Chinese Journal of Clinical Anatomy

Anatomical study and clinical significance of the first metacarpal artery ulnar perforator branch of metacarpal neck

Zhu Mingsheng, Wang Zengtao, Chen Jingguo, Hao Liwen, Chen Chao, Hou Zhidian

Chinese Journal of Clinical Anatomy. 2022, 40(3): 249-254. doi:10.13418/j.issn.1001-165x.2022.3.01

Abstract ( 158 )

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Objective To study the anastomotic types between the first metacarpal artery metacarpal neck ulnar perforator, the second dorsal metacarpal artery and the webbed artery, so as to provide anatomical basis for the safe design and incision of the second dorsal metacarpal artery flap. Methods A total of 39 fresh adult cadaveric hands were collected. All the arteries of those hands were perfused with red latex. Anatomical observation under the microscope was recorded not only the origin, course, and outer diameter of the first metacarpal artery metacarpal neck ulnar perforator, but also the anastomosis between the second dorsal metacarpal artery and the webbed artery. Results The first metacarpal artery metacarpal neck ulnar perforator branch started at the second metacarpal neck from the first metacarpal artery, with an initial diameter of (0.57±0.20) mm, and passed dorsally along the gap between the ulnar side of the second metacarpal artery and the interosseous muscles, forming anastomosis with the second dorsal metacarpal artery and the webbed artery. According to the anastomotic characteristics of the dorsal metacarpal artery and the webbed artery, it could be divided into 4 types: Ⅰ. Non-anastomosis type (accounting for 38.46%); Ⅱ. "T" type (accounting for 33.33%); Ⅲ. "Y" type (accounting for 25.64%); IV. "π" type (accounting for 2.56%). Conclusions The anastomosis between 28.20% of the second dorsal metacarpal artery and the webbed artery are not direct, but indirectly anastomosed through the first metacarpal artery metacarpal neck ulnar perforator ("Y" type, "π" type anastomosis). In these two cases, it is easy to destroy the anastomotic continuity between the second dorsal metacarpal artery and the webbed artery during the operation, which may cause the difficulty or even failure of the second dorsal metacarpal artery flap operation.

Anatomical study of endoscopic trans-supraorbital keyhole approach

Wu Pinghua, Mo Ligen, Chen Hainan, Guo Fangzhou, Mu Junbo

Chinese Journal of Clinical Anatomy. 2022, 40(3): 255-258. doi:10.13418/j.issn.1001-165x.2022.3.02

Abstract ( 194 )

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Objective To explore the anatomical structures locating at the middle area of skull base exposed by endoscopic supraorbital keyhole approach, so as to provide reference for clinical resection of tumors in the middle area of skull base. Methods The brain tissues, blood vessels and nerves locating at the middle line area of skull base exposed by endoscopic supraorbital keyhole approach were observed in five formalin fixed adult cadaveric heads. Results Through endoscopic supraorbital keyhole approach, the anterior clinoid process and its medial dura of anterior skull base, olfactory groove and olfactory nerve can be clearly exposed in anterior skull base. Optic nerves, optic chiasm, preoptic chiasm space, superior hypophyseal artery, ophthalmic artery, internal carotid artery and its surrounding space can be exposed in sellar region. The dorsum sellar dura, mastoid body, terminal basilar artery, superior cerebellar artery, posterior cerebral artery, posterior communicating artery, oculomotor nerve, trochlear nerve, trigeminal nerve, facial nerve, vestibular cochlear nerve and ventral pons can be exposed in upper clivus region. Conclusions It is feasible to resect tumors in the midline area of skull base using endoscopic supraorbital keyhole approach, and this approach is an effective supplement to conventional microscope approach and nasal endoscopic transnasal approach in the resection of tumors in midline area of skull base.

Analysis on the anatomical parameters of coracoclavicular ligament based on MRI

Zhang Lei, Zhang Huaqiang, Jin Yufeng, Zhang Mengyao, Zhou Xin, Li Bingkun, Tang Xiaogao

Chinese Journal of Clinical Anatomy. 2022, 40(3): 259-262. doi:10.13418/j.issn.1001-165x.2022.3.03

Abstract ( 211 )

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Objective 　To study the morphological characteristics of the coracoclavicular ligament and its guiding significance for transosseous tunnels construction.　Methods　The MRI scan data of 480 scapula patients were collected from January 1, 2017 to January 1, 2020. Four angles and seven distances from 480 MRI scan were defined and measured in images of the coronal and sagittal plane. All data were analyzed by SPSS 20.0. Results In the coronal plane, the average distance from the midpoint of acromioclavicular joint to the insertion at the clavicle was greater in males than in females, with statistical difference (P<0.05). In the sagittal plane, in addition to the diameter of insertion at the coracoid process, the distance from the insertion at the clavicle to the insertion at the coracoid process, the distance from the tip of the coracoid process to the insertion at the coracoid process, the distance from the supraclavicular plane of the clavicle to the subcoracoid plane of the coracoid process, the diameter of insertion at the clavicle in males were greater than those in females, with statistical difference (P<0.05).　Conclusions　These anatomical parameters could completely describe the anatomical characteristics of coracoclavicular ligament, which are beneficial for the construction of coracoclavicular ligament to create transosseous tunnels accurately and individualized treatment of acromioclavicular dislocation.

Three-dimensional analysis of anatomical parameters of temporomandibular joint in Guangdong population

Guo Jinyuan, Du Yuan, Wang Tongyue

Chinese Journal of Clinical Anatomy. 2022, 40(3): 263-266. doi:10.13418/j.issn.1001-165x.2022.3.04

Abstract ( 129 )

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Objective To evaluate various anatomic parameters of mandible and temporomandibular joint in Guangdong population. Methods A total of 265 patients admitted to Stomatology Hospital, Southern Medical University were selected to measure the condyle length , the condyle height, the height of mandibular ascending branch, and the position of the inferior mandibular nerve entering mandibular ascending branch in male and female respectively by using CBCT. Results In all patients, the mean length of the condyle was 19.2 mm in two-dimension and 20.3 mm in three-dimension, and the condyle length in males was showed longer than female by 3.6 mm. Mandibular height, condylar height, and the height of mandibular ascending branch was 59.6 mm, 22.8 mm, and 38.3 mm, respectively. Males showed longer than female in mandibular height by 6.4 mm, with statistical differences between in male and female. The width of mandible ascending branch, the distance from the uvula to the anterior ridge of the ascending ramus and the distance from the uvula to the posterior border of the ascending ramus were 29.4 mm, 14.8 mm, and 14.6 mm, respectively, with no statistical difference between male and female. Conclusions CBCT has more significant accuracy in the measurement of temporomandibular joint. The results of this experiment enrich the mandibular anatomical data of Chinese population and contribute in the development of artificial temporomandibular joint which is suitable for Guangdong population.

Anatomical study of lower lumbar Kambin triangle based on MRN technique

Wang Hongwei , Li Kaixiang, Wang Qingyun, Li Ruibing, Liu Xiaoqiang

Chinese Journal of Clinical Anatomy. 2022, 40(3): 267-270. doi:10.13418/j.issn.1001-165x.2022.3.05

Abstract ( 462 )

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Objective To measure and analyze the anatomical data of magnetic resonance neurography (MRN) of lower lumbar Kambin triangle working area in normal adults, so as to provide reference for the selection and safety evaluation of minimally invasive surgery of lower lumbar spine. Methods Twenty healthy adult volunteers (male: 10, female: 10) were performed magnetic resonance imaging scan at L4~S1 segment with 3.0 T MRN. The neuroimaging was performed by OsiriX software. The following data were measured: the distance between ganglion and superior pedicle (A), the distance between ganglion and lower pedicle (B), and the angle between nerve root and dural sac (α), area of Kambin triangle (S). Finally, the measured data were statistically analyzed. Results From L4 to S1 segment, the distance between ipsilateral ganglion and superior pedicle decreased gradually (P<0.05). But there was no statistical difference between ipsilateral ganglion and lower pedicle (P>0.05). From L4 to S1, the angle between ipsilateral outlet nerve root and dural sac gradually decreased, the difference was statistically significant (P<0.05). From L4 to S1, the area of Kambin triangle increased gradually (P<0.05). In addition, there was no statistical difference between the left and right sides of the same segment (P>0.05). Conclusions MRN technology can clearly and accurately visualize the anatomical relationship of the Kambin triangle structures of the lower lumbar spine, which is helpful to measure the relevant anatomical data and can guide the selection of minimally invasive surgical methods and the evaluation of surgical safety.

Establishment of the groin flap based on the superficial epigastric artery into axillary fossa in rats

Wu Dongfang, Liu Donghong, Fang Fang, Jing Xing, Chen Shaofeng, Zhuang Yuehong

Chinese Journal of Clinical Anatomy. 2022, 40(3): 271-276. doi:10.13418/j.issn.1001-165x.2022.3.06

Abstract ( 169 )

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Objective　To describe the procedure of transfer of the groin flap based on the superficial epigastric artery into the axillary fossa in rats. Materials Twenty clean SD male rats weighing 420~450 g were depilated after successful anesthesia. A free groin flap model with a size of 4cm×2cm was established based on the superficial blood vessel of the abdominal wall was transplanted to the axillary fossa with the lateral thoracic vessels used as the recipient vessels. The main observations were as follows: ① the origin, course and branches of femoral vessels and lateral thoracic vessels were observed, and their outer diameter and length were measured; ② survival state of experimental animals; ③ The survival of the flap on the 7th day after operation. Results The diameter of the femoral artery and vein was (0.72±0.08) mm and (1.29±0.17) mm respectively, and that of the lateral thoracic artery and vein was (0.59±0.18) mm and (1.04±0.12) mm respectively. Two rats failed to recover from anesthesia after operation, and 3 rats had complete necrosis of skin flap, resulting in a flap survival rate of 75%. Due to removal of the femoral artery, claudication of the affected limb could occur after surgery. One week later, with compensation of the blood supply, the gait of rats gradually returned to normal. Conclusions The free flap based on the superficial epigastric artery in rats is very suitable for junior doctors and researchers who want to engage in the clinical work and the basic research relating to supramicrosurgery.

The effects of brachial plexus transection on the structure and morphology degeneration of spinal motoneuron dendrites in mice

Li Mi, Xu Jiawei, Zou Ying, Guo Jiasong

Chinese Journal of Clinical Anatomy. 2022, 40(3): 277-285. doi:10.13418/j.issn.1001-165x.2022.3.07

Abstract ( 131 )

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Objective To study the correlation of time course and distance of brachial plexus transection on the dendritic degeneration of spinal motoneurons. Methods The brachial plexus of mice was transected at 3 mm or 10 mm from the intervertebral foramen, the spinal cord segments of C6~C7 was collected at 7, 14, 28 and 56 days post injury (dpi) and was subjected to perform MAP2 immunofluorescence staining, morphometric analysis, Golgi-Cox staining and Sholl analysis to assess the dendritic structure changes of spinal motoneurons. The effects of brachial plexus transection 3 mm and 10 mm from the foramina on spinal motor neuron dendrite was compared at 28 days after surgery. Results The brachial plexus transection resulted in that the density and integrity of dendrite in the spinal ventral horn decreased gradually with time. Golgi-Cox staining and Sholl analysis showed the longest dendrite, total dendritic length, the maximum span of dendrite and the number of third-grade dendrite branches of each spinal motoneuron decreased with time dependence. Compared with the transection at 10 mm from the intervertebral foramen, the length of dendritic degeneration in the 3 mm group was more severe. Conclusions The dendrite degeneration occurs and get worse in spinal motoneurons after peripheral nerve injury with time dependence, while the degree dendrite degeneration reduces with the extension of the distance between injury site and spinal cord.

Study on the mechanism of oridonin inhibiting PC-3 cells migration and invasion by up-regulating miR-204-5p

Shi Haoran, Bao Guanglong, LingHu Xitao, Wu Honghan, Zhao Zeju, Liu Xiao, Fu Yao , Huang Shuai, Wa Qingde

Chinese Journal of Clinical Anatomy. 2022, 40(3): 286-291. doi:10.13418/j.issn.1001-165x.2022.3.08

Abstract ( 99 )

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【Abstract】 Objective To explore the effect and mechanism of oridonin on the migration and invasion of PC-3 cells, to provide preliminary in vitro experiment reference for the treatment of bone metastasis of prostate cancer with oridonin. Methods The effect of oridonin on the proliferation of PC-3 cells was detected by CCK8. The effect of oridonin on the migration and invasion of PC-3 cells was detected by the Transwell test. The expression of miR-204-5p and NF-κB signaling pathways after the treatment of PC-3 cells with oridonin was analyzed by qRT-PCR. The expression of protein in the NF-κB signaling pathway after the treatment of PC-3 cells with oridonin was analyzed by Western blotting. Results Firstly, the proliferation of PC-3 cells was inhibited by oridonin solution in a concentration- and time-dependent manner; and the difference from the control group was of statistical significance (P<0.01), the IC50 value of oridonin was 10 μmol/L. Secondly, the migration and invasion of PC-3 cells were inhibited by oridonin in a concentration-dependent manner; and the difference from the control group was of statistical significance (P<0.01). Finally, the results of qRT-PCR showed that oridonin solution promoted the expression of miR-204-5p in PC-3 cells and blocked the expression of the downstream genes in the NF-κB signaling pathway; the results of Western blotting indicated that both the overexpression of miR-204-5p and oridonin could inhibit the expression of the downstream genes in NF-κB signaling pathway in PC-3 cells. Conclusions Oridonin can inhibit the proliferation, migration and invasion of PC-3 cells. Its mechanism of action may be associated with its up-regulating miR-204-5p and blocking the NF-κB signaling pathway.

Study on the reliability of differential hypervelocity centrifugation for isolation of mesenchymal stem cells derived exosomes from different species

Zhao Renli, Lai Guohua, Wu Jiachang, Wu Mingjie, Zhuang Weida, Ouyang Jun, Sang Hongxun

Chinese Journal of Clinical Anatomy. 2022, 40(3): 292-296. doi:10.13418/j.issn.1001-165x.2022.3.09

Abstract ( 102 )

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Objective　To isolate and culture the mouse and rat bone marrow mesenchymal stem cells (BMSCs)， purify the exosome by differential hypervelocity centrifugation， identify the morphology and biological function of exosomes and analyze the reliability of this method for exosome isolation.　Methods　BMSCs of 3-5 passages were differentiated by osteogenic, adipogenic and chondrogenic induction and then stained. The surface markers of BMSCs were identified by flow cytometry. Exosomes were identified by transmission electron microscopy, nanoparticle tracer analysis and Western Blot. Results Stained after osteogenic, adipogenic and chondrogenic induction, BMSCs were proved to have the unique potential of multidirectional differentiation. Flow cytometry results showed that mouse and rat BMSCs expressed the surface antigen of stem cells. Under transmission electron microscopy, exosomes showed a typical goblet structure with an average particle size of 107 nm and 152 nm. Western Blot results showed that the exosomes expressed landmark proteins.　Conclusions　Mouse and rat BMSCs are successfully isolated and cultured. Meanwhile, differential hypervelocity centrifugation is suitable and reliable to isolate and purify exosomes from BMSCs.

Relationship between expression of pEGFR and neural function recovery after decompression of compressed spinal cord injury in rats

Zhang Min, Li Xingqiong, Yan Sijin, Li Lamei, Du Yao, Zeng Qingying, Pan Lifeng, Gong Rui

Chinese Journal of Clinical Anatomy. 2022, 40(3): 297-302. doi:10.13418/j.issn.1001-165x. 2022.3.10

Abstract ( 220 )

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Objective　To investigate the relationship between expression of phosphorylated epidermal growth factor receptor (pEGFR) and neural function recovery after decompression of compressed spinal cord injury(CSCI) in rats and clarify its possible mechanisms.　Methods　The CSCI model was established. The neural function recovery after decompression were monitored by the Basso, Beattie &Bresnahan(BBB) locomotor rating scale; the expression of pEGFR, total-caspase-3, active-caspase-3 were detected by Western blot; pEGFR+-NG2+(NG2+ cells are precursors to oligodendrocytes)，active-caspase-3+-NG2+ cells were detected by double-labeling immunefluorescence assay.　Results　The BBB scores gradually increased with time after decompression of CSCI. Meanwhile, the expression of pEGFR, number of pEGFR+-NG2+ cells were up-regulated and reached the peak at day 14, consistent with the changes of motor functions. total-caspase-3, active-caspase-3 and caspase-3-NG2+ cells immediately reached the peak after decompression and gradually decreased with time. After intraperitoneal injection of pEGFR inhibitor for 14 days, expression of pEGFR and BBB scores of rats were significantly lower than those of group without pEGFR inhibitor injection. The expression of total-caspase-3, active-caspase-3, caspase-3-NG2+ cells significantly increased.　Conclusions　The expression of pEGFR is related to process of neural function recovery after decompression of CSCI in rats, and its mechanism may be due to the involvement of pEGFR in the regulation of Caspase-3 signaling pathway.

Retinoic acid improves lipopolysaccharide-induced vascular inflammation and oxidative stress through TLR4/NF-κB signaling pathway

Li Chen, Zhang Yingjie, Sun Yang, Wang Hongxin

Chinese Journal of Clinical Anatomy. 2022, 40(3): 303-308. doi:10.13418/j.issn.1001-165x.2022.3.11

Abstract ( 94 )

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Objective To study potential protective effects of retinoic acid (RA) on lipopolysaccharide (LPS)-induced vascular inflammation and oxidative stress and explore its possible molecular mechanism. Methods After SD rats were given RA and TLR4 inhibitors by oral gavage for 2 weeks, except for the control group, LPS group, RA 3 mg/kg group, RA 15 mg/kg group and TLR4 inhibitor group (TAK-242, 3 mg/kg), LPS (10 mg/kg) was injected intraperitoneally to establish a vascular inflammation model. Vascular tension measurement system was used to detect vasodilation function, nitrate reductase method was used to detect nitric oxide (NO) content in rat serum. Serum IL-18, IL-1β, TNF-α, IL-6 and GSH- px level was detected by ELISA method, WST-1 and TBA methods were used to detect the activity of superoxide dismutase (SOD) and malondialdehyde (MDA) in the serum respectively, DHE fluorescent probe was used to detect the level of vascular reactive oxygen species (ROS), and immunohistochemical method to detect the expression of vascular NF-κB p65, Western blotting to detect the expression of vascular TLR4, eNOS and p-eNOS. Results Compared with the LPS group, RA can improve the vasodilation function, increase the levels of p-eNOS and NO, decrease the serum inflammatory factors IL-18, IL-1β, TNF-α, IL-6 level, and reduce the serum MDA and ROS, increase the production of SOD and the release of GSH-px in the serum, and down-regulate the expression levels of vascular TLR4 and NF-κB p65. In addition, the effect of RA on LPS-induced vascular inflammation and oxidative stress was similar to that of TLR4 inhibitors. Conclusions RA has an inhibitory effect on LPS-induced vascular inflammation and oxidative stress, through the TLR4/NF-κB p65 signaling pathway.

The role of TLR4/NF-κB signaling pathway in the regulation of lipid metabolism of alveolar macrophages in a model of silicosis induced by SiO2

Zhao Jing, Jiao Zhuoya, Wang Juan, Liu Lu

Chinese Journal of Clinical Anatomy. 2022, 40(3): 309-314. doi:10.13418/j.issn.1001-165x.2022.3.12

Abstract ( 81 )

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Objective To investigate the role of Toll-like receptor 4 (TLR4)/nuclear transcription factor κB (NF-κB) pathway in lipid metabolism of alveolar macrophages in the silicosis model of rats induced by silicon dioxide (SiO2). Methods According to the random number table method, 36 SD rats were randomly divided into a normal group, a model group and an inhibitor group. The model group and the inhibitor group were modeled by slowly instilling 1 mL of silica suspension into the disposable trachea. After successful modeling, the rats in the inhibitor group were injected with TAK-242 (TLR4/NF-κB signal specific inhibitor) daily with the dose of 0.5 mg/kg. The rats in the normal group and model group were injected an equal dose of normal saline. After 4 weeks, the rats were sacrificed to collect bronchial lavage fluid (BALF). Enzyme-linked immunosorbent assay (ELISA) was used to determine the content of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in BALF of each group of rats. Alveolar macrophages in BALF were extracted and cultured. Oil red O staining was used to observe the lipid droplet formation of macrophages in each group. Western blot was used to detect the expression levels of TLR4, MyD88, and NF-κB in macrophages. Results Compared with the normal group, the content of IL-6 and TNF-α in the BALF in the model group and the inhibitor group, the proportion of oil red O positive macrophages, the expression of TLR4, MyD88, and NF-κB in phagocytes all significantly increased, and the differences were statistically significant (all P<0.05). Compared with the model group, the content of IL-6 and TNF-α in BALF in the inhibitor group, the proportion of oil red O positive in macrophages, the expression of TLR4, MyD88, NF-κB in macrophages significantly reduced, the differences were statistically significant (all P<0.05). Conclusions In the silicosis model of rats caused by SiO2, TLR4/NF-κB signal is involved in the regulation of lipid metabolism of alveolar macrophages, and inhibit the expression of TLR4/NF-κB signal, which can significantly inhibit the pathological damage of silicosis.

Biomechanical study of posterior flexible and dynamic fixations in the occipitocervical region

Tong Jie, Ji Wei, Huang Zhiping, Zhou Ruozhou, Fang Zuozhong, Zhu Qingan

Chinese Journal of Clinical Anatomy. 2022, 40(3): 315-319. doi:10.13418/j.issn.1001-165x.2022.3.13

Abstract ( 106 )

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Objective To analyze the effects of flexible and dynamic fixation on the stability of the occipitocervical region. Methods Biomechanical tests were performed by using six fresh adult cervical spines (occipital bone-C4 segment, Oc~C4), with the fixation site extended from the occipital bone to the C3 vertebra. The following conditions were stimulated: (1) Intact state; (2) Injury state: a combination of type II odontoid fractures and atlanto-occipital capsule injury; (3)Rigid fixation: a 3.5 mm diameter titanium rod was used to connect C3 lateral mass screws, C1, and C2 were fixed with common pedicle screws; (4) Flexible fixation: a 2.0 mm diameter titanium rod was used to fix Oc~C3 with locking connections between the screws and rods; (5) Fixation by using two rotating pedicle screws; (6) C1 and C2 were fixed with four rotating pedicle screws; (7) C1, C2 and C3 were fixed with six rotating pedicle screws. Biomechanical studies were performed by using a spinal testing machine, while applying a constant moment of 1.5 Nm in flexion-extension, left-right lateral bending, and left-right axial rotation directions were measured to analyze the range of motion (ROM) and neutral zone (NZ) of Oc~C3 segments. Results ROM of 2.0mm diameter rod fixation was significantly larger than that of rigid fixation in all directions (P<0.05). Compared with the rigid fixation, ROM of Oc~C3 in C1 and C2with a fixation that used 2~4 rotating pedicle screws was similar in all directions (P>0.05). The application of six rotating pedicle screws in C1~C3 significantly increased ROM for rotation in Oc~C3 with statistical significance (P=0.031). Different fixation methods significantly reduced the neutral zone of fixed segment in flexion, extension, lateral bending and rotation directions (P<0.05). Conclusions In the occipital cervical region Oc~C3, the stability of all directions with using flexible fixation was weaker than that of rigid fixation. In the occipital cervical region, the stability of using two or four rotating screw fixations in C1 and C2 is similar to that of rigid fixation. Using six rotating screw fixations is as stable as rigid fixation in directions of flexion, extension and lateral bending, but weaker in the direction of rotation.

Finite element analysis of anterior cervical micro-memory compression alloy plate

Tong Ling, Xu Yangyang, Wang Yidan, Ma Yuan, Wang Haiyan, Li Xiaohe

Chinese Journal of Clinical Anatomy. 2022, 40(3): 320-326. doi:10.13418/j.issn.1001-165x.2022.3.14

Abstract ( 99 )

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Objective　To evaluate the biomechanical properties of the micro memory compression alloy plate (GYZ memory alloy plate) after anterior cervical discectomy and fusion, so as to provide basis for clinical application, postoperative care, and follow-up experimental research and improvement of the implant. Methods　Three dimensional finite element models of C5, C6 cervical vertebrae and miniature memory compression alloy plate were established in a healthy adult female volunteer. The stress distribution of the stress concentration area on the endophyte under different working conditions was compared and analyzed. Results In the neutral position, the stress distribution on the plant was relatively uniform and the stress value was small. In the forward bending state, the average stress of each area was the largest relative to the other working conditions, and the maximum average stress was located in region 6, namely the lower hook part, which was (45.89±5.32) MPa. In the extension state, the stress distribution of regions 1, 2, 3 and 4, that is, the pressurized parts, was more uniform (P>0.05). Under lateral flexion condition, the stress distribution of the implant was uneven, and the average stress of the flexion side was much higher than that of the extension side (P<0.05). Under the rotating condition, the stress was concentrated in the upper part of the opposite side and the lower part of the same side. Under the condition of left rotation, they were (23.66±6.24) MPa and (23.62±7.07) MPa. Under the condition of right rotation, they were (24.16±5.42) MPa and (24.58±5.30) MPa. Except for the neutral position, under the other six working conditions, the upper and lower hooks placed inside the vertebral body were subject to greater stress.　Conclusions　After the micro memory compression alloy plate is implanted in the front of the neck, it is necessary to reduce forward bending, avoid too frequent or too intense lateral bending and rotating movements, and it is safest to maintain a neutral position. In the follow-up research and improvement process, it can be considered to strengthen the fixing strength of the upper and lower hooks of the inner plant.

Analysis on the value of ultrasound in differentiating the recurrence of bone and soft tissue tumors

Hu Wenke, Shao Xinxin, Du Shaohua, Dai Shuangwu, Kuang Yumei, Xu Guangwei

Chinese Journal of Clinical Anatomy. 2022, 40(3): 327-332. doi:10.13418/j.issn.1001-165x.2022.3.15

Abstract ( 72 )

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Objective　To investigate the different manifestations of postoperative recurrence and scar of bone and soft tissue tumors on CT and MRI, and to evaluate the clinical diagnostic value of ultrasound in differentiating postoperative tumor recurrence and scar formation.　Methods　Fifty patients with suspected recurrence of bone and soft tissue tumors treated in the Department of Bone Oncology of the Third Affiliated Hospital of Southern Medical University from January 2016 to July 2021 were retrospectively analyzed, aged 8-84 years, with an average age of (36.2±19.5) years, 21 males and 29 females. Forty-two cases were located in limbs, 6 in pelvic ring and 2 in spine. All cases were examined by ultrasound, CT and MRI. One deputy director or chief physician of the ultrasound department and the radiology department mainly engaged in the musculoskeletal system. On the basis of CT, ultrasound and MRI were diagnosed respectively. All cases had pathological results of surgical resection or puncture biopsy.　Results　Among the 50 cases, 40 cases were diagnosed by pathology as recurrence and 10 cases as cicatrix . The sensitivity, specificity and accuracy of ultrasound diagnosis were 97.50%, 90.00% and 96.00% respectively. The sensitivity, specificity and accuracy of MRI were 92.50%, 40.00% and 82.00% respectively. The specificity and accuracy of ultrasound were higher than those of MRI, there were statistical differences in specificity and accuracy between ultrasound and MRI (P<0.05), the sensitivity was the same, and the difference was not statistically significant (P>0.05). The specificity of ultrasound in patients with internal fixation (85.71%) was higher than that of MRI (42.86%), and there were statistical differences in the specificity in patients with internal fixation between ultrasound and MRI (P<0.05). Conclusions Ultrasound can improve the diagnostic efficiency of bone tumor recurrence in the differential diagnosis of postoperative recurrence and scar formation of bone and soft tissue tumors, especially when the internal fixation has an impact on CT or magnetic resonance imaging, which is worthy of clinical promotion.

The treatment of intertrochanteric fractures with modified incision placement of proximal femur antirotational intramedullary nail

Chen Liang, Hu Dingxiang, Duan Chao, Ma Chenxi , Deng Chuanfen, Liu Min

Chinese Journal of Clinical Anatomy. 2022, 40(3): 333-337. doi:10.13418/j.issn.1001-165x.2022.3.16

Abstract ( 92 )

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Objective　To explore the efficacy of modified incision placement PFNA for patients with intertrochanteric fracture.　Methods　The study included 86 patients with intertrochanteric fracture who underwent closed reduction and PFNA internal fixation from January 2017 to December 2018. There were 48 patients with modified minor incision surgery; 38 patients with standard incision surgery.The length of operation, C-arm fluoroscopy times, length of proximal incision, operative blood loss, length of hospital stay, and 1 year after operation were recorded and evaluated using Harris score and Charnley score in both groups. Results ① There were no significant differences in the gender composition and mean age of the included patients (P>0.05); ② The length of hospital stay between the two groups was not significantly different (P>0.05); ③ The modified incision group had a shorter incision length and operation time, blood loss and intraoperative fluoroscopy times were reduced, and the Harris score and Charnley score were higher than those of the standard incision group at 1-year postoperative follow-up. Conclusions The operation of PFNA implantation under the improved incision has the advantages of positioning without fluoroscopy, reduced operation time, smaller surgical incision, less bleeding, and less surgical damage.

Application of radial artery extraction technique in high-flow cerebrovascular bypass surgery

Li Qi, Sun Yang, Wang Benlin, Tong Xiaoguang

Chinese Journal of Clinical Anatomy. 2022, 40(3): 338-341. doi:10.13418/j.issn.1001-165x.2022.3.17

Abstract ( 111 )

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Objective To explore the application of extraction technology with radial artery in the high-flow cerebrovascular bypass surgery.　Methods　Thirty-two patients of high-flow bypass surgery with radial artery as a bridging vessel admitted to the Department of Neurosurgery, Tianjin HuanHu Hospital from January 2015 to June 2021 were enrolled retrospectively. The length, internal diameter, peak systolic velocity, end diastolic velocity, intima-media thickness and resistance index of radial artery were measured. The imaging data and medical records were also utilized to assess the safety and efficacy including surgery effect, postoperative complication and patency rate of the radial artery. Results No perioperative death was found in this study. Thirty-two patients had 32 bypass grafts. The average radial artery length was (20.20±2.06) cm. The average internal diameter of the proximal end was (2.41±0.28) mm, as the average inner diameter of the distal end was t (2.28±0.42) mm. These examinations combined with Allen’s test and angiography indicated that the radial arteries were selected with good patency and suitable for high-flow bypass surgery. In this study, the bypass technique had a 100% success rate. Postoperative and follow-up imaging findings demonstrated graft vessel patency. None of the patients had suffered ischemic stroke due to radial artery spasm. The muscle strength of forearm and wrist showed no drop compared with that before operation. Postoperative 4 cases showed injury symptoms of lateral forearm cutaneous nerve and superficial branch of radial nerve, and relieved within 3 months.　Conclusions　Application of extraction technology with radial artery in cerebrovascular bypass surgery was demonstrated good safety and efficacy. This technique with high-flow cerebrovascular bypass surgery has wide application prospects in the cranial base tumors, complex cerebrovascular disease and other fields.

Effects of dexmedetomidine as an adjuvant to ropivacaine in quadratus lumbar block for postoperative analgesia with laparoscopic total hysterectomy

Zhang Longsheng, Zhang Kaihong, Yang Duo, Zhang Huankai, Huang Zhiliang, Lu Yan, He Qixia

Chinese Journal of Clinical Anatomy. 2022, 40(3): 342-346. doi:10.13418/j.issn.1001-165x.2022.3.18

Abstract ( 180 )

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Objective To investigate the effect of dexmedetomidine as an adjuvant to ropivacaine in quadratus lumbar block for postoperative analgesia with laparoscopic total hysterectomy. Methods From November 2019 to June 2020, sixty-six cases of hysteromyoma were selected and scheduled to undergo laparoscopic hysterectomy. They were randomly divided into a dexmedetomidine group (group D) and a ropivacaine group (group R), thirty-three cases in each group. TIVA was adopted in both groups and bilateral posterior quadratus lumbar block (QLB) was performed before induction of anesthesia. In group D,0.2% ropivacaine with dexmedetomidine 0.50μg/kg(30 mL) were injected on each side, while in group R, 0.2% ropivacaine (30mL) was injected on each side. VAS scores of resting and exercise pain were recorded 2 h, 6 h, 12 h, 24 h and 48 h after surgery. The first postoperative pressing time of the analgesic pump, the total effective pressing times within 48 h after surgery, the total dose of sufentanil within 48h after surgery, the number of cases of apethidine for analgesia and the analgesia satisfaction degree were recorded. Results Compared with group R, the VAS scores of resting and exercise pain in group D significantly reduced at 12 h, 24h and 48h after surgery (P<0.05). The total times of pressing the analgesia pump, the total dose of sufentanil 48h after surgery and the number of cases requiring pethidine for analgesia significantly reduced in group D (P<0.05). The first pressing time of the analgesic pump, the degree of analgesic satisfaction significantly increased in group D (P<0.05). Conclusions Dexmedetomidine 0.5 g/kg combined with 0.2% ropivacaine for bilateral QLB can be safely and effectively used for postoperative analgesia in patients undergoing laparoscopic total hysterectomy, which enhance the analgesic effect, prolong the analgesic time, reduce the dose of postoperative opioid analgesics, improve the postoperative recovery quality, and patient satisfaction, and provide a new option for multimodal analgesia schemes. It is more effective than using 0.2% ropivacaine alone.

Effects of Shuotongscope and ureteroscopy on the treatment of upper urinary tract stones combined with pyogenic kidney on clearing rate, urosepsis and T lymphocyte subsets

Zhao Zhenwei, Liu Yanjie, Li Dong, Yu Qian, Zhou Weidong, Wu Jingzhang

Chinese Journal of Clinical Anatomy. 2022, 40(3): 347-355. doi:10.13418/j.issn.1001-165x.2022.3.19

Abstract ( 326 )

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Objective To explore the effect of Shuotongscope and ureteroscopy on the treatment of upper urinary tract stones combined with pyogenic kidney on clearing rate, urosepsis and T lymphocyte subsets. Methods From January 2018 to December 2019, 102 patients with upper urinary tract stones combined with pyogenic kidneys were selected and divided into 2 groups according to random number table method, 51 cases in each group. Both groups underwent renal puncture and drainage of pus and antibacterial treatment under the guidance of B ultrasound before operation. After controlling the inflammation, the Shuotongscope group was given the Shuotongscope holmium laser lithotripsy, and the ureter soft mirror group was given the ureter soft mirror holmium laser lithotripsy. The operation time, postoperative hospital stay, success rate of sheath insertion, stone removal rate at 1 d and 1 month after operation, inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] levels, T-lymphocyte subsets (CD3+, CD4+, CD4+/CD8+), renal function indexes [urinary α1 microglobulin (α1-MG), blood urea nitrogen (BUN), blood creatinine (SCr), serum cystatin C (Cys-C), glomerular filtration rate (GFR)], complications of the two groups were compared. Results The operation time of the Shuotongscope group was longer than that of the flexible ureteroscope group (P<0.05). The stone clearing rate (84.31%) on the 1st postoperative day of the Shuotongscope group was higher than that of the flexible ureteroscope group (66.67%) (P<0.05). The stone removal rate (96.08%, 92.16%) of the two groups after 1 month of operation was not statistically significant. CRP, IL-6 and TNF-α in the Shuotongscope group were lower than those in the flexible ureteroscope group at 6 h and 24 h after operation (P<0.05). The number of CD3+, CD4+, CD4+/CD8+ in the Shuotongscope group was higher than that in the flexible ureteroscope group at 6 h and 24 h after operation (P<0.05). There was no significant difference in α1-MG, BUN, SCr, Cys-C, and GFR between the two groups before operation and 2 weeks after operation. There was no statistically significant difference in the total incidence of complications (1.96%, 5.88%) between groups. Conclusions Shuotongscope and flexible ureteroscope are safe and effective in treating upper urinary tract stones with pyogenic kidney, but the early stone clearing rate after Shuotongscope is higher, and it can improve the perioperative inflammatory reaction and body cellular immunity.

Effects of tranexamic acid and different anticoagulants on perioperative blood loss in total knee arthroplasty

Chen Senrong , Xiao Jun, Li Qiang , Hu Yong , Shi Zhanjun

Chinese Journal of Clinical Anatomy. 2022, 40(3): 356-361. doi:10.13418/j.issn.1001-165x.2022.3.20

Abstract ( 122 )

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Objective To investigate the effect of tranexamic acid and different anticoagulants on blood loss during the perioperative period of total knee arthroplasty. Methods A total of 158 patients with knee osteoarthritis who underwent total knee arthroplasty (TKA) from October 2014 to October 2019 and met the criteria were enrolled. According to different tranexamic acid injection methods and postoperative use of different anticoagulants, they were divided into four group: Group A: intraoperative intravenous injection of tranexamic acid + postoperative rivaroxaban anticoagulation; Group B: intraoperative intravenous injection of tranexamic acid + postoperative enoxaparin anticoagulation; Group C: intraoperative vein injection + local injection of tranexamic acid + postoperative rivaroxaban anticoagulation; Group D: intraoperative intravenous injection + local injection of tranexamic acid + postoperative enoxaparin anticoagulation. The preoperative preparations, intraoperative and postoperative treatments of the patients in each group were the same. The general information, intraoperative conditions, blood loss, blood coagulation function, blood transfusion and incidence of perioperative adverse events were compared in the four groups. Results The combined use of tranexamic acid could further reduce total bleeding, overt bleeding, blood transfusion rate and plasma D dimerization body (P<0.05). After the use of rivaroxaban for anticoagulation, the bleeding volume, blood transfusion rate and perioperative adverse event rate were equivalent to enoxaparin. Conclusions The application of intravenous tranexamic acid combined with local injection during TKA can further effectively reduce the blood loss, transfusion rate and Plasma D dimer during the perioperative period. Rivaroxaban or enoxaparin is used for anticoagulation after operation, there is no significant difference in the blood loss and the incidence rate of perioperative adverse events.

Ultrasonic imaging features of tuberculous granulomas in upper retroperitoneal lymph nodes

Shi Jingfang, Wang Jun, Qu Tao, Yu Rong, Xiong Qingyu

Chinese Journal of Clinical Anatomy. 2022, 40(3): 362-365. doi:10.13418/j.issn.1001-165x.2022.3.21

Abstract ( 125 )

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Objective To investigate the ultrasonic imaging features of retroperitoneal tuberculous granulation in upper retroperitoneal lymph nodes, so as to provide the imaging basis for clinical diagnosis and treatment. Methods The ultrasonic imaging data of one patient with upper retroperitoneal lymphatic tuberculosis granuloma admitted to our hospital were retrospectively analyzed, and the domestic and foreign imaging documents closely related to retroperitoneal tuberculosis were reviewed and analyzed in Wanfang and Pubmed medical network. Results In this case, the patient went to the hospital because of dull pain and discomfort in the upper abdomen for 1 month. Color dopper ultrasonography showed upper retroperitoneal cystic solid mass with calcification, tuberculosis was not excluded. There were solid nodules posterior to upper peritoneum. CT showed solid lesions in the upper abdomen with calcification, and multiple larger lymph nodes with calcification. Solid granulomatous lesions and tuberculosis were considered. OT test of the patient was negative, blood sedimentation rate did not rise, CT examination 2 years ago suggested tuberculosis. Finally, the patient was diagnosed as retroperitoneal tuberculosis with calcification in the lesion. After consultation of a number of clinical experts was recommended follow-up observation, after half a year, no obvious enlargement in the mass size, continued to follow up observation. Ultrasound examination 1 year later showed that the size of the cystic solid mass in the upper retroperitoneum significantly reduced, and the solid nodules in the upper retroperitoneum disappeared. Conclusions Retroperitoneal tuberculous granuloma is extremely rare, with characteristic ultrasonic imaging features, providing clear imaging basis for clinical diagnosis and treatment, greatly reducing the incidence of misdiagnosis, misdiagnosis and mistreatment, and effectively reducing the physical and mental pain and economic burden of patients.

The technique of making 3D printed model of the seminal vesicle and ejaculatory duct

Li Zheyu, Liu Chang, Xiao Zhaoming, Wu Kuncheng, Xu Guangwei, Luo Baohua, Luo Shiwen, Ma Ziwei, Luo Jianheng, He Shanli, Liang Haibing, Zeng Yilin, Ouyang Jun

Chinese Journal of Clinical Anatomy. 2022, 40(3): 366-368. doi:10.13418/j.issn.1001-165x.2022.3.22

Abstract ( 355 )

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Research progress of anterior cruciate ligament injury

Jiang Wenbin, Yu Shengbo, Sui Hongjin

Chinese Journal of Clinical Anatomy. 2022, 40(3): 369-371. doi:10.13418/j.issn.1001-165x.2022.3.23

Abstract ( 178 )

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Advances in imaging based brain pathology of PMS/PMDD

Li Shujing, Meng Chen, Gao Yingying, Wei Enhua, Qu Songlin, Guo Yinghui

Chinese Journal of Clinical Anatomy. 2022, 40(3): 372-375. doi:10.13418/j.issn.1001-165x.2022.3.24

Abstract ( 100 )

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