OBJECTIVE: To observe the heart anatomic and histological structure of the Banna mini-pig inbred-lined and to provide the morphological data for heart xenotransplantation and breeding transgens pig. METHODS: Ten Banna mini-pigs (12-18 months old) were affused and fixed by common coratid artery. The heart were observed and measured by gross anatomy and histology. RESULTS: There were many similarities between the Banna pig heart and the human heart in anatomy and histology. However, the following differences were observed in the Banna pig heart: 1. Azygos vein directly drew into right atrium cordis. 2. The intercalated disk of cardiac muscle was less than that of human. 3. The Purkinje’s fibre was bigger than that of human. CONCLUSION: On the morphology and histology, the structure of Banna pig heart is similar to the heart of human being. It is possible that Banna minipig heart becomes organ donors for xenotransplantation.
Objective To investigate the number and location of parathyroid glands in relation to thyroid gland, to increase the knowledge about anatomical variation of parathyroid glands, and to reduce injury of the parathyroid and recurrent laryngeal nerve. Methods A total of 50 cadavers were sectioned. The number and distribution of parathyroid glands and their relations with adjacent structures were observed. Results Mean number of parathyroid glands in one individual was 3.52±0.48, mainly located at the retro-medialis of thyroid, which was called “tri-domain and one area”. Superior parathyroid glands were mainly located in the area of cornu inferior thyroidal cartilage; the inferior parathyroid glands except ectopic parathyroid glands were located in radix nasi of thyroid glands; while the area around inferior thyroid artery contains both the superior and inferior parathyroid glands. These three areas constitute the region of retro-medialis of thyroid that parathyroid glands were inclined to get injured. Most superior parathyroid glands were located beside the lateral of recurrent laryngeal nerve （67.8%） and the inferior parathyroid gland mainly located next to recurrent laryngeal nerve （71.9%）, both showed statistical significance (P＜0.005). About 85.0% of superior parathyroid located in the area around posterior suspensory ligament of thyroid, and most common place for ectopic parathyroid gland was around lingual lobe of thymus (28.6%). Conclusion With extreme caution, familiarity with anatomy and skillful technique, the injury to parathyroid glands and recurrent laryngeal nerve can be prevented, which may not be a restrain of putting standard thyroid operation into practice.
Objective To review the recent anatomy and biomechanical research progress of knee posteromedial corner, to analyze deficient aspect, and to predict future research directions. Methods Domestic and international l iterature about the anatomy and function of knee posteromedial corner in recent years was reviewed extensively, at the same time, the biomechanics of corresponding structure was summarized and analyzed. Results The anatomical structures ofknee posteromedial corner included the static stabil ity structures and the dynamic stabil ity structures. The dynamic stabil ity structures were more important, including posterior root of medial meniscus, posterior obl ique l igament, semimembranosus extensions, meniscotibial l igament and obl ique popl iteal l igament. The posterior obl ique l igament was most important structure to contribute to stabil ization of valgus, anterior internal rotation of knee and posterior movement of tibia. Conclusion Anatomical reconstruction of knee posteromedial corner especially the posterior obl ique l igament is the key to the reconstruction of knee posteromedial function stabil ity.
Objective To explore the anatomical features of some major dorsal wrist interosseous l igaments, and to measure their biomechanical properties to screen a suitable donor site for the repair of scapholunate dorsal l igament. Methods Sixteen wrist joints from 8 frozen fresh male adult cadavers were selected, whose age was 20-38 years and whose height was 165-178 cm. There were no injuries to their wrists. The follow l igaments were observed and measured for the interosseous l igaments: volar and dorsal scapholunate l igaments (SL-v, SL-d), lunotriquetral dorsal l igament (LT), trapezoidcapitate dorsal l igament (TC), capitohamate l igament (CH) and the 2nd-4th carpometacarpal l igaments (CMC-2-4). The bone-l igament-bone samples of the above l igaments were prepared for further biomechanical measurements. Ligament extension testing was performed for each bone-l igament-bone sample on a material testing system. The broken load and length were measured and statistically analyzed. Results The SL and the LT were both “C” shape, attaching to the volar, proximal and dorsal joint surface. The TC and CH l igaments were mainly transverse fibers, which connected with each other at the dorsal side of capitate. The CMC-2-4 l igaments were obl iquitous fibers. Within these wrist interosseous l igaments, the SL-v and CMC-4 were relatively long. The l igament length differences were significant between SL-v and TC and between CMC-4 and TC (P lt; 0.05). TC and CMC-2 were fairly thick. But there was no significant difference among the l igaments (P gt; 0.05). SL-d had the highest broken load of (73.6 ± 9.6) N. The broken load differences were all significant between SL-d and other l igaments (P lt; 0.05). SL-v had largest broken length of (5.24 ± 1.65) mm. The broken length differences were all significant between SL-v and other l igaments (P lt; 0.05). Conclusion The anatomical structures and biomechanical features of the wrist interosseous l igaments were closely related with their physiological functions. CMC-2 and CH are both suitable to be used for the repair of scapholunate dorsal l igament.
Objective To investigate the classification of atlas pedicles and the methods of the pedicle screw fixation. Methods To study the classification of atlas pedicles, 48 dry adult atlas specimens were measured. By atlas 3D-CT reconstruction, two transverse sections were establ ished by going through the one third of the lateral atlas pedicle and 2 mmbelow the vertebral artery sulcus. By setting 3.50 mm and 1.75 mm as the standardized diameter and radius for the screwand according to the thickness of bone substance of vertebral artery sulcus that went through the one third of the lateralatlas pedicle, the anatomical morphology of atlas pedicles were classified into three types: general type with 40 specimens (83%), l ight variation type with 6 specimens (13%), and severe variation type with 2 specimens (4%). The entry pathway was confirmed by the intersection l ine of the two transverse sections that went through the lateral one third of the atlas pedicle and 2 mm below the vertebral artery sulcus. The project-point of the entry pathway on the atlas posterior arch was considered to be the entry point. Forty-eight dry atlas specimens were used to measure the following relevant anatomic data with an electronic cal iper: the distance between the entry point and the posterior margin of the lateral mass (L1), the height of atlas pedicle at the entry point (L2), the vertical distance between the entry point and the inferior articular facet of the lateral mass (L3), the mass height at the entry point (L4), the mass width at the entry point (L5), the width of the atlas pedicle at the entry point (L6), the thickness of the pedicle under the vertebral artery sulcus at the entry pathway (H1). To research the method of the pedicle screw fixation, 12 fresh-frozen adult atlas specimens were adopted to simulate the fixation of the pedicle screw. The thickness of the bone substance of vertebral artery sulcus on both the left and the right sides of the pathway was grinded into 3 types: 1.5 mm and 2.5 mm, 1.5 mm and 4.0 mm, 2.5 mm and 4.0 mm, and each type had four specimens. The entry pathway was confirmed by the intersection l ine of two transverse sections that went through the lateral one third of atlas pedicle and 2 mm below the vertebral artery sulcus. Results On the left side, L1 was (5.79 ± 1.24) mm, L2 (4.55 ± 1.29) mm, L3 (5.12 ± 1.06) mm, L4 (12.43 ± 1.01) mm, L5 (12.66 ± 1.37) mm, L6 (7.86 ± 0.77) mm, and H1 (4.11 ± 1.25) mm. On the right side, L1 was (5.81 ± 1.26) mm, L2 (4.49 ± 1.22) mm, L3 (5.15 ± 1.05) mm, L4 (12.49 ± 0.98) mm, L5 (12.65 ± 1.38) mm, L6 (7.84 ± 0.78) mm, and H1 (4.13 ± 1.29) mm. There was no significant difference between the two sides (P gt; 0.05). After simulation of inserting screws, no screw in the specimens was found to break the bone substance in the sulcus of vertebral artery. Conclusion For the pedicle screw fixation of those patients whose atlas posterior arches are not high enough, we might partly drill through or beyond the atlas posterior arch. The entry point should be ascertained by preoperative 3D-CT reconstruction and intra-operative exploration.
OBJECTIVE: To explore the importance of the posterior and lateral arterial network of elbow in the application of the super-regional and mutual-pedicled axial flap. METHODS: Twenty-seven upper extremities of adult cadavers were prepared as casts of Acrylomintril Batradiene Styrene(ABS) resin and corroded in a b solution of NaOH according to natural layers of human tissue. The source, site and structure of the posterior and lateral arterial network of elbow were observed, the number and total sectional area of anastomosing branches crossing the line between two humeral epicondyles were measured and compared with the medial and anterior region. RESULTS: There are 8.64 +/- 2.74(36.42%) and 8.30 +/- 1.19(35.0%) anastomosing branches crossing the posterior and lateral regions, and total section areas are (0.48 +/- 0.11) mm2 and (0.37 +/- 0.03) mm2 respectively. So there is very rich arterial network around the elbow. CONCLUSION: The enough number of anastomosing branches and their section areas of the posterior and lateral region of the elbow make it possible to connect super-regional and mutual-pedicled axial flaps crossing the elbow.
Abstract: Objective To investigate the clinical anatomy of ventricular septal defect(VSD) in tetralogy of Fallot(TOF)，reassess its classification and technique of surgical closure. Methods The data of one hundred consecutive patients with TOF (between January 2002 and June 2006) were reviewed. Their ages ranged from 2 months to 13 years, weights ranged from 5 to 38kg, percutaneous oxygen saturation(SpO2) ranged from 57％ to 92％, haematocrit(HCT) ranged from 0.34 to 0.74, Nakata index ranged from 90 to 210mm2/m2 and McGoon ratio ranged from 0.8 to 2.0. The clinic anatomy of the VSD was studied intraoperatively. Results Among them, seventy one patients had fibrous continuity between the leaflets of the aortic and tricuspid valve. Ninteen patients had a muscular postero-inferior border. Ten patients had subpulmonary VSD’s. There was no third degree atrioventricular block (3°AVB). Two patients had transient-atrioventricular dissociation but subsequent returned to sinus rhythm. Twenty two patients had incomplete right bundle branch block. Three patients were found to have very small residual VSD (less than 0.2cm) in the posteroinferior borders which closed spontaneously after 6 months. ConclusionVSD in TOF when classified as peri-membranous, muscular and subpulmonary VSD may improve the accuracy of surgical closure.
Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
Objective To investigate the application of multi-detector row spiral CT （MDCT） and multi-planer reconstruction （MPR） in identify the anatomy detail of normal adult groin region. Methods We retrospectively collected the CT images of 50 adult subjects with normal groin anatomic structure underwent groin region thin-slice MDCT scans between July and December 2009, 30 males and 20 females, obtained the coronal and sagittal views by MPR, investigated the value of different plans in identifying anatomic detail. Results Bilateral inferior epigastric artery (100/100, 100%), spermatic cord (60/60, 100%), and round ligament of uterus (40/40, 100%) were well identified on all plans in all subjects. The bilateral “radiological femoral triangle” could be demonstrated on coronal views in all subjects (100/100, 100%). The bilateral inguinal ligament were visible on coronal view in all subjects (100/100, 100%) and on sagittal views in 34 subjects (68/100, 68%), but on axial views was identified in 3 male subjects (6/100, 6%). The bilateral inguinal canal and deep inguinal ring were reliably visible on coronal views in all subjects (100/100, 100%), and on sagittal views in 46 subjects (92/100, 92%). On coronal views, the widths of inguinal canal was (0.97±0.35) cm in left, (0.89±0.23) cm in right for males, and (0.62±0.11) cm in left, (0.71±0.11) cm in right for females. No significant difference was found between two sides (P=0.059 in males， P=0.067 in females), but there were significant differences between males and females (P=0.007 in left， P=0.009 in right). Transverse diameter of deep inguinal ring was (1.32±0.31) cm in left, (1.31±0.36) cm in right for males, and (1.07±0.35) cm in left, (1.07±0.30) cm in right for females. No significant difference was found between two sides (P=0.344 in males， P=0.638 in females), but there were significant differences between males and females (P=0.001 in left， P=0.002 in right). Conclusion MDCT with different plans plays an important role in identify the anatomic details of groin region, the coronal views especially.
Objective To provide anatomy evidence of the simple injury of the deep branch of the unlar nerve for cl inical diagnosis and treatments. Methods Fifteen fresh samples of voluntary intact amputated forearms with no deformity were observed anatomically, which were mutilated from the distal end of forearm. The midpoint of the forth palm fingerweb wasdefined as dot A , the midpoint of the hook of the hamate bone as dot B, the ulnar margin of the flexor digitorum superficial is of the l ittle finger as OD, and the superficial branch of the unlar nerve and the forth common finger digital nerve as OE, dot O was the vertex of the triangle, dot C was intersection point of a vertical l ine passing dot B toward OE; dot F was the intersection point of CB’s extension l ine and OD. OCF formed a triangle. OCF and the deep branch of the unlar nerve were observed. From May 2000 to June 2007, 3 cases were treated which were all simple injury of the deep branch of the unlar nerve by glass, diagnosed through anatomical observations. The wounds were all located in the hypothenar muscles, and passed through the distal end of the hamate bone. Muscle power controlled by the unlar nerve got lower. The double ends was sewed up in 2 cases directly intra operation, and the superficial branch of radial nerve grafted freely in the other 1 case. Results The distance between dot B and dot O was (19.20 ± 1.30) mm. The length of BC was (7.80 ± 1.35) mm. The morpha of OCF was various, and the route of profundus nervi ulnaris was various in OCF. OCF contains opponens canales mainly. The muscle branch of the hypothenar muscles all send out in front of the opponens canales. The wounds of these 3 cases were all located at the distal end of the hook of the hamate bone, intrinsic muscles controlled by the unlar nerve except hypothenar muscles were restricted without sensory disorder or any other injuries. Three cases were followed up for 2 months to 4 years. Postoperation, the symptoms disappeared, holding power got well, patients’ fingers were nimble. According to the trial standard of the function of the upper l imb peripheral nerve establ ished by Chinese Medieal Surgery of the Hand Association, the synthetical evaluations were excellent.Conclusion Simple injuries of the deep branch of the unlar nerve are all located in OCF; it is not easy to be diagnosed at the early time because of the l ittle wounds, the function of the hypothenar muscles in existence and the normal sense .