Microsurgical anatomy of the arterial network of submental flap / 中华显微外科杂志

Objective:To provide microsurgical anatomy data in the course, branch, distribution, arterial network profile of the submental artery and the range of the flap excision in submental flap transplantation.Methods:From March, 2015 to March, 2020, a total of 36 head and neck cast specimens were studied. Acrylic-butadience-styrene plastic (ABS) filler were perfused into the external carotid artery to make cast specimens. The course, branching, distribution and the arterial framework of the submental artery under a surgical microscope were investigated.Results:The submental artery originated from the facial artery before reaching the lower edge of the mandible (1.50±0.50) cm, with a diameter of (1.50±0.85) (0.6-2.3) mm. The main trunk of submental artery was (5.5±0.5) cm in length, which ran forward along the lower edge of the mandible and branched out (9.0±3.0) (7-13) branches with diameters between 0.1-0.5 mm, and mainly distributed to skin and superficial fascia of the submental area. The main trunk of submental artery divided into ascending, horizontal and descending branches about 3.0 cm of the midline of the mandible. The ascending branch went upwards over the lower edge of the mandible and joined up with the lower labial arch or participated in the formation of the lower labial arch; the horizontal branch divided into several branches and joined up with the branches from the opposite side; the descending branch branched posteriorly and inferiorly, joined up with branches of lingual artery and superior thyroid artery. The branches of the submental artery and the branches of the peripheral arteries were joined up in the submental area to form the submental artery network. The diameter of the vessels in the network ranged 0.1-0.2 mm. The arterial network was built in the form of 1 to 3 layers, and the area of main network was about 7.0 cm×5.0 cm.Conclusion:The submental artery has a long trunk, many branches and abundant anastomoses between the branches, forming a dense submental artery network, which provides sufficient pedicle length, rich blood supply and cutting area for submental flap. The flap can be transplanted free or transposed. The best location of submental flap is near the midline of arterial network, and the appropriate area is 7.0 cm×5.0 cm.

Microscopic anatomy study of artery of auricle for auricle replantation / 中华显微外科杂志

To provide the anatomical information for auricle replantation. Methods From March, 2016 to March, 2019, a total of 25 fresh adult cadaveric head were used, 20 of these specimens were perfused with plastic and eroded to be vascular cast mold, 5 specimens perfused with red latex for anatomy, then observed the origin, course, diameter and arteries anastomose between branches of the posterior auricular artery (PAA) and superfi-cial temporal artery (STA). Results The main blood supply to the auricle were auricle branches of PAA and STA. The auricle branches of PAA and STA both divided into superior, intermedius and inferior branches, and distributed in the auricle posterior surface and anterior surface, respectively.The auricle branches of PAA running across ear car-tilage, distributed in the anterior surface, and anastomosed with auricle branches of STA. The diameters of these branches at the initiating portion were 0.2-0.8 mm. Eighty percent of blood supply to earlobe was from the inferior branches of PAA, and 20% from the STA. Conclusion The auricle branches of PAA played an important role to the auricle replantation.The auricle branches of PAA should be the firstly selected vessle in operation, and the auricle branches of STA be the second choice.

Applied anatomied study in bilobed micro-flap of second dorsal metacarpal artery and dorsal digital artery / 中华显微外科杂志

Objective To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal dig鄄ital artery. Methods From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected.The ra鄄dial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results The distal 1/3 seg鄄ment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface.The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries.The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6 ±0.4 cm and the diameter was 0.2±0.1 mm.Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue de鄄fect on the thumb and purlicue.

Applied anatomied study in bilobed micro-flap of second dorsal metacarpal artery and dorsal digital artery / 中华显微外科杂志

Objective@#To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery.@*Methods@#From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed.@*Results@#The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches.@*Conclusion@#The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue.

The applied anatomy of posterior tibial artery cutaneous branches-chain flap / 中华显微外科杂志

To provide anatomy information for harvesting the posterior tibial artery cutaneous branches-chain flaps. Methods The research was performed from January, 2017 to January, 2018. Anatomic ob-servation on 10 legs from fresh human cadaver were performed. The location of cutaneous branches of the posterior tibial artery was observed and its diameter and length was measured. Five legs were prepared to investigate the cuta-neous branches of posterior tibial artery.The anastomosis of cutaneous branches of posterior tibial artery was observed by PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography in 5 perfused legs. The cutaneous branches with diameter over 0.2 mm in 10 legs of latex perfusion microdissection were included in the statistical analysis.The data were clustered and analyzed to find the location of distant and near cutaneous branches, which was called the gathering point of cutaneous branch vascular plexus. Secondly, the measured data of distal and near seg-ments containing cutaneous branches were compared by t-test.Then the distribution of cutaneous branches of posteri-or tibial artery on the tibiofibular side was compared by Chi-square test.It was considered to be significant if P value was under 0.05. Results ①There were 4.3 cutaneous branches raised from the posterior tibial artery.There was no significant difference on the tibial and ribula side distribution of the cutaneous branches from the posterior tibial artery (P＞0.05).②The distal cutaneous branch clusters was located at about 1/5 of the distal leg and there were 3.6 cutaneous branches raised from the posterior tibial artery. While the proximal clusters was located at 1/3 of the proximal leg and there were 0.7 cutaneous branches raised from the posterior tibial artery.There were no significant differences in the di-ameters (P=0.28) and pedicle length (P=0.14) between distal and proximal cutaneous branches. ③There were the large cutaneous perforators (≥1.0) mm from the posterior tibial artery at (6.37±1.22) cm proximal to the medial malleolus.The diameter and pedicle length of the distal perforators were (1.11±0.09) mm and (6.53±1.51) mm respectively.④The vas-cular chains parallel to the posterior tibial artery were formed via anastomosis of the adjacent cutaneous perforators. Conclusion The cutaneous expenditure of posterior tibial artery is constant, with a certain pedicle length and diameter. There are 2 relatively dense vascular plexus of cutaneous branches. The proximal and distal vascular flaps can be de-signed with these 2 vascular dense points as rotation points.

Transoral endoscopic thyroidectomy with central neck dissection: experimental studies on human cadavers / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With the development of natural orifice trans-luminal endoscopic surgery, studies on transoral video-assisted thyroidectomy in preclinical experiments (e.g., human anatomy and animal trials) were progressing gradually. From 2009 to 2011, embalmed human cadavers were dissected to define the anatomical location, surgical planes, and related neural and vascular structures to create a safe transoral access to the front cervical spaces. Recently, experimental transoral endoscopic thyroidectomy was performed to verify the feasibility of this approach on 15 fresh specimens.</p><p><b>METHODS</b>Fifteen specimens were placed in the supine position with slight neck extension. Endoscopic incision was made on the midline between the Wharton's duct papillae and two other incisions were made on mandibular first premolar buccal mucosa. Sublingual combined bilateral vestibular tunnels were created from oral cavity to the cervical region. The neck subplatysmal working space was insufflated with CO2 at 6-8 mmHg. The bilateral thyroid lobes and central lymph nodes were dissected under craniocaudal view.</p><p><b>RESULTS</b>Three incisions were made in the oral cavity without any incisions on the body surfaces. The distance from the oral cavity to front neck region was the shortest. Bilateral thyroid lobes and central neck region were fully resected via transoral approach. This approach provided a craniocaudal view, in which retrosternal thyroid gland and lymph nodes were easily accessible. The recurrent laryngeal nerve could be identified safely on the inferior cornu of the thyroid cartilage. The only structure at risk was the mental nerve. Camera motion was somewhat limited by the maxillary dentition. The volume of harvested thyroid nodule through sublingual tunnel in the fifteen human cadavers was (40 ± 15) cm(3).</p><p><b>CONCLUSION</b>The transoral procedure is progressive and innovative which not only gives the best cosmetic result and minimal access trauma but also provides a craniocaudal view.</p>

The new method of estimation on intracranial pressure of patients with brain injury / 中国医师进修杂志

Objective To discuss the feasibility of estimation on intracranial pressure of patients withbrain injury by measuring optic nerve sheath diameter (ONSD) with uhrasonography.Methods From July 2008 to December 2011,90 patients with brain injury were selected.According to the admission Glasgow Coma Scale (GCS),they were divided into experimental group 1 (60 cases with light and medium brain injury,GCS 9-15 scores) and experimental group 2 (30 cases with severe brain injury,G CS 3-8 scores).The conventional physical examination 50 cases and volunteers 50 cases in neural surgical outpatient were selected as control group.ONSD of all groups were measured 3 mm behind the globe through orbital by ultrasonography with different time after admission.The intracranial pressure was measured at 0.5-1.0 h after ultrasonography by lumbar vertebra puncturing in different groups and analyzed statistically.Results After admission 1,3,7,14 d; ONSD in experimental group 1 respectively was (4.49 ± 0.31),(4.45 ±0.28),(4.41 ±0.32),(4A3 ±0.25) mm;ONSD in experimental group 2 respectively was (5.69 ±0.32),(6.30 ± 0.47),(5.71 ± 0.26),(4.77 ± 0.36) mm.After admission 1,3,7,14 d ;the intracranial pressure in experimental group 1 respectively was (78 ± 16),(83 ± 17),(90 ± 15),(82 ± 14) mmH2O (1 mmH2O =0.0098 kPa) ;the intracranial pressure in experimental group 2 respectively was (230 ± 22),(269 ± 21),(228 ± 13),(147 ± 22) mumH2O.ONSD and the intracranial pressure was (4.58 ± 0.41)mm and(88 ± 10) mmH2O in control group.ONSD and the intracranial in Experimental group 1 and control group had no difference (P ＞0.05); those of control group and experimental group 2,experimental group 1 and experimental group 2 had difference (P＜ 0.05).Conclusions ONSD and the intracranial pressure in light,medium brain injury patients have no change.In patients with severe brain injury after different time,the intracranial pressure change differently,ONSD enlargement with the intracranial pressure rising,examination of ONSD by ultrasonography can reflect the changes of the intracranial pressure,it is a new method to evaluate the intracranial pressure,has the certain application value.

The anatomic relationship between the thoracic transverse process and adjacent bony structures / 中华创伤骨科杂志

Objective To study the anatomic relationship between the thoracic transverse process and adjacent bony structures and its clinical significance for thoracic screw fixation.Methods The present anatomic measurement used 45 dry cadaveric specimens of the normal adult thoracic vertebrae.We measured the distances from the horizontal midline of the transverse process to the superior,middle and inferior margius of the pedicle,the height of the anterolateral transverse process sheltered by ribs,and the position at the horizontal midline of the transverse process corresponding to the vertebral body.Results The horizontal midlines margius of the transverse processes of T1 to T10 are localized in the plane ranging from the superior to the inferior margins of the pedicle.The midlines of the transverse process are closer at T6 and T7 while more apart at T9 and T10.From T1 to T8,the anterolateral transverse process is totally or mostly sheltered by ribs,but the shelter is much less at T9 and T10.The horizontal midline of the transverse process corresponds to the upper 1/3 or middle 1/3 of the vertebral body.Conclusion Thoracic screw fixation across the transverse process to the vertebral body is safe,reliable and feasible in clinic.

Arantius ligament approach to left hepatic vein in partial hepatectomy: experience in 43 patients / 中华肝胆外科杂志

Objective To investigate the maneuver of dividing Arantius duct to expose the posterior of left hepatic vein.Methods Based on the anatomy of Arantius duct on 33 cadavers,exposure of posterior of left hepatic vein was carried out in 43 patients by dividing the Arantius ligament.Results The posterior of left hepatic vein was dissected to expose the left hepatic vein in 43 patients.The operations and the recovery of the patients were smooth and uneventful.Conclsion Cutting the Arantius ligament allows safe exposure and extrahepatic division of left hepatic vein.

The applied anatomy of posterior interosseous artery cutaneous branches-chain flap / 中华显微外科杂志

ObjectiveTo provide anatomy information for harvesting a pedicle or free posterior interosseous artery cutaneous branches-chain flaps. MethodsFourteen forearms from fresh human cadaver were used to study the anatomy characteristics of the posterior interosseous artery cutaneous branches-chain flaps with the following three methods:latex perfusion for microanatomy,denture materials and vinyl chloride mixed packing for cast,and PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography.The cutaneous perforator with a diameter ≥ 0.2 mm were included for statistical analysis.Results① There were 6.2 cutaneous branches raised from posterior interosseous artery. Measuring from the radial edge of ulnar head to the lateral epicondyle of humerus as the standard distance, the distal cutaneous branch clusters located at 21.24％ relative to the standard distance,while the proximal clusters located at 47.86％.② There were two large cutaneous perforators from the posterior interosseous artery at(5.82 ± 1.22)cm proximal to the ulnar styloid and (10.34 ±0.98)cm distal to the epicondyle of humerus.The diameter and pedicle length of the distal perforators were(0.50± 0.04)mm and (16.79 ± 5.12)mm respectively,while the proximal perforator were (0.60 ± 0.08 )mm in diameter with a pedicle (21.20 ± 12.28)mm in length.③ The vascular chains parallel to the posterior interosseous artery were formed via anastomosis of the adjacent cutaneous perforators. ConclusionThere is clinical significance to use pedicle or free posterior interosseous artery cutaneous branches-chain flaps.

Clinical anatomy study on neurocutaneous vascular flap / 中华显微外科杂志

Objective To provide vascular feature of neurocutaneous vascular flap and anatomical details about how to design the flap.Methods Ten fresh human body sample with twenty limb were perfused.The clinical anatomy of lateral antebrachial cutaneous nerve,medial antebrachial cutaneous nerve,sural nerve,superficial peroneal nerve,saphenous nerve and their nutrient vessels were studied.The distribution of their nutrient perforators were observed.Results Neurocutaneous nutrient vessels or nutrition artery with large diameter were accompanying nervus cutaneus by a long distance; Or longitudinal vascular chains were formed by ramus communicans with the ascending branches and descending branches from multiple segmental vessels.Medial antebrachial cutaneous nerve,lateral antebrachial cutaneous nerve,sural nerve,superficial peroneal nerve,saphenous nerve has the ulnar artery perforating branches,radial artery perforating branches,anteriolateral supra malleolar perforating branches,posterolateral supra malleolar perforating branches,medial supra malleolar perforating branches,accompanied separately,and the occurrence rate were 100％,95％,80％,90％,100％ respectively.Conclusion Cutaneous branch from the main deep artery is the anatomical basis of neurocutaneous nutrient vessel.Its distribution also accord to pressure balance rule.Mostly nervus cutaneus had constant perforator attending to suply its nutrition.Actually neurocutaneous nutrient vessel is a predictable and reliable vascular chain.

Applied anatomy of the endoscopic endonasal approach to the ventral middle-lower part of clivus / 中国医师杂志

Objective To establish the surgical landmarks of the endoscopic endonasal approach to the ventral region of middle-lower part of clivus and provide anatomic basis. Methods Twenty 10% formalin-fixed intact adult head specimens were used to dissect and observe the anatomic feature of this access in order to establish the surgical landmarks of the approach, and some relative anatomic data were measured. Five fresh and intact head specimens injected with colored latex were used, and completely analogical operation via endoscopic endonasal approach to the middle-lower part of clivus was performed in all cases. Results Anatomic landmarks of the approach included middle turbinate, choana narium, eustachian tube ostium, nasopharynx mucosa, longus capitis and longus colli, pharyngeal tubercle, and basi-on. To expose the ventral region of middle-lower part of clivus completely, the shortest distance was ( 89.60 ± 2. 52) mm. The ranges of stripping the inferior wall of sphenoid sinus and the lower clivus were bounded by pterygoid canal and foramen lacerum, and the distances from the median line were (9. 37 ± 0.59) mm and (10. 75 ± 0. 63 ) mm, respectively. Conclusions The structures of the ventral middle-lower part of clivus can be revealed sufficiently via an endoscopic endonasal approach.

Protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming / 中国组织工程研究

BACKGROUND: A lot of important organs are worthless for clinical application because they are hard to store for a long time. In addition, tissues or organs which are dealt with cryopreservation also attack ischemia/reperfusion injury with the recovery of blood flow; especially, skeletal muscle is the most involved tissue.OBJECTIVE: To observe the protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming.DESIGN: Randomized contrast animal study.SETTING: Basic Medical College of Southern Medical University; Department of Hand and Foot Surgery, Shandong Provincial Hospital.MATERIALS: The experiment was carried out in the Cryopreservation Laboratory, Shandong Provincial Hospital from April to November 2006. A total of 36 healthy adult male Wistar rats were provided by Experimental Animal Center of Medical College of Shandong University. All rats were randomly divided into control group, cryopreservation group and edaravone group with 12 in each group.METHODS: Femoral artery and vein of rats in control group were exposured, but extremities were not blocked. Rats in other two groups were used to establish ischemia/reperfusion injury models of replanted extremities. Before cryopreservation, their right hindlimbs were cut off and maintained in liquid nitrogen container for 1 month. After the operation mentioned above, the broken limbs were rewarmed, perfused with routine eluant and replanted. Four hours later, blood supply of extremities was recirculated and the samples were selected. Eluant in edaravone group contained 0.5 mg/kg edaravone. Samples of skeletal muscle were selected at the same time point to establish cellular membrane and extract mitochondria. Furthermore, fluorescence polarization of cellular membrane (reflecting liquidity in cellular membrane lipid area), malondialdehyde (MDA) content of mitochondria, superoxide dismutase (SOD) activity and respiratory controlling rate were measured; meanwhile, mitochondrial ultrastructure of skeletal muscle was observed under transmission electron microscope.MAIN OUTCOME MEASURES:①Fluorescence polarization of cellular membrane, MDA content of mitochondria, SOD activity and respiratory controlling rate of skeletal muscle; ②mitochondrial ultrastructure of skeletal muscle.RESULTS: All 36 rats were involved in the final analysis without any loss. ①SOD activity and respiratory controlling rate of mitochondria in skeletal muscle: The values of these two items were higher in edaravone group that those in cryopreservation group (P＜0.05).②Fluorescence polarization of cellular membrane and MDA content of mitochondria in skeletal muscle: The values of these two items were lower in edaravone group than those in cryopreservation group (P＜0.05). ③Mitochondrial ultrastructure of skeletal muscle: Injured degree of skeletal muscle was milder in edaravone group than that in cryopreservation group.CONCLUSION: Edaravone can relieve ischemia/reperfusion injury of skeletal muscle and protect cellular membrane and mitochondria of skeletal muscle. Its mechanism may be related to directly inhibiting hydroxy free radicals, increasing SOD activity of skeletal muscle, reducing generation of MDA and promoting normal oxidative phosphorylation.

Applied anatomical and clinical application of the lateral approach to the vertebral lamina for treating extreme lateral lumber dsic herniation / 中国矫形外科杂志

[Objective]To provide microsurgery anatomical data for the surgical operation in treating of extreme lateral lumbar dsic herniation through the observations of the regional anatomic structure about the post-median approach tolateral vetebral lamina(PMALVL).[Method]Thicknesses of intertransverse ligament,the distribution of anterior branches of lumbar nerve and vessel were measured at the adult cadavas specimens.Retrospectively analyzed with 12 cases of extreme lateral lumbar disc herniation from January 2004 to January 2006,including 7 cases were treated by the lateral approach to the vertebral lamina,5 cases treated by PMALVL.[Result]The thickness of intertransverse lingament is 0.6~1.3 mm.More than 90 percent of anterior branches of lumbar segmental arteries and the accompanying veins from L_3 to S_1 were located ventrally in the superior portion of the intertransverse ligament.A branch from Lumbar artery permanently locates in the hfiddle of post-lateral intertransverse ligament.The angle between the anterior branch of Lumbar nerve root and midline sagittal plane is 18.9?~39.2?.The distance from the root of the tranverse to the anterior branch of lumbar nerve root and from the lateral margin of the pars interarticul aris to the anterior branch of lumbar nerve root(5.6~8.0)mm and(1.7~3.6)mm respectively.The period of follow up in 12 cases was from 3 months to 24 months,with an average of 10 months.The resultwas excellentin 8 cases,good in 3 cases,total fine rate according the classification of Nakal was 91.67%.[Conclusion]Intertransvarse ligament is a reliable landmark for PMALVL and treating extreme lateral lumbar disc herniation through PMALVL may get microtraumatic and excellent effect.

Anatomical study of compartment syndrome of foot after calcanealintar-articular fractures / 中国矫形外科杂志

Objective To study the anatomical character of compartment syndrome of foot after calcaneal intra-articaular by experimental model. MethodSix intact human cadaver lower extremities were used to produce calcaneal intra-articular fracture models, fracture patterns of the model were observed with radiographical technique, and anatomical study was proceeded to observe the fractures and their effects on soft tissues and compartments in foot.ResultAll specimens were sustained calcaneal intra-articular fractures successfully, 4 were joint depression fracture in x-ray, 2 were tongue type; 3 were Sander Ⅱ type and others were Sander Ⅲ type in CT. the primary fracture line coursed from anterolateral to posteromedial, and from anterosuperior to posteroinferior. It damaged all the soft tissue arosed from fractures medially and laterally, included adductor hallucis,quadratus plantae, flexor digitorum brevis and abductor digiti minimi as well.ConclusionFrom anatomical view, soft tissues of many compartments in foot rather than of simple compartmen are injuried when calcaneal intra-articular fractures occur, decompressive fasciotomies should be performed in all compartments involved. The present experimental protocol is useful to reproduce calcaneal intra-articular fractures.

Placement of percutaneous translaminar facet screw: an anatomic study / 中国矫形外科杂志

[Objective]To provide anatomic basement for the clinic appliance of percutaneous thranslaminar facet screw.[Method]From L_1 to L_5,anatomic measurements for screw path length,superior and inferior lamina border thickness in 30 dried lumbar spines,caudal and lateral angles of laminar were measured with CT and X ray.[Result]The superior border of the lamina was relatively thinner from L_1 to L_5,The thickness of the inferior border of the lamina,the mean values of the length of the screw path and lateral angle gradually increased,and the caudal angle of screw placement relative to transverse plane gradually decreased.[Conclusion]A translaminar facet screw with 4.5 mm in diameter is safe.from L_(1~5).Screw should be inserted in inferior lamina border,not in the superior border of the lamina,caudal and lateral angles of laminar should be ajustable to fit the lumbar facet joint.

Microsurgical anatomy of craniocervical junction region / 中华外科杂志

<p><b>OBJECTIVES</b>To study the shape and the structures in the craniocervical junction region (CCJR) and the safety of far lateral approach.</p><p><b>METHODS</b>Ten cadaveric heads and 20 skull-base specimens were fixed with 10% formalin, and 4 of the 10 cadaveric heads were sectioned in different plane with the aid of operative microscope. The shape and relation of structures in the CCJR were observed.</p><p><b>RESULTS</b>The third segment of the vertebral artery(VA) was 21.6(15.3 31.9) mm. An incomplete bony canal was found to be 15% and complete bony canal surrounding the VA to be 5% on the VA groove. The distance of the left and right VA was 14.3a(c)(9.8 15.2) mm on the entry into the dura. The length of the occipital condyle was 26.8(25.1 28.2) mm, with the thickness of its anterior, middle and posterior one-third part was 9.9(9.6 10.6) mm, 11.2(9.2 13.1) mm and 8.6 (8.3 9.0) mm respectively. The distance between the posterior pole of the occipital condyle and the intracranial orifice of the hypoglossal canal was 9.9(8.6 11.4) mm, and between the posterior pole and the extracranial orifice was 16.1(13.5 17.1) mm. The transverse process of the atlas was the most important bony landmark for the approach.</p><p><b>CONCLUSIONS</b>Knowing the shape and relationship of the VA and occipital condyle in the CCJR is helpful in preserving the important structures in far lateral approach to target region.</p>

Microanatomy study on sinus triangle region / 中华外科杂志

<p><b>OBJECTIVES</b>To explore shape and position relationship of the structures with in sinus triangle region, and provide the anatomic foundation for extended presigmoid operative approach.</p><p><b>METHODS</b>Ten cadaveric heads and 15 skull-base specimens fixed with 10% formalin, with aid of operative microscope, the shape and relations of structures with in the sinus triangle region were observed and microphotographed. Four cadaveric heads were sectioned in different plane using collodion embedding process.</p><p><b>RESULTS</b>Jugular blub (JB) had high -placed jugular blub (HJB), normal jugular blub (NJB) and low-placed jugular blub (LJB). The incidence of HJB was 8% and 18% for the left and right sides (P < 0.01). The JB dome can extend upward the hypotympanic cavity and the posterior wall of the internal acoustic meatus. The incidence of NJB and LJB was 36% and 30%, and 6% and 2% respectively. The level distance between the posterior semicircular canal and petrosal posterior surface was (4.1 +/- 1.1) mm. The distance between the JB and vertical part of the facial nerve was (3.2 +/- 0.5) mm and (2.0 +/- 0.4) mm. The distance between the JB and posterior margin of the internal acoustic port was (7.5 +/- 1.7) mm and (4.0 +/- 1.0) mm.</p><p><b>CONCLUSIONS</b>Knowing the shape and position relationship of structures in the sinus triangle region is favorable for preserving the important structures in extended presigmoid operative approach.</p>

Anatomical and Morphological Research for Laparoscopic Anterior Lumbar Interbody Fusion / 中国微创外科杂志

Objective To study the vascular anatomy for laparoscopic anterior lumbar interbody fusion(LALIF),and to evaluate the feasibility of the surgical approach.Methods Vascular anatomy of 36 adult human bodies were studied by infusing red latex into the arteries.They were classified according to the percentage of the exposed lumbosacral disc in the interiliac triangle.Results The mean height of the aortic bifurcation(AB)was(41.81?13.82)mm,and the height of the confluence of the common iliac vein(CCIV)was(20.22?14.20)mm.The angles of the AB and CCIV were(51.88?12.09)? and(77.08?20.98)? respectively.The width of the median sacral artery(MSA)were(1.57?0.42)mm and(1.33?0.50)mm respectively at the top and bottom of the lumbosacral disc.While the distance from the right iliac vessel(RIV)to MSA at the top and bottom of the lumbosacral disc were(20.83?7.73)mm and(27.60?7.80)mm.The average width of the exposed disc was(36.78?13.06)mm,which accounts for(72.29?25.64)% of that of the disc.According to our morphological classification,22 specimens(61.1%)belong to type Ⅰ(Standard type,being exposed by more than 65%),9(25.0%)type Ⅱ(Narrow type,being exposed by 45% to 65%),and 5(13.9%)type Ⅲ(Barrier type,being exposed by less than 45%).The height of CCIV was negatively,but not significantly,correlate to its angle(r=-0.287,P=0.089).Conclusions In 86.1% of our patients,anterior approach is a safe and effective way for laparoscopic interbody fusion.Moreover,in 61.1% of the patients,the procedure can be carried out without managing the iliac vessels arround the interiliac triangle.

Transplant the big toe tip to reconstruct the finger tip / 中华显微外科杂志

Objective To explore the method to reconstruct finger tip. Methods Transplanted the big toe tip to reconstruct the finger tip and anastomosed the artery and nerve of big toe with the artery and nerve of the finger.The venae digitales plantares of finger,toe and venae digitales volares of finger and toe were anastomosed with microsurgery. Results All the reconstituted finger tips were successful.The shape of the reconstituted finger tips were near to the normal finger tip.The shape of the big toes had only a little change. Conclusion Use the big toe tip can reconstruct a beautiful finger tip look like the normal finger.