Chinese Journal of Clinical Anatomy

Clinical anatomy study of cholecystic vein and distribution of its branches

Ding Ran, Zheng Xuefeng, Ding Zihai, Wu Tao

Chinese Journal of Clinical Anatomy. 2023, 41(3): 249-253. doi:10.13418/j.issn.1001-165x.2023.3.01

Abstract ( 206 )

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Objective To observe the reflux mode of cholecystic vein and the exact locations of venous confluence, so as to provide an anatomical understanding of the hematogenous metastasis in gallbladder carcinoma and surgical operation in laparoscopic cholecystectomy. Methods Thirty-two cases of fresh adult liver and gallbladder specimens were made into section specimens, in which the number of branches and tributaries of cholecystic vein were counted and the diameter of these vessels were measured. The patterns of reflux and the and the various locations of venous confluence were observed. Results Normally, there were 2-4 chloeytic veins from the gallbladder. The average longitude the veins was about 1.6 (1.1-2.1) mm The average diameter of middle location was about 3.1(2.4-4.1) cm. The cholecystic vein had 3 (2-5) branches with a terminal diameter of 1.6 (0.8-2.8) mm. There were 4 (3-5) branches of the cholecystic vein, with a diameter of 1.5 (0.8-2.2) mm at the beginning. About the various locations of cholecystic veins, it was observed in 10 cases that there was one single branch on both left and right side. Two branches on both sides were found in 6 cases, one branch on left side with two branches on right side were found in 7 cases, three branches on left side with one branch on right side in one single case. The small tributaries of the cholecystic vein which arose from the body and fundus of the gallbladder were accompanied by the branches of the cholecystic artery, then went to both sides of the gallbladder, and formed 2-5 tributaries through 2-3 tiers of arcades, and merged into the cholecystic vein near the edge of the gallbladder bed. Further, the cholecystic vein g sent out 3-5 branches, ran 5~8 mm and anastomosed with the third to fifth tiers of the right branch of hepatic portal vein. At the bottom of the gallbladder bed, 3-5 small cholecystic veins anastomosed directly with the small branches of the right branch of the hepatic portal vein. Gallbladder jugular vein and the cholecystic duct met with the veins from the common bile duct or the hepatic duct, and went upward to flow into the right or left branch of the hepatic portal vein. Conclusions The veins from the body and fundus of the gallbladder anastomose with the right branch of the hepatic portal vein in the gallbladder portal vein pattern, that is, at first, the ends of the gallbladder capillary veins converges into venules, then each tributary merge into couple of cholecystic veins, and the cholecystic vein branches are divided into several tiers branches, which are anastomosed with the third to fifth tiers of the right hepatic portal vein.

Microdissection of the atrioventricular conduction axis of fresh porcine heart

Wang Dechang, Gong Zheyi, Liao Chenghao, Zhi Shasha, Zou Xufei, Hu Yaohui, Wang Kai, Lou Yangyun, Li Ting

Chinese Journal of Clinical Anatomy. 2023, 41(3): 254-257. doi:10.13418/j.issn.1001-165x.2023.3.02

Abstract ( 131 )

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Objective To observe the morphological characteristics of the atrioventricular conduction axis in fresh porcine heart by the microdissection and histological methods. Methods The anatomical data of the porcine cardiac atrioventricular conduction axis was observed, explored and measured by dissecting 30 cases of fresh porcine hearts under stereomicroscope, and their histological data were observed and analyzed by the conventional HE and Masson's staining techniques. Results The atrioventricular conduction axis was successfully detected in 22 of 30 porcine hearts, and it was found that the proximal portion of left bundle branch was arranged in fascicular, and the distal portion was flared. The capsules of his bundle, left bundle branch, and right bundle branch of porcine heart were relatively thick and easy to identify with the naked eye. The width of the atrioventricular bundle (AVB), the length of AVB, the proximal width of the left bundle branch were (1.58±0.75) mm, (17.56±7.79) mm, (2.40±1.11) mm, respectively, and the angle between the left bundle branch and the AV bundle was (114.46±13.06)°. Conclusions The position and morphological feature of AVB, left bundle branch and right bundle branch in pigs may be slightly different from other animals.

Morphological characteristics of nutrient foramina on femoral neck and its clinical significance

Li Haiyan, Si Lina, Yao Xingchen, Du Xinru

Chinese Journal of Clinical Anatomy. 2023, 41(3): 258-262. doi:10.13418/j.issn.1001-165x.2023.3.03

Abstract ( 183 )

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Objective To explore the distribution and morphological characteristics of nutrient foramina in femoral neck and to discuss its relation with the osteoporosis femoral neck fracture. Methods Seventy-three cases of dry femoral specimens were collected in this study, among them, there were 12 cases in the osteoporosis group and 61 cases in the normal group. The location, number, diameter and square about the nutrient foramina in femoral neck were investigated and the proportion of the different diameters of the nutrient foramina was measured as well. Results The number and area percent of the nutrient foramina in superior area were the most both in normal group and in osteoporosis group. Compared with the normal group, the diameter and area percent of nutrient foramina in the posterior and superior area in osteoporosis group were obviously smaller, there was significant difference between these two groups. Conclusions The number of the nutrient foramina in the superior area is large, with large square, this may be an anatomical factor causing structural weakness in the area which resulting in the femoral neck fracture. The area percent and diameter of nutrient foramina in the same area in osteoporosis group is obviously smaller, it is possible that the osteoporotic femoral neck fracture has close relations with its poorly blood supply.

Anatomical study of superficial temporal artery trunk based on three-dimensional measurement

Liao Xiaoshuang, Lu Hui, Liu Rong, Wei Zairong, Zhou Jian, Chen Wei, Jiang Haifang, Nie Kaiyu

Chinese Journal of Clinical Anatomy. 2023, 41(3): 263-269. doi:10.13418/j.issn.1001-165x.2023.3.04

Abstract ( 84 )

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Objective To measure the anatomical parameters of superficial temporal artery trunk by three-dimensional measurement, and to provide anatomical reference for related clinical operation. Methods Original images of 70 patients aged 30-79 years old (mean 60.0 years old) who underwent cranial CTA examination in Affiliated Hospital of Zunyi Medical University from January 2021 to June 2021 were selected, including 32 females and 38 males. After the superficial temporal artery was reconstructed by professional medical 3D reconstruction software (MIMICS), the anatomical parameters of the main trunk of the superficial temporal artery were measured: length of the superficial temporal artery (AB), length of the C-type bending (CD), distance between the external auditory canal and the superficial temporal artery (EF) measured horizontally, and curvature of the C-type bending. Results There was no statistical difference between male and female in 3D visualization model. There was no statistical difference among different age groups. C-type curve was found in 66% of the zygomatic arch of the superficial temporal artery. The bending length of type C was linearly correlated with the bending degree y= (0.82788±0.03574) x+ (-0.02919± 0.00388). Eighty-nine percent of the C-type bending had branching vessels. The branches from the C-type bending were 7% of the middle temporal artery, 64% of the zygomatic orbital artery, and 29% of the middle temporal and zygomatic orbital artery. In the data of 70 cases, one parietal branch of the superficial temporal artery was absent, and the bifurcation point of the frontoparietal branch of the superficial temporal artery was located at the zygomatic arch. The bifurcation point was in the midpoint of C-type bending. Conclusions Three-dimensional visualization can accurately measure the anatomical parameters of the superficial temporal artery, and provide anatomical reference for relevant clinical operations.

Three-dimensional reconstruction of superior petrosal vein by multi-modal fusion technology

Wu Shiyuan, He Haoqiang, Chen Zhenghe, Mou Yonggao, Li Yanbing, Huang Wenhua, Zhong Shizhen

Chinese Journal of Clinical Anatomy. 2023, 41(3): 270-276. doi:10.13418/j.issn.1001-165x.2023.3.05

Abstract ( 106 )

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【Abstract】 Objective To reflect the morphological characteristics of SPV and its adjacent bone structures objectively, contrast enhanced magnetic resonance angiography (CEMRA) and computer tomography (CT) were used by combining with multi-modal fusion technology to reconstruct the normal anatomical structure of the superior petrosal vein complex and its surrounding skull, which providing reference for anatomical research and clinical surgery. Methods By adjusting the concentration of the contrast agent, the injection speed of the contrast agent, the start time of scanning, the scanned 3D CEMRA was judged to be developed successfully by the MIP post-processing of image processing workstation. The original data of 3D CEMRA and 3D-CT were imported into 3Dslicer software together. After image registration, threshold segmentation, structure pruning and data package storage, the packaged data of these two modalities were imported together and 3D fusion was performed at the same time. The related anatomical parameters were measured by using the module of 3Dslicer software. Results ①The relevant angiographic parameters of the sigmoid sinus, superior petrosal sinus (SPS), SPV, and SPV tributary was obtained, but the success rate was not stable; ②Through the three-dimensional reconstruction of the DICOM data from the head CEMRA and cranial CT, SPV and its branch, SPS, sigmoid sinus, transverse sinus and cavernous sinus, bone anatomical landmarks of skull base such as internal auditory canal, petrosal sinus groove and transverse sinus groove near the petrosal area were obtained; ③ Three-dimensional fusion map of venous structure and osseous structure after multi-modal fusion was obtained; ④The measurement diagram was obtained by using the measurement module in the 3Dslicer software. Conclusions The combination of imaging and 3Dslicer software can realistically display the anatomical structure of multi-modal fusion, providing a new possibility for the study of anatomical morphology, and also providing personalized reference for clinical surgery.

Comparison and correlation analysis of sagittal inclination of anterior teeth and lengths of dental arch and basal bone arch in adult skeletal malocclusions

Lin Sidou, Wu Bulin, Huang Wenhua

Chinese Journal of Clinical Anatomy. 2023, 41(3): 277-282. doi:10.13418/j.issn.1001-165x.2023.3.06

Abstract ( 72 )

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Objective To compare the sagittal inclination of anterior teeth and lengths of dental arch and basal bone arch in skeletal malocclusions and to evaluate the relevance between these three variables. Methods One hundred and four pretreatment CBCT data of subjects with skeletal Class I, II, III malocclusion and normal occlusion were collected. MATLAB software was used to measure the sagittal inclination of anterior teeth, lengths of dental arch and basal bone arch. The differences and correlation between the indexes were evaluated and analyzed. Results The sagittal inclination of anterior teeth in class III group was significantly less than in other three groups. The lengths of dental arch and basal bone arch in class III group were greater than in the other three groups. The sagittal inclination of incisors in class II group was significantly greater than in the other three groups. The sagittal inclination of anterior teeth was moderately negatively correlated with the lengths of the corresponding basal bone arch (r=-0.557,-0.554,-0.489 P<0.001), while the sagittal inclination of anterior teeth was not correlated with the length of dental arch. Conclusions There were differences in sagittal inclination of anterior teeth, lengths of dental arch and basal bone arch between different skeletal malocclusions. We can evaluate the sagittal growth of basal bone by sagittal inclination of anterior tooth. However, changing sagittal inclination of anterior tooth has little impact on the length of dental arch.

CT imaging anatomical study of lumbar vertebral basivertebral foramen in elderly patients with osteoporotic vertebral compression fractures

He Ailing, Wang Qing, Li Guangzhou

Chinese Journal of Clinical Anatomy. 2023, 41(3): 283-287. doi:10.13418/j.issn.1001-165x.2023.3.07

Abstract ( 71 )

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Objective To observe the morphological characteristics of basivertebral foramen (BVF) in patients with osteoporotic vertebral compression fracture (OVCF). Methods One hundred and seven cases of lumbar OVCF patients were studied. The number and morphology of BVF were observed on CT images. The basivertebral foramen width (BFW), basivertebral foramen depth (BFD), basivertebral foramen height (BFH), BFW relative value (BFWr), BFD relative value (BFDr), BFH relative value (BFHr), left vertebral body width (VWL), right vertebral body width (VWR), vertebral body up (VHU) and vertebral body below (VHB) were measured. All the data were analyzed by SPSS25.0 software. Results Most BVF were single-hole type, rectangular on coronal images and triangular or trapezoidal on horizontal images. The average width of BVF was (7.8±1.6) mm, average depth was (12.4±2.1) mm and average height was (5.4±1.1) mm. The average width, depth and height of BVF respectively accounted for 1/5, 2/5 and 1/4 of the vertebral body width, depth and height. There was no statistical difference between VWL and VWR in L1 and L3 (P>0.05), but there were statistical differences between VWL and VWR in L2, L4 and L5 (P<0.05). There were statistical differences between VHU and VHB (P<0.05), and BVF was closer to the upper endplate. Conclusions The puncture target position and amount of bone cement are determined in surgery according to the morphological characteristics and anatomical data of BVF, which is beneficial for preventing bone cement leakage.

Study on the relationship between the grade IV perforator’s vessels and the survival of reticular blood-supplying flap

Song Hehua#, Zhang Qi#, Wu Bihua, Chen Wei, Zhang Tianhua, Nie Kaiyu, Chang Shusen, Deng Chengliang, Li Hai, Zhou Jian, Li Shujun, Wei Zairong

Chinese Journal of Clinical Anatomy. 2023, 41(3): 288-295. doi:10.13418/j.issn.1001-165x.2023.3.08

Abstract ( 47 )

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Objective To investigate the relationship between the perforating vessels of grade IV perforators and the survival of reticular blood-supplying flap, and to compare the distribution of grade IV perforating vascular network in multi-site skin tissue of the whole human body. Methods Eighteen healthy adult SD rats, weighing 200~250 g, were not restricted to males and females. They were divided into a normal skin group (control group), a reticular blood supply flap group on both sides of the abdomen, and a reticular blood supply flap group on both sides of the back. There were 6 flaps in each group. The model was made by using the method of making blood-supply skin flaps with reticular blood vessels. At the same time, the excess skin tissue of the "cat ear" deformity formed during suture of donor site of patients with skin defects of head and face, inner and outer thighs and the inner and outer leg were collected in our hospital. On the 7th day after operation of the rat, the survival rate of the skin flap was calculated by using Image J software. The skin tissues of each group of rats and the excess skin tissues of the patient′s donor area were taken. HE and CD31 staining were used to compare the density of IV perforator blood vessels and diameter situation. Results On the 7th day after operation, the survival rate of the back reticular blood supply flap was higher than that of the abdominal reticular blood supply flap (P<0.05). The density of grade IV perforator blood vessels in the back skin of the normal group was higher than that in the abdominal skin (P<0.05), but there was no significant difference in diameter (P>0.05). The diameter of the distal grade IV perforating vessels was significantly decreased compared with the proximal end in the abdominal and back flap group (P<0.05), while the density was significantly increased compared with the proximal end (P<0.05). Comparison of the diameters of grade IV perforator vessels: head > inner thigh, outer thigh, inner calf, outer calf > inner calf, the difference was statistically significant (P<0.05), the outer thigh was larger than the inner thigh, the difference was not statistically significant. Comparison of blood vessel density: head > inner and outer thigh, inner and outer calf, outer thigh> inner thigh, outer calf> inner calf, the difference was statistically significant (P<0.05). Conclusions The distribution of grade IV perforating vessels is different in different parts of the whole body. The density of grade IV perforating vessels is of great significance for the survival of skin flap. The ratio of length to width of the reticular vascular flap is related to the density of subdermal vascular network and / or the diameter of blood vessels.

Correlation between learning and memory ability and gut microbiota structure in mice induced by high-altitude hypoxia

Li Wenhao, Qi Baoning, Shi Yi, Wang Yuhao, Zhao Zaihua, Wang Yu, Shen Xuefeng

Chinese Journal of Clinical Anatomy. 2023, 41(3): 296-303. doi:10.13418/j.issn.1001-165x.2023.3.09

Abstract ( 45 )

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Objective To investigate the characteristic changes of learning and memory function, gut microbiota and their correlation in high-altitude hypoxia. Methods C57BL/6 mice were randomly divided into a control group and a hypoxia group, with 7 mice in each group. The hypoxia group simulated at an altitude of 4000 meters exposure for 4 weeks. The open field test, the novel object recognition and Morris water maze were used to detect the autonomous activity, anxiety- and depression-like and the learning and memory ability of the mice. 16S rDNA and Spearman correlation coefficient were used to detect the structural changes of gut microbiota and analyze the correlation between cognition and gut microbiota of the mice. Results Compared with the control group, the discrimination index and the percentage of time in the target quadrant were decreased significantly in hypoxia group (P<0.05). The structure of gut microbiota changed and the diversity decreased. The relative abundance of Akkermansia, Alistipes, Enterorhabdus and Ruminococcus increased at the genus level. The discrimination index and the percentage of time in the target quadrant were significantly positively correlated with α diversity (P<0.05), The discrimination index was negatively correlated with the relative abundance of Akkermansia and Alistipes (R= -0.709, -0.604, P<0.05). The percentage of time in the target quadrant was negatively correlated with the relative abundance of Akkermansia, Alistipes, and Ruminococcus (R= -0.704, -0.560, -0.547, P<0.05). Conclusions The exposure of high-altitude hypoxia causes the structural changes of intestinal flora in mice. The increased relative abundance of Akkermansia, Alistipes and Ruminococcus is correlated with the decreased learning and memory ability in mice.

Macamide B promoting the expression of PGRN in hypoxic-ischemic brain damage neonatal mice

Zhou Qian, Li Lixia, Yang Xiaoxia, Yang Junhua, Wen Jinkun, Li Pengfei, Luo Li, Li Guoying

Chinese Journal of Clinical Anatomy. 2023, 41(3): 304-309. doi:10.13418/j.issn.1001-165x.2023.3.10

Abstract ( 81 )

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Objective To investigate the effect of Macamide B on the expression of progranulin (PGRN) in neurons of neonatal mice with hypoxic-ischemic brain damage (HIBD) and HT22 mouse hippocampal neuron cell line after oxygen-glucose deprivation (OGD) and explore the mechanism of the neuroprotective effect of Macamide B after HIBD in neonatal mice. Methods The HIBD model of C57 mice was established after 7 days of birth and the mice were divided into Sham group, HIBD group and Macamide B group. HT22 cells were cultured, then the OGD model of HT22 cells was established, and the cells were divided into Control group, OGD group and Macamide B group. The expression of PGRN in mouse neurons or HT22 cells was detected by immunofluorescence staining and Western blot. Results In vivo experiments showed that compared with Sham group, the expression of PGRN in mice neurons of HIBD group was reduced. Compared with HIBD group, the expression of PGRN in neurons of Macamide B group was increased. In vitro, compared with Control group, the expression of PGRN in HT22 cells of OGD group was decreased. Compared with OGD group, the expression of PGRN in HT22 cells of Macamide B group rose significantly. Conclusions Macamide B may play a neuroprotective role in HIBD neonatal mice by promoting the expression of PGRN.

Carnosine protects OGD/R-induced astrocyte injury via Nrf2/ARE signaling pathway

YU Lu, Ndolo Rodgers Odhiambo, REN Yi, ZHAO Yan, YANG Wen-qiang, YANG Xin-xia, YANG Jing

Chinese Journal of Clinical Anatomy. 2023, 41(3): 310-317. doi:10.13418/j.issn.1001-165x.2023.3.11

Abstract ( 77 )

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Objective To explore the role and mechanism of Semaphorin3B (SEMA3B) in Schwann cells during Wallerian degeneration in the injured peripheral nerve. Methods The Schwann cell specific SEMA3B knockout (cKO) mice and the littermate Cre mice were selected as an experimental group and a control group, respectively. The in vivo and in vitro models of Wallerian degeneration by nerve transection injury and nerve explant culture were prepared. Five days later, the tissues were collected to perform immunofluorescence and Western blotting with antibodies of MBP, NF, c-Jun, MAG, p-AKT, AKT, p- GSK3β, GSK3β, p-ERK, ERK, p-JNK, and JNK. Moreover, SC79 (the agonist of AKT) was used to perform the rescue experiment in the in vitro model. Results After 5 days of nerve injury, the expression of MBP and NF in both in vivo and in vitro models of the cKO group was higher than that of the Cre group, indicating Wallerian degeneration was delayed in the cKO group. Compared with the Cre group, the expression of c-Jun was lower and MAG was higher in the cKO group, suggesting that the Schwann cell dedifferentiation was reduced. The expression of p-AKT and p- GSK3β was down-regulated, while there was no significant difference in the levels of p-ERK and p-JNK. The administration of AKT agonist (SC79) could reverse the changes of MBP, and NF caused by SEMA3B cKO. Conclusions SEMA3B conditional knockdown in Schwann cells delay the Wallerian degeneration through inhibiting the AKT/ GSK3β pathway.

Feasibility and accuracy analysis of detection system of tibiofemoral joint in vivo based on robotic arm ultrasonic imaging combined with registration of CT images to ultrasound images technology

Wang Fei, Xu Hao, Jiang Jiang, Yang Cui, Jia Rui, Du Bingran, Li Jianyi

Chinese Journal of Clinical Anatomy. 2023, 41(3): 336-341. doi:10.13418/j.issn.1001-165x.2023.3.15

Abstract ( 49 )

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Objective To build a detection system of tibiofemoral joint in vivo based on robotic arm ultrasonic imaging combined with registration of CT images to ultrasound images technology and evaluate the accuracy of the system. Methods CT and ultrasound images of pork tibiofemoral joints and femur were collected and registered after three-dimensional reconstruction. After femur’s movement at six degrees of freedom, ultrasound images were collected and reconstructed and then registered to CT three-dimensional model. The displacement between CT three-dimensional model and real displacement were compared to calculate registration accuracy. The registration and accuracy calculation were implemented by two researchers to calculate intraclass correlation coefficient. Results It was feasible to use three-dimensional geometric information for ultrasound-CT manual registration to build a detection system of tibiofemoral joint in vivo. Translation accuracy ranged from 0.94 mm to 1.16 mm, and rotation accuracy ranged from 0.63 ° to 1.50 °. Intraclass correlation coefficient was 0.794 (P=0.014). Conclusions The ultrasound-CT registration method proposed in this article is feasible, and the accuracy can meet the requirements of tibiofemoral dynamic detection. In the future, we need to further improve the method of ultrasound images’ obtaining by robotic arm and use computer image processing technology for fast registration research.

Follow-up of the clinical efficacy and sagittal balance of 3D printing spine intervertebral fusion cage in treatment of cervical spondylosis

Wang Jianhua, Wu Di, Sun He, Zhang Yilong, Xin Lili, Li Le

Chinese Journal of Clinical Anatomy. 2023, 41(3): 342-348. doi:10.13418/j.issn.1001-165x.2023.3.16

Abstract ( 72 )

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Objective To investigate the clinical efficacy and sagittal balance changes of a 3D-printed interbody fusion cage in the treatment of single-level cervical spondylosis during anterior cervical discectomy and fusion (ACDF). Methods Retrospective analysis of 60 patients with cervical spondylosis who underwent single-segment ACDF operation in our hospital from June 2017 to June 2019 was performed, thereinto, the experimental group consisted of 30 patients with 3D printed titanium interbody fusion apparatus, the control group was 30 patients treated with polyether ether ketone (PEEK) interbody fusion cage. Related indexes, average length of stay, VAS score at each follow-up period, JOA score and related image parameters, evaluation of curative effect and sagittal balance changes during surgery in the two groups were recorded. Results The operative time of the experimental group was (76.1±5.7) min and the intraoperative blood loss was (33.7±6.5) ml, both of which were lower than the control group ((85.5±6.5) min and (45.3±5.8) mL), the difference was statistically significant (P<0.05). Preoperative JOA and VAS scores of two groups were (4.8±2.3) points, (7.7±1.5) points and (5.1±2.1) points, (8.0±1.6) points respectively. The last postoperative follow-up JOA and VAS scores of two groups were (15.5±1.3) points, (1.0±0.6) points and (14.3±1.5) points, (1.8±0.7) points, respectively, the two scores were significantly improved compared with those before surgery, and the differences were statistically significant (P<0.05). Between groups, the last follow-up data showed statistical difference (P<0.05). There was no significant difference in comparison of preoperative imaging parameters between the two groups (P>0.05). Compared with the group before operation, the postoperative image parameters of each period were significantly improved (P<0.05). At the last follow-up, intervertebral height and angle, C2-7 Cobb angle and T1 inclination angle between experimental group and control group were (6.8±1.3, 5.7±1.4) mm, (7.3±1.3, 6.0±1.4) °, (23.6±5.3, 19.3±5.4) ° and (24.3±2.2, 20.3±2.6) °, respectively. The experimental group was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusions The application of 3D printed titanium alloy interbody fusion cage in the treatment of single level cervical spondylosis in ACDF has a good clinical effect. It is superior to the traditional PEEK fusion cage in improving and maintaining intervertebral height and angle, cervical sagittal balance and other aspects.

Application of customized traction table in hemiarthroplasty through the direct anterior approach

Li Junran, Liang Junsheng, Li Dongmei, Zhai Jingxiu, Xu Ying, Wang Hongrun, Deng Fukuan, Li Ligeng

Chinese Journal of Clinical Anatomy. 2023, 41(3): 349-353. doi:10.13418/j.issn.1001-165x.2023.3.17

Abstract ( 105 )

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Objective To explore the clinical value of customized traction table in hemiarthroplasty through the direct anterior approach (DAA) for the treatment of femur neck fractures in elderly patients. Methods A retrospective analysis of 75 elderly patients with femur neck fractures treated with hemiarthroplasty through DAA were involved in our hospital from September 2018 to December 2019. According to with or without using the traction table, the patients were divided into two groups: Group A (39 cases, DAA hemiarthroplasty with assistance of traction table) and Group B (36 cases, DAA hemiarthroplasty without traction table). There was no significant difference in gender, age, Garden classification, fracture side and other general date between the two groups (P>0.05). The operation indexes, efficacy, postoperative Harris hip score and complications were compared between the two groups. Results Group A had longer preoperative preparation time and less operation time than Group B (P<0.05). There was no significant difference in anesthesia time, intraoperative blood loss and incision length between groups A and B (P>0.05). The central fixation ratio of femoral prosthesis in Group A was higher than that of Group B (P<0.05). The ratio of limb length discrepancy shortened than 10mm, time of first postoperative standing, time of first postoperative walking with crutch, time of first postoperative walking independently, and the Harris score in 1 month and 1 year after the operation were not significantly different (P>0.05). The complication rate was 12.8% (5/39) in Group A and 19.4% (7/36) in Group B (P>0.05). In Group A, lateral femoral cutaneous nerve injury was found in 2 patients, greater trochanteric fracture in 2, and incisional drainage in 1. In Group B, there were 3 patients with lateral femoral cutaneous nerve injury, 2 with greater trochanteric fracture, and 2 with incisional drainages. Conclusions For the treatment of femur neck fractures in elderly, hemiarthroplasty via DAA with assistance of customized traction table has remarkable effectiveness. It can significantly shorten the operation time and improve the central fixation ratio of femoral prosthesis, but it also can prolong the preoperative preparation time.

Application of simulated surgery combined with 3D printing patient-specific instrumentation in high tibial osteotomy

Li Jun, Liang Shuai, Wang Jian

Chinese Journal of Clinical Anatomy. 2023, 41(3): 354-359. doi:10.13418/j.issn.1001-165x.2023.3.18

Abstract ( 82 )

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Objective To investigate the accuracy and safety of simulated surgery combined with 3D printing patient-specific instrumentation (PSI) assisted medial open wedge high tibial osteotomy (HTO) in knee osteoarthritis. Methods The clinical data of 23 patients with knee osteoarthritis who were treated with simulated surgery combined with 3D printing PSI assisted medial open-wedge HTO between May 2019 and May 2021 were retrospectively analyzed. There were 2 males and 21 females, with an average age of 58.9 years (ranged 49-83 years). The disease duration ranged from 1 to 30 years, with an average of 6.3 years. Postoperatively, the weight bearing lineratio(WBL), medial proximal tibial angle (MPTA), hip-knee-ankle angle (PTSA), knee-ankle angle (HKA) and joint line convergence angle (JLCA) were measured and compared with the preoperative values, and the postoperative WBL, HKA, MPTA and actual correction angle of the lower limbs were compared with the preoperative design target values. At the final follow-up, the knee pain and function were assessed by VAS and AKS. Results All the patients were followed up for 7-19 months, with an average of 11.8 months. The postoperative WBL (57.52±3.99) %, MPTA (90.77±0.68)°, HKA (182.84±1.58)°, and JCLA (0.17±0.36)°were significantly improved compared with the preoperative values (P<0.05). There was no significant difference between preoperative and postoperative PTSA (P>0.05). The postoperative WBL, MPTA, HKA and actual correction angle of the lower limbs were slightly lower than the preoperative design target values, but the differences were not significant(P>0.05). At the final follow-up, the VAS scores were (0.78±0.52), which were significantly lower than the preoperative VAS scores (P<0.05). The AKS scores were (88.52±2.98), which were significantly higher than the preoperative AKS scores (P<0.05). Conclusions Simulated surgery combined with 3D printing PSI surgery assisted HTO is an effective method in knee osteoarthritis, which can achieve satisfactory clinical effects.

Diagnostic value of CTA and HR-MRI in young stroke patients with arterial dissection

Lv Juan, Xu Shili, Lu Jing

Chinese Journal of Clinical Anatomy. 2023, 41(3): 360-364. doi:10.13418/j.issn.1001-165x.2023.3.19

Abstract ( 63 )

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Objective To compare and analyze the diagnostic value of CT angiography (CTA) and high-resolution magnetic resonance angiography (HR-MRI) in young stroke patients with arterial dissection. Methods Seventy young stroke patients diagnosed in our hospital from January 2016 to December 2021 were selected, 47 were diagnosed with arterial dissection by digital subtraction angiography (DSA) and 23 were diagnosed with non-arterial dissection. All patients were performed with CTA and HR-MRI imaging. The diagnostic rate and consistency of CTA and HR-MRI in young stroke patients with arterial dissection were analyzed. The diagnostic value of CTA and HR-MRI in young stroke patients with arterial dissection was analyzed by receiver operating characteristic curve (ROC). Results Compared with non-dissected patients, patients with arterial dissection were older and had more head and neck pain symptom (P<0.05). The positive rate of CTA and HR-MRI for young stroke patients with artery dissection was 30.00%（21/70） and 48.57%（49/70）, respectively. Using DSA as the gold standard, the correlation between CTA and DSA was Kappa 0.458, and the correlation between HR-MRI and DSA was Kappa 0.829, indicating the consistency between HR-MRI and DSA was good. ROC curve analysis showed that the sensitivity of CTA and HR-MRI for young stroke patients with arterial dissection were 64.87% and 87.68%, respectively, the specificity were 80.27% and 90.82%, respectively, and the area under curve (AUC) of ROC were 0.86 and 0.95, respectively. Compared with the diagnostic efficiency of CTA, HR-MRI had a higher AUC. It had high diagnostic value for young stroke patients with arterial dissection. Conclusions Compared with CTA, HR-MRI has higher diagnostic value in highly suspected young stroke patients with arterial dissection.

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