chinese Journal of Clinical Anatomy. 2021, 39(5): 524-528. doi:10.13418/j.issn.1001-165x.2021.05.005

Abstract ( 449 )

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Objective　To investigate the anatomic characteristics of the needle entry path of the modified percutaneous approach, providing morphological basis for the clinical puncture.　Methods　Eighty dried cadaveric adult skulls (160 sides) were collected and stimulated by using a curved needle (with a front end of 10mm bending 30°) according to the modified puncture approach. The following parameters were measured: the depth of the first arrival with the needle from the lower margin of the zygomatic arch to the maxillary surface (L1), the depth (L2) that the needle reached the maxillary margin of pterygomaxillary fissure, and gliding distance (L3), the fissure width that the needle reached the maxillary margin of pterygomaxillary fissure (L4), the distance from the external opening of foramen rotundus to the infraorbital fissure (L5), the maximum length of the fissura pterygomaxillaris (L6) and the maximum width (L7), the maximum length (LA) and width (LB) of the skull. Thirty-six sagittal head specimens with intact soft tissue were taken for simulated puncture to verify the feasibility of bone measurement results in the head.　Results　On the left side, the measured values of L1, L2, L3, L4, L5, L6, L7 were (23.04±3.42)mm, (38.14±3.63)mm, (20.67±3.93)mm, (5.85±1.27)mm, (19.66±2.61)mm, (23.38±2.49)mm, (6.66±1.24)mm, respectively. And on the right side, these measured values were (22.96±3.34) mm, (38.40±3.49) mm, (20.82±3.93) mm, (5.86±1.33) mm, (19.29±2.61) mm, (23.85±2.38) mm, (6.76±1.21) mm, respectively. There was no statistical difference between the left side and the right side (P>0.05). Bilateral L1 and L2 were positively correlated with LA, but not with LB. Bilateral L1 was positively correlated with L2 but negatively correlated with L3, and L2 was positively correlated with L3. Confirmatory experiments showed that the correlation of skull specimen measurements was still applicable in cranial biopsy.　Conclusions 　There is no significant difference in the trajectory of the puncture when the paracentesis is performed on either side of the skull. The puncture depth is related to the length of skull and gliding distance, but irrelevant to the width and the sides of the skull.

Imaging anatomy study of the intracranial falcine sinus by MRV reconstruction

Fan Yacao, Li Kelei, Wei Liangfeng, Wang Shousen

Chinese Journal of Clinical Anatomy. 2021, 39(5): 529-534. doi:10.13418/j.issn.1001-165x.2021.05.006

Abstract ( 430 )

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Objective To investigate the incidence and imaging anatomical features of intracranial falcine sinus in healthy human. Methods The data of three-dimensional enhanced magnetic resonance angiography (3D CE-MRV) of 177 healthy patients (81 males and 96 females) with complete falcine and dural venous sinus were analyzed, and volume rendering technique (VRT) was used to observe the falcine sinus. Results The falcine sinus was found in the cerebral falx of 43 patients, of which 37 patients were located at the junction of the middle and posterior one third region of the cerebral falx. Six patients were located at the posterior one third region of the cerebral falx. According to the structure of the veins connecting to the two ends, the falcine sinus was divided into three types: type Ⅰ (derived from the cerebral falx, injected into the inferior sagittal sinus, vein of Galen or straight sinus), type Ⅱ (derived from the cerebral falx and injected into the posterior part of the superior sagittal sinus) and type Ⅲ (connected the superior sagittal sinus to the inferior sagittal sinus、vein of Galen or straight sinus). Type I falcine sinus consisted of mass-type, triangle-type, strip-type and irregular shape-type. Type II falcine sinus included straight strip-type and curved strip-type. Type III falcine sinus included thin strip-type, wide band-type and V-type. The V-type was usually formed by the fusion of type I and type II falcine sinuses. A total of 11 cases of type Ⅰ falcine sinus, 21 cases of type Ⅱ falcine sinus and 14 cases of type Ⅲ falcine sinus were found (figure 1). Among them, 4 patients had type Ⅰ falcine sinus and type Ⅱ falcine sinus simultaneously, 6 patients had type Ⅱ falcine sinus and type Ⅲ falcine sinus simultaneously, 5 patients had double type Ⅱ falcine sinus, and 4 patients had triple type Ⅱ falcine sinus in their cerebral falx. Conclusions 3D CE-MRV combined with VRT is a good method for observing falcine sinus. Falcine sinus is not rare and has various types.

Imaging study on the relationship between sagittal angle asymmetry of cervical facet joint and cervical facet joint degeneration

Xu Cong, Xu Qingping, Ai Wen, Jiang Kaiyan, Yuan Jia, Wu Binghua, Yin Shengjiang, Bi Zhenyu, Jiao Peifeng

Chinese Journal of Clinical Anatomy. 2021, 39(5): 535-538. doi:10.13418/j.issn.1001-165x.2021.05.007

Abstract ( 207 )

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Objective To investigate the relationship between sagittal angle asymmetry of cervical facet joint and the degeneration of cervical facet joint. Methods The sagittal facet angle and the degeneration degree of 160 facet joint at C3/4-C6/7 segments on the axial CT of 20 fresh cervical cadaver specimens were evaluated blindly and statistically analyzed by 3 reviewers using the 4-degree evaluation method. Results There was no significant difference in sagittal asymmetrical angles of the facet joint between different segments (F= 0.55,P=0.65), and there was also no significant difference in the degeneration of cervical facet joint (left: Z=3, P=0.646; right: Z=3, P=0.376) between different segments, but there were significant differences between the sagittal angle asymmetry of cervical facet joint and the degeneration of cervical facet joint at C3/4 and C4/5 segments of 20 fresh cervical cadaver specimens（C3/4:Z=8.567, P=0.014,C4/5; Z=2.000, P=0.025）. Conclusion The sagittal angle asymmetry of cervical facet joint may be related to the degeneration of the facet joint.

Three-dimensional morphological analysis and application research of ankle joint in Chinese normal adults based on CT

Xue Haowen, Chu Hongyu, Zuo Xiepeng, Wu Kehui, Han Qing, Cheng Kailiang, Yang Yanyan, Zhu Qingsan

Chinese Journal of Clinical Anatomy. 2021, 39(5): 539-545. doi:10.13418/j.issn.1001-165x.2021.05.008

Abstract ( 210 )

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Objective　To provide a fundamental basis and morphological database for the design of total ankle arthroplasty (TAA) prosthesis by measuring the ankle joint morphology and analyzing the results in the Chinese population.　Methods　The computer tomography (CT) images of 191 ankle points (106 in males and 85 in females) were three-dimensional(3D) reconstructed and 32 morphologic parameters were measured such as anterior-posterior inclination angle (APA) and maximal tibial thickness (MTiTh）on the 3D reconstruction model, and the ratios of 3 parameters such as the ratios of the arc length and width of the tibial mortise (MTiTh/TiW) and the trochlea tali (TaAL/TaW) were calculated.　Results　(1) In terms of gender, there were significant differences in 23 parameters among the 32 parameters tested (P<0.05). The other 20 parameters in males were found larger than that in females except for following 2 parameters: APA and anterior-posterior gap (APG). (2) Compared with the results of our previous study based on X-ray, there were 8 parameter different between X-rays and CT reconstruction images except for the following 3 parameters: APG, APA and tibial arc length (TiAL). The results based on X-ray were larger than that in CT reconstruction images. (3) Due to the differences of race and region, the 3D morphological parameters of the ankle joint in normal Chinese adults were different from those of French, Italian, Korean, and Taiwan population. The morphology of the talus differed from that of Egyptian, Greek and north China.　Conclusions　There was significant differences in the morphological parameters of ankle joints between Chinese adults and Western adults.

Imaging anatomic characteristics of renal artery in middle-old aged people from southwest Zhejiang province

Shen Jiayi, Lv Lingchun, ChenJun, Zhao Yanan, Lu Chenying, Wei Tiemin

Chinese Journal of Clinical Anatomy. 2021, 39(5): 546-551. doi:10.13418/j.issn.1001-165x.2021.05.009

Abstract ( 439 )

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Objective　To investigate the imaging characteristics of renal artery in middle-old aged people from southwest Zhejiang province, and provide the imaging data for renal artery interventional surgery. Methods　Research object was collected from 45-75 years old resident population in 10 urban communities in Lishui City. CTA examination of renal artery was performed. FORCE enhanced abdominal CT was used to observe the origin, structure, location and variation of renal artery. The data collected from the questionnaire were statistically analyzed by t-test and χ 2 test according to gender and side.　Results　A total of 3090 subjects were included, including 1447 males and 1643 females. There were significant differences between males and females in smoking, drinking, height, waist circumference, diastolic pressure, pulse pressure, taking high blood pressure drugs and taking diabetes drugs (P＝0.00). There was no statistical difference in the length and the diameter of bilateral renal arteries between males and females. The length and average diameter of renal artery were (37.43±13.73) mm, (6.37±6.6) mm on the left side and (24.52±25.5) mm, (4.4±2.67) mm on the right side. The angle between renal artery and abdominal aorta was more than 45 ° [male (72.3% in left side, 70.9% in right side), female (74.8% in left side, 71.8% in right side)]. The opening position of the renal artery was concentrated in the left side (67.8%, 30.1%) of the second lumbar vertebrae (L2) and the first lumbar vertebrae (L1); the right side (75.9%, 20.4%), and the right side was higher than the left side (56.7%, 56.6%). The renal artery mainly entered the kidney through the hilum (male accounting for 48.5%, female 47.6%). The renal vascular deformation was mainly oblique on the left side and flat on the right side, with statistical difference between the two sides (P = 0.00). The incidence rate of renal artery variation was 24.5% (95% CI 22.3%~26.8%) in male and 22.3% (95% CI 20.3%~24.4%) in female. The detection rate of accessory renal artery was 15.4% (95% CI 13.5%~17.3%) in male, 11.1% (95% CI 9.7%~12.7%) in female, and the total physical examination rate was 26.4%. The incidence rate of unilateral accessory renal artery was 15.0% and bilateral accessory renal artery was 3.9%. Conclusions Dual source computer tomography (DSCT) can directly and accurately display the structure and variation of renal artery, and there is a great difference between male and female in the variation of renal artery. Preoperative renal CTA examination can reveal clearly the structure and variation of renal artery, which is conducive to the smooth development of renal artery intervention.

Diffusion tensor imaging observation in the postoperative and follow-up of anterior cruciate ligament reconstruction

Wang Changqing, Yang Rongli, Fu Shengqi

Chinese Journal of Clinical Anatomy. 2021, 39(5): 552-556. doi:10.13418/j.issn.1001-165x.2021.05.010

Abstract ( 230 )

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Objective　To provide image data for prognosis evaluation after the anterior cruciate ligament reconstruction.　Methods　One hundred cases of normal knee joint and sixty-one cases of patients with Ⅲ grade, Ⅳ grade in reconstruction of the anterior cruciate ligament injury and fifty-seven cases of follow-up patients in the Affiliated Hospital of Xinxiang Medical University were selected by diffusion tensor imaging. The regions of interest of the anterior cruciate ligament injury, reconstruction and the corresponding position of normal group were divided. The fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values were measured, and the tractography images were generated.　Results　The preoperative and 1 week, 3 months postoperative FA values and ADC values of anterior cruciate ligament reconstruction were (0.395±0.047), (0.541±0.056), (0.542±0.058) and (2.791±0.336)×10-3 mm2/s, (2.263±0.224)×10-3 mm2/s, (2.028±0.341)×10-3mm2/s, respectively. There was no significant difference in the FA values between the 1 week and 3 months after the operation, there was statistical significance in the FA values and ADC values among other groups. The FA values and ADC values were (0.542±0.058), (0.595±0.056), (0.684±0.059), (0.577±0.064) and (2.028±0.341)×10-3 mm2/s, (1.699±0.175)×10-3 mm2/s, (1.375±0.151)×10-3 mm2/s, (1.324±0.160) ×10-3mm2/s at 3 months, 6 months, 1 year in postoperative follow-up and the normal group. There was no significant difference in the FA values between the 6 months in postoperative follow-up and the normal group, and the ADC values between the 1 year in postoperative follow-up and the normal group, there was statistical significance in the FA values and ADC values among other groups. Conclusions The diffusion tensor imaging can objectively reflect the microstructural changes after anterior cruciate ligament reconstruction, it has important diagnostic value in the prognosis evaluation.

Anisodamine relieves hypoxic-ischemic brain damage and neurologic impairment in young rats

Zhu Yu , Wei Jing , Wu Pengcheng , Yuan Xiao , Zhou Zhenhua, Li Min

Chinese Journal of Clinical Anatomy. 2021, 39(5): 557-562. doi:10.13418/j.issn.1001-165x.2021.05.011

Abstract ( 189 )

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Objective　To investigate the regulatory effect of anisodamine on brain injury and neurological damage in young rats with hypoxic-ischemic brain damage.　Methods　Fifty young rats were divided into five groups (n=10): a healthy control group, a model group, and three model dosing groups (intravenously injected anisodamine for 2.5, 5, 10 mg/kg). Brain tissue wet and dry weight method was used to detect brain index and brain water content. HE staining was used to observe the pathological damage of brain tissue. TUNEL staining was used to observe the apoptosis of brain tissues around hippocampal neurons. Western blot detects the protein expression levels of Bax/Bcl-2, caspase-9, caspase-3, BDNF and NGF in brain tissue. RT-PCR was used to detect the expression level of BDNF and NGF mRNA, and the kit was used to detect the content of SOD, MDA and GSH-Px.　Results　Compared with the healthy control group, the brain tissue and nerve function of young rats in the model group were seriously damaged (P<0.05). Compared with the model group, the brain index and brain water content of young rats in the 5 mg/kg and 10 mg/kg anisodamine groups significantly reduced (P<0.05). The pathological damage of the brain tissue significantly improved, and the apoptotic cells around the hippocampal neurons in the brain Apoptosis decreased, Bax/Bcl-2, caspase-9, and caspase-3 expression levels decreased (P<0.05), BDNF and NGF expression levels increased (P<0.05), MDA content decreased, SOD and GSH-Px content increased (P<0.05).　Conclusions　Anisodamine can alleviate brain damage and nerve function damage in young rats with HIBD.

Effect of irbesartan on insulin resistance IRS-1/PI3K/GLUT4 signaling pathway in rats with hypertension and type 2 diabetes mellitus

Liu Li, Luo Peng, Zhou Tiantian, Li Yan, Xie Hongyan, Lv De

Chinese Journal of Clinical Anatomy. 2021, 39(5): 563-568. doi:10.13418/j.issn.1001-165x.2021.05.012

Abstract ( 281 )

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Objective To investigate the effect of irbesartan on insulin resistance in hypertensive rats with type 2 diabetes mellitus (T2DM). Methods Spontaneously hypertensive rats (SHR) were randomly divided into a model group, an irbesartan low dose group and an irbesartan high dose group. Normal rats were used as control group. Irbesartan was administered daily at 30 and 60 mg/kg in the low and high dose groups, while the same amount of normal saline was performed in the control group and model group. Systolic blood pressure (SBP), fasting blood glucose (FBG), insulin resistance model evaluation index (HOMA-IR), insulin receptor substrate -1 (IRS-1), phosphatidylinositol (-3) kinase P85 subunit (PI3Kp85), protein kinase B (AKT), phosphorylated protein (p-AKT), and glucose transporter 4 (GLUT4) were measured in rats. Results Compared with the control group, SBP, FBG, FINS and HOMA-IR in the model group significantly increased (P<0.05), while IRS-1, PI3Kp85, P-Akt and GLUT4 significantly decreased (P<0.05). Compared with the model group, the above indicators were reversed in both the low and high dose irbesartan groups(P<0.05). Conclusions Irbesartan can improve insulin resistance in T2DM rats with hypertension through IRS-1/PI3K/GLUT4 signaling pathway.

Saikosaponin A attenuates hippocampal neuron damage in rats with cerebral ischemia-reperfusion

Ma Daliang, Cui Hongli, Rong Weijiang, Jia Qi, Huang Fuxian

Chinese Journal of Clinical Anatomy. 2021, 39(5): 569-574. doi:10.13418/j.issn.1001-165x.2021.05.013

Abstract ( 188 )

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Objective　To investigate the role of saikosaponin A (SA) in reducing hippocampal neuron damage in ischemia reperfusion (I/R) rats by up-regulating SIRT1 levels.　Methods　Rats were randomly divided into 6 groups: a sham operation group (Sham), a model (I/R) group, an I/R + SA 1mg/ kg group, an I/R + SA 5mg/kg group, an I/R + SA 10mg/kg group and an I/R + NMDP 1mg/kg group, 9 rats in each group. The cerebral ischemia-reperfusion model was constructed by the bilateral common carotid artery (CCA) with arterial clip clamping method, and it was administered intragastically for 7 days. The number of mistakes made by the jumping test and the number of new maze tests in the Y-maze test were recorded in each group of rats. Pathological damage of brain tissue was observed by HE staining. The 2,3,5-triphenyltetrazolium chloride method was used to calculate the cerebral infarction rate, brain tissue water content and brain index of each group of rats. Neuronal apoptosis was detected by Nissl body staining. The expression of Caspase3, Caspase9, Bax / Bcl-2 and SIRT1 was detected by Western blotting. The contents of superoxide dismutase (SOD), malondialdehyde (MDA), and lactate dehydrogenase (LDH) were detected by the kit. The expression of SIRT1 was detected by RT-PCR.　Results　Saikosaponin A reduced the number of mistakes in the platform-jumping experiment in rats, increased the number of new arms entering, reduced cerebral infarction rate, brain tissue water content, and brain index, and reduced Bax / Bcl-2, the ratio of Cleaved caspase3 and caspase3, Cleaved caspase9 and caspase9, decreased the content of MDA and LDH, increased the activity of SOD, and increased the expression level of SIRT1 (P<0.05). 　Conclusions　Saikosaponin A alleviates hippocampal neuronal injury and oxidative stress in ischemia-reperfusion rats, which is related to the up-regulation of SIRT1.

Wnt/β-catenin signaling pathway involved in the deformity of congenital talipes equinovarus

Li Fenjie, Chen Xi, Li Yangjie, Liao Jiaxin, Li Zhifu, Liu Anzhuo, Zhang Yueqiu, Yan Nan, Wang Zhengdong

Chinese Journal of Clinical Anatomy. 2021, 39(5): 575-578. doi:10.13418/j.issn.1001-165x.2021.05.014

Abstract ( 144 )

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Objective　To investigate the effect of sex determining region Y-box 9 (Sox9), β-catenin and Wnt/ β-catenin signaling pathway on the congenital talipes equinovarus (CTE) and its mechanism. Methods　SD rats at 10 days of gestation were randomly divided into an experimental group and a control group. All trans retinoic acid (135 mg/kg) was dissolved in mineral oil to make fetal rat CTE model in the experimental group. The control group was given the same amount of mineral oil. Immunohistochemistry, RT-PCR and Western blot were used to detect the expression levels of β-catenin, Sox9 and phosphorylated β-catenin-s552 in ankle soft tissue of control group and model group.　Results　Compared with the control group, HE staining showed more collagen deposition in CE model tissues, immunohistochemical results showed that the expression of β-catenin and Sox9 in the model group significantly increased. RT-qPCR result showed that the mRNA level of Sox9, β-catenin increased. Western blot result showed that the expression of P-β-catenin-s552 increased, the expression of Sox9 and β-catenin in the experimental group decreased. Conclusions　The high expression of Sox9 in the ankle tissue of rats with congenital clubfoot is regulated by Wnt / β-catenin signaling pathway, which is involved in the formation of congenital clubfoot.

The mechanism of resveratrol in the treatment of nonalcoholic steatohepatitis in rats based on Nrf2/ARE signaling pathway

Feng Chengjun, Zhou Yanmeng, Tian Yingjuan

Chinese Journal of Clinical Anatomy. 2021, 39(5): 579-585. doi:10.13418/j.issn.1001-165x.2021.05.015

Abstract ( 361 )

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Objective　To explore the mechanism of resveratrol in the treatment of nonalcoholic steatohepatitis rats based on Nrf2/ARE signaling pathway.　Methods　Nonalcoholic steatohepatitis rats were molded by high-fat diet. Rats were divided into control group (CD group), high-fat diet group (HCD group), resveratrol group (HCD+RSV group) and resveratrol +Nrf2/ARE inhibitor oleanolic acid derivative OAD85 group (HCD+RSV+OAD85 group), with 8 rats in each group. The CD group was always fed a normal diet, while other groups were fed a free high-fat diet. The HCD+RSV group and the HCD+RSV+OAD85 group were given 10 mg/kg RSV or 10 mg/kg RSV+100 μg /kg OAD85 by intragastric administration for 28 days at the fourth week of feeding. The liver pathological changes were observed by hematoxylin-eosin staining, and the fat changes were observed by oil red O staining of frozen sections of the liver. Kit method was used to detect alanine aminotransferase (ALT), aspartate aminotransferase (AST), cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL) and free fatty acid (FFA). Western blot and qRT - PCR were used to detect the protein and mRNA levels of Keap1, Nrf2, ARE, 1 NQO1, HO-1. Results Compared with the CD group, hepatic steatosis, lobular inflammation, portal vein inflammation, swelling NASH score, fat content, serum enzyme indicators ALT and AST significantly increased in the HCD group (P<0.05). Compared with the HCD group, all the above indicators in the HCD+RSV group significantly decreased (P<0.05), there were no statistical difference in the above indicators between the HCD group and the HCD+RSV+OAD85 group (P>0.05). Compared with the CD group, the protein expressions of NQO1,HO-1, Nrf2, ARE and mRNA in the HCD group significantly increased (P<0.001), while the expressions of Keap1 protein expression decreased (P<0.001). Compared with the HCD group, the protein expressions of NQO1,HO-1, Nrf2, ARE and mRNA in the HCD+RSV group also increased (P<0.001), while the expressions of Keap1 protein expression and mRNA decreased (P<0.001) There was no statistical difference in the above indicators between HCD group and HCD+RSV+OAD85 group (P>0.05).　Conclusions　Resveratrol in the treatment of non-alcoholic steatohepatitis rats may be based on the activation mechanism of Nrf2/ARE signaling pathway, thereby improving the level of oxidative stress and alleviating liver pathological damage.

Stress distribution of the scapholunate interosseous ligament under different load conditions on the wrist

Wei Mingjie, Xu Yujian, Wu Yipeng, Wang Teng, Wu Huan, Yuan Libo, Tang Wenbao, Guo Xiaojv, Xu Yongqing

Chinese Journal of Clinical Anatomy. 2021, 39(5): 586-592. doi:10.13418/j.issn.1001-165x.2021.05.016

Abstract ( 305 )

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Objective　To study the stress distribution of the scapholunate interosseous ligament(SLIL) of the wrist joint during different movements of the wrist by established a three-dimensional finite element model of the wrist joint.　Methods　The CT data of normal wrist joints were selected and imported into Mimics software to construct a three-dimensional finite element model of the wrist joint.. The SLIL stress distribution of the wrist joint under different motion directions was analyzed.　Results　With the increasing of the dorsiflexion angle, the SLIL stress increased. When the dorsiflexion angle increased to 90°, the maximum stress of SLIL was 1.3787 MPa. When the dorsiflexion angle was 30°, the maximum stress of SLIL was 0.1596 MPa. When the angle of palmar curvature increased to 90°, the maximum stress of SLIL reduced to 0.2452 MPa. The maximum stress of SLIL was 0.8145 MPa at 25° radial deviation, and 0.1356 MPa at 25° ulnar deviation. The maximum stress of SLIL was 0.4465 MPa when the radial force was applied to the wrist joints at 20 N, and 0.4635 MPa when the ulnar force was applied at 20 N.　Conclusions　The three-dimensional finite element model of the wrist joint can simulate the force of SLIL in different wrist movements. The stress of SLIL is maximum when the wrist joint dorsiflexion angle reaches 90°. When doing ulnar deviation and radial deviation, the maximum stress of SLIL radial deviation is about 6 times of the maximum stress of ulnar deviation at the same deflection angle.

Repair of extremity wounds with single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle

Liu Zhijin, Ju Jihui, Liu Shengzhe, Jin Guangzhe, Li Lei, Zhou Rong

Chinese Journal of Clinical Anatomy. 2021, 39(5): 593-597. doi:10.13418/j.issn.1001-165x.2021.05.017

Abstract ( 209 )

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Objective　To explore the clinical effect of repairing limb wounds by single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle.　Methods　Twenty-four cases of limb wounds were repaired with fascial pedicled bilobed anterolateral thigh perforator flaps in our hospital from August 2013 to September 2019, of which 18 cases were single wounds with wound area from 14cm× 7cm to 24 cm×14 cm. Five cases had two contiguous wounds on the hand or foot, with the wound area ranging from 4 cm×4 cm to 30 cm×17 cm. One patient’s wounds located on the distal dorsal side of the left 2-5 fingers, which were also treated as two wounds. In all cases, single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle were designed for repairing. And the donor areas were sutured directly.　Results　All the bilaterally lobed flaps survived successfully and all the donor areas of thigh healed in stage I. All the patients were followed-up for 4 to 70 months, which showed that all the flaps were of good color and texture, and the sensation of the flaps recovered partially. Linear scars were remained in all donor sites. One case had a large scar area without any scar contracture, pain or other discomfort. Two cases had paresthesia in the incision area in the early postoperative period, which gradually recovered 3 months later without any other serious complications. Conclusions　The application of single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle can solve the problem that the bilobed flap cannot be cut because of perforator variations, and reduce the width of the donor area at the same time, which effectively reducing the injury.

Effect of “accordion” technique on the clinical treatment of bone defect by Ilizarov bone transport

Han Xiaofei, Sun Zhenzhong, Song Sheng, Liu Xueguang, Zhang Shujun, Du Shihao

Chinese Journal of Clinical Anatomy. 2021, 39(5): 598-602. doi:10.13418/j.issn.1001-165x.2021.05.018

Abstract ( 454 )

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Objective　To investigate clinical effects of ‘accordion’ technique on the treatment of large segmental tibial bone defects by Ilizarov bone transport technique.　Methods　The clinical data of 29 patients admitted to our hospital treated with large segmental tibial bone defects using Ilizarov bone transport technique were retrospectively analyzed. These patients were randomly divided into two groups. There was no statistically significant difference between the two groups in gender, age, length of bone defect, operation frequency, preoperative adjacent joint score before bone transport. External fixation time, healing time, healing grade and complications after surgery and function recovery of the lower limb were analyzed.　Results　All patients experienced no or minor complications during the perioperative period, then recovered completely. Follow up about 20~40 months, with a mean value of 24.3 months. The bone healing time of the control group was（14.35±3.39）months while that of the “accordion” group was（12.56±2.80）months , there was statistical difference in the bone healing time between the two groups. Bone healing grade in the control group: 8 cases were excellent, 4 cases good, overall good rate was 80%. Bone healing grade in the “accordion” group: 7 cases excellent, 5 cases good, overall good rate was 85.7%. Bone healing grade of “accordion” group was better than that of control group, but there was no statistical difference(P>0.05). The complication rate of “accordion” group was lower than that of the control group, there were statistical differences in the complication rate between the two groups. Lower limb function recovery in the control group: 7 cases were excellent, 6 cases good, with an overall good rate of 86.7%. While for that in the “accordion” group, 8 cases were excellent, 5 cases good, the overall good rate was 92.8%. The external fixation time of the control group was (15.15±2.86) months while that of the accordion group was (14.69±2.23) months, there was no statistical difference in the external fixation time (P>0.05).　Conclusions　“Accordion” technology can shorten the time of bone healing at the union end, improve the rate of natural healing rate and reduce complications of surgeries, which plays a positive role in the recovery of limb function.It is worthy of our attention on its application in clinical practice.

The application and 5 years follow-up of stand-alone MC+polyether-ether-ketone (PEEK) Cage in anterior cervical fusion

Yan Huibo, Deng Shangxi, Li Qingchu, Jin Dadi, Liu Zezheng, Cheng Liang, Jiang Jian

Chinese Journal of Clinical Anatomy. 2021, 39(5): 603-608. doi:10.13418/j.issn.1001-165x.2021.05.019

Abstract ( 241 )

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目的　探讨单嵌片自稳型颈椎融合器在颈椎前路减压融合术中的应用，报告5年随访疗效。方法　选取47例因脊髓型或神经根型颈椎病行颈椎前路减压+单嵌片自稳型颈椎融合器置入术患者。侧位X线片观察椎间高度、颈椎前凸角及植骨融合率；术前及术后进行JOA评分，观察神经功能恢复情况；VAS评分评价患者颈部或肢体疼痛；SF-36健康调查评分观察临床疗效。结果　术后6个月67个融合节段均获骨性融合。椎间隙高度术前为（4.47±0.86）mm，末次随访为（7.41±0.72）mm。颈椎前凸角术前为（0.7±4.1）°，末次随访为（5.9±3.6）°。随访56~96个月，所有患者未出现严重手术并发症，神经功能有明显恢复。JOA评分由术前（9.15 ±0.22）分增至末次随访（14.89±0.16）分，VAS评分由术前（5.24±1.44）分减至末次随访（0.35±0.49）分。JOA及VAS评分术前较术后各次随访具有统计学差异（P<0.05)，但术后各次随访之间无统计学差异（P>0.05）。SF-36健康调查评分6个维度，术前及术后评分均具有统计学差异（P<0.05）。结论　单嵌片自稳型颈椎融合器能使融合节段获得即刻稳定性，有效恢复和维持椎间隙高度，植骨融合率高，中远期疗效好，适用于多种需前路减压的颈椎退变性疾病。

The characteristics and clinical application of membrane anatomy in laparoscopic inguinal hernia repair

Jiang Ming, Bao Wenzhong, Jiang You, Wang Jie, Yang Renbao, Li Liang, Yao Baozhong, Mao Zhihai

Chinese Journal of Clinical Anatomy. 2021, 39(5): 609-612. doi: 10.13418/j.issn.1001-165x.2021.05.020

Abstract ( 66 )

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Objective　To investigate the membrane anatomical characteristics and clinical application of laparoscopic inguinal hernia repair.　Methods　The anatomy of the anterior abdominal wall and postoperative video analysis were observed during laparoscopic inguinal hernia repair in 47 patients with inguinal hernia in our hospital. The surgical approach and anatomical level were described.　Results　Laparoscopic inguinal hernia repair was performed between the transverse abdominal fascia and the preperitoneal fascia. The avascular plane could be dissected and separated with minimal bleeding. The parietal plane and the visceral plane were connected to each other and the preperitoneal fascia needed to be removed.　Conclusions　Laparoscopic inguinal hernia repair under the guidance of membrane anatomy can make the operation more delicate and reduce surgical complications.

Study on the effect of modified laparoscopic uterosacral fixation on the treatment of moderate and severe metroptosis

Ai Xiaoyan, Zhu Yirong, Ke Cancan, Yu Yujie

Chinese Journal of Clinical Anatomy. 2021, 39(5): 613-618. doi:10.13418/j.issn.1001-165x.2021.05.021

Abstract ( 240 )

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Objective　To explore the clinical effect and the effect on the quality of life of patients with pelvic organ prolapse quantitive examination POP-Q Ⅱ/Ⅲmetroptosis treated by modified laparoscopic uterosacral fixation (MLUC).　Methods　Sixty cases of moderate and severe metroptosis admitted in our hospital from May 2017 to January 2019 were selected as the study object. The patients were randomly divided into two groups: a conventional group and an improved group, 30 cases each. The conventional group was treated with laparoscopic uterosacral fixation (LUC), and the improved group was treated with MLUC. The clinical indexes, objective cure rate, clinical complications, recurrence rate, quality of life and sexual function improvement were compared between the two groups.　Results　The operation time, intraoperative bleeding volume, catheter retention time and hospitalization time of the improved group were all less than those of the conventional group (P<0.001). Aa, Ba, D, Ap and Bp of the two groups at six months after operation significantly improved compared with those before operation (P<0.001). There was no obvious change in TVL of the conventional group (P>0.05), but TVL of the improved group was significantly less than that of the conventional group (P<0.05).There was no significant difference in the objective cure rate (93.33% in the improved group: 90.00% in the conventional group), recurrence rate (13.33% in the improved group: 16.67% in the conventional group) between the two groups (P>0.05). The incidence of clinical complications in the improved group (6.67%) was lower than that in the conventional group (26.67%),(P<0.05). Six months after operation, the quality of life and sexual function of the two groups significantly improved (P<0.001). The PFDI -20, UDI-6, POPDI -6, CRADI-8 and the score of sexual pain in the improved group were lower than those in the conventional group, and the scores of libido, sexual arousal, orgasm, vaginal lubrication and sexual satisfaction were higher than those in the conventional group (P<0.05). Conclusions LUC is a safe and effective treatment for patients with moderate and severe metroptosis. Compared with conventional LUC, MLUC is simpler, with less bleeding shorter operation time and hospital stay, lower postoperative complications, and better improvement effect on the patients’ quality of life, which is worthy of further promotion and application.

A new method of displaying cutaneous perforator vessels

Qiu Chuiming, Shi Xiaotian, Wan Wei

Chinese Journal of Clinical Anatomy. 2021, 39(5): 619-620. doi:10.13418/j.issn.1001-165x.2021.05.022

Abstract ( 274 )

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Research progress of local bone autograft in anterior cervical decompression and fusion

Gu Honglin, Chang Yunbing

Chinese Journal of Clinical Anatomy. 2021, 39(5): 621-623. doi:10.13418/j.issn.1001-165x.2021.05.023

Abstract ( 176 )

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Research progresson on risk assessment for central lymph node metastases in papillary thyroid microcarcinoma

Wu Yuanyuan, Wang Jun

Chinese Journal of Clinical Anatomy. 2021, 39(5): 624-626. doi:10.13418/j.issn.1001-165x.2021.05.024

Abstract ( 157 )

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Progress in the treatment of inguinal lymphatic leakage

Xiong Hongtao, Zhuang Yongqing, Fu Xiaokuan, Wen Xuexian

Chinese Journal of Clinical Anatomy. 2021, 39(5): 627-629. doi:10.13418/j.issn.1001-165x.2021.05.025

Abstract ( 257 )

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Absence of right external jugular vein and variation of homolateral cephalic vein: one case report

Yang Jiping, Cheng Juanjuan, Zhong Yuxi, Li Haoxu

Chinese Journal of Clinical Anatomy. 2021, 39(5): 523. doi:10.13418/j.issn.1001-165x.2021.05.026

Abstract ( 214 )

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The variations of celiac trunk and its branches: one case report

Yu Yanan, Li Lu, Liu Tingting, Huang Haitao, Qian Jiazhi, Cheng Jiamao

Chinese Journal of Clinical Anatomy. 2021, 39(5): 528. doi:10.13418/j.issn.1001-165x.2021.05.027

Abstract ( 287 )

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