Objective To assess the possibility of placing the posterior pedicle screw on atlas. Methods Twenty human cadaver specimens were used to insert pedicle screws in atlas, through the posterior arch or the pedicle of C1 into the lateral mass. The screw entry point was on the posterior surface of C1 posterior arch and at the intersection of the vertical line through the center of C2 inferior articular process and the horizontal line at least 3 mm below the superior rim of the C1 lamina. The screw of 3.5 mm in diameter was placed in a direction of 10° medial angle and 5° upwardangle. After placement of C1 pedicle screw, the distance from C1 screw entry point to the mediallateral midpoint of C1 pedicle, the maximum length of screw trajectory and the actual screw trajectory angles were measured. The direction of screw penetrating through the cortical of C1 pedicle or lateral mass and the injuries to the vertebral artery and spinal cord were observed.Results Forty pedicle screws were placed on atlas, the mean distance from C1 screw entry point to the medial-lateral midpoint of C1 pedicle was (2.20±0.42)mm, the maximum length of screw trajectory averaged (30.51±1.59)mm, and the actual screw trajectory angle measured (9.7±0.67)° in a medial direction and (4.6±0.59) ° in a upward direction. Only 1 screw penetrated the upper cortical bone of the atlas pedicle because the upward angle was too large, and 8 screws were inserted so deep that the inferior cortical bone of the C1 lateral mass was penetrated. But no injuries to the vertebral artery and spinal cord wereobserved. Conclusion C1 posterior pedicle screw fixation is quite accessible and safe, but the su
OBJECTIVE: To investigate the feasibility of segmentation of latissimus dorsi on the basis of anatomy and electrophysiology. METHODS: Ten cadaveric latissimus dorsi was dissected according to the blood supply, nerve innervation. Electromyelogram (EMG) of latissimus dorsi of 13 healthy persons was recorded with superficial electrode plate in the motion of shoulder joint. The results of record were managed with statistic methods. Ten patients(including reconstruction of breast and repair of scar on elbow joint and on chest wall) were treated with the lateral inferior myocutaneous island flap. RESULTS: According to the medial and lateral vasculonervous branches, latissimus dorsi can be divided into the medial superior and lateral inferior segments. The clinical application of the segment achieved good results in reconstructing breast and in repairing scars on elbow and on chest wall. CONCLUSION: Latissimus dorsi can be divided into two segments and applied separately. The lateral inferior segment is more useful in shoulder motion.
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 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.
ObjectiveTo study the significance, methods, and technique of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer. MethodsThe relevant data of the 141 examples of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer from Jan.1, 2008 to Dec.31, 2011 were retrospectively analysized. ResultsOne hundred and forty-one patients were successfully completed the group No.6 lymphadenectomy of laparoscopic distal gastrectomy with D2 lymph node dissection. With the number of cases of operation increasing, the operation time, bleeding volume, incidence rate of complication, and the number of operation transit cases stepped down year by year, and the number of the lymph node dissection stepped up (P < 0.000 1). No case died of the lymphadenectomy of the group No.6 lymph node. The medium vessels of colon, pancreas, and the gastroduodenal artery were the anatomic landmarks of the group No.6 lymphadenectomy. The space between the anterior lobe and the posterior lobe of transverse mesocolon and the prepancreatic space were the important surgical plane to carry out the group No.6 lymphadenectomy. ConclusionsOnly a team shall complete a certain amount of the operation, take the medium vessels of colon, pancreas, and the gastroduodenal artery as the anatomic landmark, accurately identify the space between the anterior lobe and the posterior lobe of transverse mesocolon, and the prepancreatic space, and take operation on the correct surgical plane, shall the group No.6 lymphadenectomy conform to the principle of the radical cure of the tumour and achieve the aim of the minimal invasion.
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 clarify the thin-layer 16-slice spiral CT features of coal worker’s pneumoconiosis and the superior distribution of comorbidities in their staging and lobes and lung field anatomy. Methods Sixty-six patients with coal worker's pneumoconiosis diagnosed by the pneumoconiosis diagnosis and identification group from October 2014 to March 2015 were enrolled. All patients underwent 16-slice spiral CT and thin-layer CT reconstruction with a thickness of 1.5 mm. The thin-slice CT signs and comorbidities of coal workers’ pneumoconiosis were observed, and the superior distribution of CT signs in patients at different stage and different lobes and lung field anatomy were evaluated. Results There were 16 cases of irregular small nodules in the lungs, 22 cases of large shadow fusion, 18 cases of intraocular shadow calcification, 41 cases of emphysema, 21 cases of pulmonary bullae, 21 cases of pulmonary hypertension, and 31 cases of enlarged lymph nodes in the mediastinum and calcified. The above signs were mostly distributed in stage Ⅲ pneumoconiosis (P<0.05). There were 32 cases of regular small nodules, which were mostly distributed in stage Ⅰ pneumoconiosis. In the 16 cases of irregular small nodules, the advantage was distributed in the middle and outer lobes of the double lungs. In the 22 cases of large shadow fusion, the advantage was distributed in the upper and lower lobe of the lungs. In the 16 cases of tuberculosis, the advantage was distributed in the upper lobe of the lungs. In the 21 cases of bullous bullae, the advantage was distributed in the upper lobe of the two lungs, mostly in the right upper lung. Conclusion The thin 16-slice spiral CT signs of coal worker’s pneumoconiosis can reflect the pathological changes, and have a certain correlation with the stage of pneumoconiosis, and have obvious characteristics in the anatomical distribution of lung and lung fields.
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 .
The purpose of this study was to investigate the arterial supply of the pisiform bone. Fifty upper extremities from adult human cadavers of both sexes were studied. The observations showed that there was a small branch(named the main artery of pisiform) arising from the lower part of the ulnar artery in each cases. The mean value of the length of the main artery of the pisiform was 23.89±8.68mm, the diameter of the artery was 0.79±0.21mm. The length, width and thickness of the pisiform were 11. 61±1.98mm, 11.40±1.87mm and 10.30±1.26mm, respectively. The length and width of the space accupied by the lunate on the X-ray films were measured, they were 16.38±1.96mm and 12.03±1.17mm, respectively.
Objective To demonstrate the anatomical and biomechanical basis of scaphoid ring sign in advanced Kienbock’s disease. Methods The study consisted of two sections. The ligaments stabilizing the proximal pole of the scaphoid were observed in 5 specimens. Under 12 kg dead weight load through the tendons of the flexion carpal radial, the flexion carpal ulnar, the extension carpal radial, and the extension carpal ulnar for 5 minutes, the stresses of the scaphoid fossa and lunate fossa were measured in the case of neutral, flexion, extension, radial deviation and ulnar deviation of the wrist joint under normal and rupture conditions respectively by FUJI prescale film and FPD-305E,306E.Results Based on anatomical study, the ligaments stabilizing the proximal pole of the scaphoid consisted of the radioscaphocapitate ligament, long radiolunate ligament and scapholunate interosseous ligament; and the latter two ligaments restricted dorsal subluxation of the proximalpole of the scaphoid. When compared rupture condition with normal condition, thescaphoid fassa stress of radial subregion was not significantly different (0.90±0.43 vs 0.85±0.15), and the ones of palmar, ulnar and dorsal subregions decreased (0.59±0.20, 0.52±0.05 and 0.58±0.23 vs 0.77±0.13, 0.75±0.08 and0.68±0.09) in the case of extension; the scaphoid fassa stresses of all subregions increased or had no difference in the case of neural, flexion, radial deviation and ulnar deviation. The lunate fossa stresses of all subregions increased in thecase of neural, and the ones of all subregions decreased or had no difference inthe case of flexion, extension, radial deviation and ulnar deviation.Conclusion Rotary scaphoid subluxation should be treated operatively at Ⅲ B stage of Kienbock’s disease to avoid traumatic arthritis of theradioscaphoid joint.