Morphological Analysis of Major Segments of Coronary Artery Occlusion: Importance in Myocardial Revascularization Surgery / Análisis Morfológico de los Principales Segmentos de Oclusión de las Arterias Coronarias: Importancia en la Cirugía de Revascularización Miocárdiaca

Revascularization surgery should ensure morphological similarity between the coronary artery and the graft. This is an important factor for its duration and permeability. The aim of this study was to analyze the morphological characteristics and morphometrics of the coronary artery segments with greater occlusion. This was an observational, cross-sectional descriptive study that consisted of two phases. A macroscopic phase in which 11 cadaveric hearts were extracted and coronary dominance and length of the anterior interventricular artery (AIA), the right coronary artery (RCA) and the circumflex artery (CXA) were determined. In the microscopic phase a total of 77 segments of these arteries were obtained and the luminal diameter, wall thickness, and amount of elastic fibers and the presence and size of the atheroma were determined. Right coronary dominance was the most frequent. Total vessel length was 15.65±1.17 cm for the AIA, 12.67±2.02 cm for the RCA and 8.79±2.5 cm for the CXA. Diameters ranged from 2.3 mm in the proximal segments and between 1.1 mm to 1.8 mm in the distal segments. Wall thickness in the proximal segments was between 354 µm and 396 µm and in the distal segments it ranged from 120 µm to 305 µm. The amount of elastic fibers showed that they were muscular arteries. Atheromas were present in 35% in the CXA, and in 32.5% in the AIA and the RCA. The largest ones were found in the proximal segments. This study examined the morphology and morphometry of the segments of the coronary arteries that are more frequently occluded. It provides information on the most significant parameters to be considered for election of the vascular graft in myocardial revascularization surgery.

En la cirugía de revascularización miocárdica se debe asegurar la similitud morfológica entre la arteria coronaria y el injerto. Esto es un factor importante en su duración y permeabilidad. El objetivo fue analizar las características morfológicas y morfométricas de los segmentos de mayor oclusión de las arterias coronarias. Estudio observacional, transversal y descriptivo que constó de dos fases. Una macroscópica en la que se extrajeron 11 corazones de cadáveres y se determinó la dominancia coronaria y longitud de la arteria interventricular anterior (AIA), la arteria coronaria derecha (ACD) y la arteria circunfleja (ACX). En la fase microscópica se obtuvo un total de 77 segmentos de estas arterias y se determinó el diámetro luminal, grosor de pared, cantidad de fibras elásticas y presencia y tamaño de ateroma. La dominancia coronaria derecha fue la más frecuente. La longitud total de los vasos fue de 15,65±1,17 cm para la AIA, de 12,67±2,02 cm para la ACD y 8,79±2,5 cm para la ACX. Los diámetros oscilaron entre los 2,3 mm en los segmentos proximales y entre 1,1 mm a 1,8 mm en los segmentos distales. Los grosores de pared en los segmentos proximales se presentaron entre 354 µm y 396 µm y en los segmentos distales oscilaron entre 120 µm a 305 µm. La cantidad de fibras elásticas demostró que son arterias musculares. El 35% de los ateromas se presentó en la ACX y el 32,5% en la AIA al igual que en la ACD. Los de mayor tamaño se encontraron en los segmentos proximales. Este estudio analizó la morfología y la morfometría de los segmentos de las arterias coronarias que se ocluyen con mayor frecuencia. Los resultados encontrados aporta información sobre los parámetros más significativos que se deben considerar para la elección del injerto vascular en la cirugía de revascularización miocárdica.

A new morphological classification of the anterior inferior iliac spine: relevance in subspine hip impingement / Nueva clasificación morfológica de la espina iliaca anteroinferior: relevancia en el pinzamiento subespinoso de la cadera

Femoroacetabular impingement syndrome (FAI) is a clinical entity that has been recognized in recent years as a frequent cause of pain and the early development of hip arthrosis. Subspine hip impingement is characterized by the prominent or abnormal morphology of the anteroinferior iliac spine (AIIS), which contributes to the development of a clinical picture that is similar to FAI. The aims of this study were to propose a new morphological classification of the AIIS, to determine the prevalence of the different AIIS morphologies based on this classification and to correlate the presence of said morphologies with different gender and age groups. The sample consisted of 458 hemipelvises from individuals of known age and sex (264 men and 194 women). Each specimen was analyzed to determine the prevalence of each of the different morphologies of the AIIS based on the classification proposed as Type 1: the presence of a concave surface between the AIIS and the acetabular rim; Type 2A: the presence of a flat surface between the AIIS and the acetabular rim; Type 2B the presence of a convex surface between the AIIS and the acetabular rim; and Type 3: the AIIS protrudes inferiorly toward the anterior acetabulum. A prevalence of 69.87% was determined for Type 1 AIIS (320/458). In regard to abnormal morphology, prevalences of 17.90% (82/458), 3.71% (17/458) and 8.52% (39/458) were determined for type 2A, Type 2B and Type 3, respectively. The prevalence of abnormal AIIS morphology was 30.30% (80/264) in male specimens and 29.90% (58/194) in female specimens. This study demonstrates the prevalence of the different morphologies of the AIIS, providing information that will be useful in determining the role of the AIIS in the emergence of subspine hip impingement.

El Síndrome de Pinzamiento Femoroacetabular (PFA) es una entidad clínica reconocida en los últimos años como una causa de dolor y desarrollo de artrosis temprana de cadera. El pinzamiento subespinoso de la cadera se caracteriza por una espina iliaca anteroinferior (EIAI) prominente o con una morfología anormal, lo que contribuye al desarrollo de un cuadro clínico similar al PFA. El objetivo fue proponer una nueva clasificación morfológica de la EIAI y determinar las prevalencias de las distintas morfologías de la EIAI en base a la misma y correlacionarla con los distintos sexos y grupos de edad. La muestra consistió en un total de 458 hemipelvis, de sexo y edad conocidos (264 hombres y 194 mujeres). Cada pieza fue analizada para determinar la prevalencia de variaciones morfológicas de la EIAI en base a la clasificación propuesta. Tipo 1: presencia de una superficie cóncava entre la EIAI y reborde acetabular, Tipo 2A: presencia de una superficie plana entre la EIAI y el reborde acetabular, Tipo 2B: presencia de una superficie convexa entre la EIAI y el reborde acetabular y Tipo 3: la EIAI protruye hacia el acetábulo anterior o inferiormente. Se determinó una prevalencia de 69,87% para la EIAI Tipo 1 (320/458). En cuanto a las morfologías anormales, se determinó una prevalencia de 17,90% (82/458), 3,71% (17/458) y 8,52% (39/459) para los Tipos 2A, 2B y 3, respectivamente. La prevalencia de una morfología anormal en las EIAI de especímenes del sexo masculino fue de 30,30% (80/264) y en el sexo femenino 29,90% (58/194). Se evidencia la prevalencia de las diferentes morfologías que puede tener la EIAI; esta información será de ayuda para determinar el papel de la EIAI en la aparición del pinzamiento subespinoso de la cadera.

Age- and gender-related variations in morphometric characteristics of thoracic spine pedicle: A study of 4,800 pedicles.

Transpedicular spinal fusion is the most commonly used fixation technique for the surgical treatment of vertebral disorders. However, the instrumentation of the thoracic spine using this technique continues to be controversial. The objective of the present study was to determine the morphometric characteristics of the thoracic pedicle and to establish how these characteristics vary with gender and age. Two hundred thoracic spines (4800 thoracic pedicles) from individuals of known gender and age were analyzed (in accordance with the order of vertebrae). The spines were divided into six groups according to age and gender. The horizontal and vertical diameters of the thoracic pedicle were determined for each piece. The mean and standard deviation of each variable were determined, and differences between age groups for each gender were evaluated using parametric correlation tests. The pedicle diameters of men and women differed significantly for most groups (P < 0.05). The horizontal diameters decreased from T1 to T5 and increased up to T12. The vertical diameter followed a cephalocaudal pattern of development from T1-T12. The pedicle diameters decreased with increasing age in women, while the opposite trend was observed in men. In men, the dimensions of the thoracic spine pedicle increase with increasing age; in women, they decrease. These differences should be taken into account when selecting the appropriate pedicle screw.

[Morphometric characteristics of the sacrum in Mexican population. Its importance in lumbosacral fusion and fixation procedures]. / Características morfométricas del sacro en población Mexicana. Su importancia dentro de los procedimientos de fusión y fijación lumbosacra.

BACKGROUND: the morphology and the morphometric characteristics of the sacrum and its components determine the size of pedicle implants in both width and length and the orientation of the screw at the time of implantation. The present study aimed to determine the morphometric characteristics of the sacrum in the Mexican population in order to establish safe approaches for the placement and orientation of the screws during lumbosacral instrumentation. METHODS: morphometric characteristics were determined for 50 dry sacra distributed in 44 measurement parameters (39 linear and 5 angular) divided in five categories: 1) anterior and posterior sacral foramina; 2) S1 vertebral pedicle and intermediate sacral crest; 3) vertebral bodies and the general parameters of the sacrum; 4) S1 superior articular process facet and sacral canal, and 5) S1 pedicle approaches. RESULTS: the S1 pedicle average length was 25.00 mm ± 2.41, the S1 pedicle anterior and posterior average height was 20.68 mm ± 3.40 and 24.64 mm ± 3.77 respectively, the sacral canal dimensions on its superior opening were 15.13 mm ± 2.40 in the sagital diameter and 31.07 mm ± 2.65 for the transverse diameter, in S1 the anteriomedial screw trajectory average distance was 50.08 mm ± 3.72 with an average angle of 34.30° ± 4.1 from the screw entry point. CONCLUSION: the results from this study are important for the correct screw placement and position in lumbosacral instrumentation, and also for other procedures that involve the sacral region as a surgical and diagnostic target.