Objective To provide the anatomic bases for clinical application of the second dorsal metacarpal artery(SDMA) island flap with double pivot points. Methods The origin,branches and distribution of the recurrent cutaneous branch of the SDMA were observed in 30 adult fresh cadaver specimens, which were illustrated with special dye.Eighteen cases of skin defets of the thumb were repaired with the SDMA island flap. The defect locations were the dorsal part in 11 cases and palmar part in 7 cases, including 3 cases of defect in association with long pollical extensor defect and 2 cases of defect in association with dorsal skin defect of proximal finger. The flap area ranged from 2 cm×3 cmto 3 cm×5 cm. Results The appearance of therecurrent cutaneous branch of the SDMA was observed in all cases(100%), which originated 0.5±0.2 cm distant from the distal intersectiones between the SDMA and the index extensor and disappeared 1.2±0.5 cm distant from the proximal metacarpophalangeal joint. The branches of 1.7±0.7 were seen with a longitudinal fan-like distributionforward proximal part on the deep surface of the dorsal superficial vein. The exradius and the length of the recurrent cutaneous branch of the SDMA were 0.3±0.1 mm and 6.5±0.8 mm, respectively. The transplanted flaps survived in all cases and 16 cases were followed up for 8-14 months. The colour and appearance of the skin were satisfactory. The two-point discriminations were 0.9 mm in 3 cases by bridging digital nerve and 1.1 mm in 9 cases by anastomosing dorsal digital nerve; while the two-point discrimination was 13-15 mm in 4 cases without anastomosing nerve. Conclusion The origin,branches and distribution of the recurrent cutaneous branch of the SDMA is constant, which provide a potentially longer pedicle and increase the possibility to rotate the flap and also avoid the donor skin defect of rotation of the flap.
ObjectiveTo compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament (ACL) reconstruction. MethodsEighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach (group A) and the tibial tunnel approach (group B). ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90°in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups. ResultsThe correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle (r=0.611, P=0.000; r=0.852, P=0.000). The incidence of chondral injury was 69.1% (56/81) and 48.1% (39/81) in groups A and B respectively, showing significant difference (χ2=7.356, P=0.007). The sublevel analysis showed that the chondral injury incidence of group A (36.1%, 13/36) was significantly higher than that of group B (0) at 0-30°(χ2=15.864, P=0.000), but no significant difference was found between group A (95.6%, 43/45) and group B (86.7%, 39/45) at 45-90°(P=0.267). ConclusionIt has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.
OBJECTIVE: To explore the kidney anatomic structure of banna minipig inbred-lines, and to provide data for kidney xenotransplantation. METHODS: The fresh and infused kidneys of banna minipig (including the vessel and the ureter) were checked by anatomic microscope and vernier caliper in original location and away body. The tissue structure was observed by HE stain. RESULTS: The structure of kidney of banna minipig inbred-lines (including the vessel and the ureter) are similar to that of human being. The fascia propria of kidney is divided into three layers including capsula fibrosa, capsula adipose and fascia renalis. The thickness of cortex renalis is (20.0 +/- 2.4) mm. The average diameter of renal artery is 5.1 mm and is similar to that of human being. All the kidneys of banna minipig inbred-lines have a single branch renal artery. The diameters of left and right ureters are 5.1 mm and 4.7 mm, respectively. CONCLUSION: The kidney of banna minipig inbred-lines is an ideal replacement of human kidney for xenotransplantation.
Objective To observe and measure the approach next to the erector spinae in the thoracic and lumbar segments of the spine and adjacent anatomical structures by the topographic method, to clarify the positioning method and safe range so as to provide the anatomical basis of the approach for spinal canal decompression. Methods Twelve formaldehyde-treated adult cadaver specimens were selected, including 6 males and 6 females with an average age of 43 years (range, 27-52 years) and with an average height of 166 cm (range, 154-177 cm). The related data of the approach at T1-S1 levels were respectively measured: the distance between the lateral edge of the erector spinae and the spinous process, the length of the approach, the angle between the approach and the horizontal plane, the size of intervertebral foramen, and the vertical distance between the segmental artery and the upper edge of the vertebrae. Results The distance between the lateral edge of the erector spinae and the spinous process ranged from (41.75 ± 3.29) mm to (74.54 ± 7.08) mm. The length of the approach ranged from (66.75 ± 10.81) mm to (97.13 ± 13.35) mm. The angle between the approach and the horizontal plane ranged from (38.38 ± 6.16)° to (53.67 ± 4.40)°. The vertical distance between the segmental artery and the upper edge of the vertebrae ranged from (9.50 ± 0.60) mm to (18.30 ± 1.56) mm. The size of foraminal was also measured. The spinal canal could reach when iliocostalis lateral edge was used as the starting point in the lumbar segments, and longissimus lateral edge as the starting point in the thoracic segments. It was confirmed that there was enough safe space for the spinal decompression without the resection of the articular process. Conclusion The approach next to the erector spinae can reach spinal canal to achieve the purpose of decompression through the intervertebral foramen. The minimally invasive approach is feasible and safe. It has the value of the operative application.
ObjectiveTo explore early clinical effects of Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium minitype plate fixation, to research the data of the best slotting in the CT-based open-door cervical operation and to provide the reference for accurate operation. MethodsA retrospective analysis of the patients who had received Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation from West China Hospital of Sichuan University from February 2013 to November 2013 were performed. The neurological function assessment results (JOA score), cervical curvature indexhave, Pavlov value, spinal canal cross-sectional area and different position, angle and depth of C7 lamina slotting data of all patients before and after the operation were all analyzed and compared. ResultsA total of 58 patients were included. The postoperative JOA score was significantly higher than that of the preoperative (9.4±2.9 vs. 14.7±2.6, t=11.417, P=0.000). The sagittal diameter of vertebral canal (21.3±2.1 mm vs. 9.7±2.1 mm, t=27.737, P=0.000), Pavlov value (0.92±0.13 vs. 0.44±0.12, t=30.621, P=0.000), and spinal canal cross-sectional area (276±37 mm2 vs. 129±25 mm2, t=32.104, P=0.000) at the end of the last follow-up were significantly greater than those of preoperative. When comparing the last follow-up with preoperative, cervical curvature index showed significant difference (11.2±11.5 vs. 9.3±11.7, t=-1.713, P=0.000). Significant differences were found in the comparison of the ideal position and angle of the open door of the C7 lamina and the angle and position of the operation (all P values >0.05); when comparing the position and angle of the ideal position and angle of the C7 lamina hinge with that of the actual operation, no significant differences were found (all P values >0.05); but when comparing the ideal depth with the actual depth of the operation, a significant difference was found (P<0.05). ConclusionCenterpiece micro plate used in posterior cervical expansive open-door laminoplasty forming operation of laminectomy fixed screw loosening and plate breakage, can effectively maintain the lamina in the open state, and prevent it to be closed. The patients have good recovery of nerve function after operation and the clinical efficacy is good.
OBJECTIVE: To provide anatomy basis for a free latissimus dorsal muscular flap with the sensate nerve. METHODS: The structure of back and lateral chest area were dissected and the origin, alignment and distribution of the intercostals nerve within the area of latissimus dorsal muscular flap were observed in 40 adult cadaver specimens. RESULTS: The 5th to 10th lateral posterior branches of the thoracic nerve pierced from respective intercostal area near the axial anterior line and run a long distance in deep fascia. They distributed mainly in lateral latissimus skin outside the scapular line and anastomosed with the lower branch near the scapular line. Among these branchs, the 6th to 8th branches had a longer nerve distribution respectively and the pedicle of nerve and artery was parallel and long. CONCLUSION: It is possible to design a sensate latissimus dorsal muscular flap with the 6th to 8th lateral posterior branch of the intercostal nerve.
Objective To explore the arterial origin and the distribution of the extracranial branches of the facial nerve. Methods Red latex or red chlorinated polyvinyl chloride was injected into the arteries of 15 fresh adult head specimens by both common carotid artery catheterization. The arterial origin and distribution of the extracranial branches of the facial nerve were observed. Results The nutrient arteries of the extracranial branches of the facial nerve originated from stylomastoid artery of the posterior auricular artery, the facial nervous branch of superficial temporal artery, transverse facial artery, superior and inferior facial nervous branches of external carotid artery and the posteriorand anterior facial nervous branches of external carotid artery. The outer diameters of them were (0.8±0.2) mm, (0.9±0.4) mm, (1.9±0.3) mm, (1.0±0.2) mm, (1.1±0.4) mm, (1.0±0.2) mm and (1.1±0.6) mm respectively. The sub-branches ofthe attendant artery of the facial nerve anastomosed each other in addition to supplying their own nerve, and a rich vascular network was formed between the facial nerve and adjacent tissue. Conclusion The study on blood supply of the extracranial segment of the facial nerve can provide anatomic basis for avoiding injury of the nutrient arteries of the facial nerve during operation of the parotidean and masseteric region clinically.
Objective To provide the anatomic basis for thelag screw placement in the anterior column of the acetabulum. Methods Twenty-two pelvis specimens with 44 acetabula of the native adult cadavers were studied. The anthropometric measurement was performed on 44 acetabula to determine the shape of the transverse section of the anterior column of the acetabulum, the optimal entry point for the lag screw on the outer table of the ilium, the direction of the screw, and the distance from the entry point to the obturator groove. Results The transverse section of the anterior column of the acetabulum was almost triangle-shaped. The path for the lag screw placement was 10.5±0.8 mm in diameter. The optimal entry point on the posterolateral ilium for the screw fixation was found toexist 9.2±2.4 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 38.5±3.8 mm superior to the greater sciatic notch. The distance from the entry point to the obturator groove was 84.1±6.2 mm. The inclination of the lag screw was 54.2±5.5° at the caudal direction in the sagittal plane and 40.7±3.8° in the horizontal plane. The device for the safe screw placement in the anterior column was designed. Conclusion The above datacan facilitate an insertion of one 6.5 mm lag screw into the anterior acetabular column and minimize the risk of articular violation or cortical penetration, which has a narrow margin of safety. The safe length of the lag screw should be 70 mm.The optimal entry point on the posterolateral ilium for the screw fixationis determined to be 10 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 40 mm superior to the greater sciatic notch. The inclination of the lag screw should be 55° at the caudal direction in the sagittal plane and 40° in the horizontal plane. It is safe to place thelag screw in the anterior column with the help of the targeting device.
【Abstract】 Objective To investigate the feasibil ity of contralateral C7 nerve transfer via posterior spinal route fortreatment of brachial plexus root avulsion injury by anatomical study. Methods Ten cadaveric specimens of 7 men and3 women were selected, who had no obvious deformity and no tissue defect in neck neutral position. By simulating surgical exploration of brachial plexus injury, the length of contralateral C7 nerve root was elongated by dissecting its anterior and posterior divisions to the distal end, while the length of C7 nerve from the intervertebral foramen to the branching point and the length of the anterior and posterior divisions were measured. By simulating cervical posterior approach, the C7 vertebral plate and T1 spinous process were fully exposed; the hole was made near vertebral body; and the C7 nerve root lengths by posterior vertebra path to the contralateral upper trunk and lower trunk were measured. Results C7 nerve root length was (58.62 ± 8.70) mm; the length of C7 nerve root plus posterior or anterior division was (65.15 ± 9.11) mm and (70.03 ± 10.79) mm, respectively. By posterior spinal route, the distance was (72.12 ± 10.22) mm from the end of C7 nerve to the contralateral upper trunk of brachial plexus, and was (95.21 ± 12.50) mm to the contralateral lower trunk of brachial plexus. Conclusion Contralateral C7 nerve can be transferred to the contralateral side through posterior spinal route and it only needs short bridge nerve or no. The posterior spinal route can effectively prevent from neurovascular injury, so it might be the best surgery approach for the treatment of brachial plexus root avulsion injury.
OBJECTIVE: To study the anatomical basis for reconstruction of vertebral artery with neighboring non-trunk arteries. METHODS: Twenty preserved adult cadavers were used in this study to observe the morphology of superior thyroid artery, inferior thyroid artery, transverse cervical artery, thyrocervical trunk and extracerebral portion of vertebral artery, and reconstruction of vertebral artery with these arteries was simulated in two preserved cadavers. RESULTS: The calibers of superior or inferior thyroid artery, or transverse cervical artery were more than 2 mm in diameter, and the arteries had suitable free length for end-to-side anastomosis with vertebral artery. Thyrocervical artery had similar caliber to vertebral artery so that end-to-end anastomosis could be carried out between them, but only 38.5% of this artery had adequate artery trunk (more than 10 mm). It was proved from the simulated procedures that the reconstruction of vertebral artery with these neighboring non-trunk arteries was possible. CONCLUSION: Reconstruction of vertebral artery with neighboring non-trunk arteries has anatomical basis and can be used clinically for treatment of the lesion affecting the first or second portion of vertebral artery.