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 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 summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.
Objective To find out some parameters to judge the stability of the wrists after four-corner arthrodesis and to explore the strategyfor improving the range of motion (ROM) of the wrist after four-corner arthrodesis. Methods After the simulated four-corner arthrodesis was performed in both wrists of 8 men and 4 women cadaver, the wrists were fixed on the wrist motor simulator; and wrist movement including flexion, extension, radial deviation, ulnar deviation was simulated. The standard posteroanterior and lateral radiographs were taken for measuring the change of capitolunate angle（α）, radiolunate angle（β）, capitolunate posteroanterior angle（θ）, the height（H）and width（W）of the fused four carpal bone bloc. Results There were statistically significant differences in α,β,θ angles (P＜0.01) in the case of 50° flexion or 40° extension, and in H and W values (P＜0.05) in the case of 25° ulnar deviation or 15° radial deviation when compared with before movement. Conclusion Capitolunate angle, radiolunate angle, capitolunate posteroanterior angle, the height and the width of thefused four carpal bone bloc can be used to judge the stability of the wrists after four-corner arthrodesis.
Objective To investigate the morphological anatomical abnormal ities of high congenital dislocation of hip in adults and provide anatomical basis for the total hip arthroplasty (THA). Methods From May 1997 to July 2008, 49 patients (57 hi ps) with high congenital dislocation of hip (Hartofilakidis type III) were treated. There were 6 males and 43 females with an average age of 29.4 years old (18-56 years old). The locations were left in 24 hi ps and right in 33 hi ps. The morphological parameters (including femoral length, isthmus, height of femoral head center, neck-shaft angle, medialhead offset, anteversion angle, canal flare index, anteroposterior diameter of the true acetabulum, posterior thickness of the true acetabulum, depth of the true acetabulum) of suffering hips (dislocation group, n=57) were measured by preoperative X-ray, CT and intraoperative cl inical observation and were compared with those of contralateral hips (control group, n=41). The intraoperative situations of hip were observed. Results The height of dislocation was (45.41 ± 2.15) mm. The length difference of both lower extremities was (40.41 ± 2.02) mm. In dislocation group, isthmus was shortened; height of femoral head center, neck-shaft angle and medial head offset were decreased; and anteversion angle was increased. CT showed that the canal flare index was larger than 4.7, femoral shape was funnel-shaped according to Noble classification. Anteroposterior diameter of the true acetabulum became smaller, posterior thickness of the true acetabulum became thicker, and depth of the true acetabulum was shallower. There were statistically significant differences in the morphological parameters of femur and acetabulum between two groups (P lt; 0.05). The intraoperative measurements showed that the anteroposterior diameter of acetabulum was (32.98 ± 1.02) mm and the depth of acetabulum was (14.21 ± 0.56) mm. There was no statistically significant difference between intraoperative measurements and preoperative measurements (P gt; 0.05). The acetabulum was full of fat and fibrous tissues. Running of the sciatic nerve in 40 cases were changed and it ran upward and laterally. Conclusion When high congenital dislocation of the hip in adults is treated with THA, anatomical variation must be fully taken into account. The acetabulum is expanded toward posterosuperior, excessive reamed should be avoided to prevent femoral fractures, and appropriate or tailor-made prosthesis was selected.
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 variation of supratrochlear vein and its relationship with supratrochlear artery and to provide anatomical basis for the reduction of congestive necrosis of paramedian forehead flap in the reconstruction of nasal defect. Methods Twenty sides of 10 antiseptic head specimens were anatomized macroscopically and microscopically. Using the horizontal and anterior median l ine of supraorbital rim as X and Y axis to locate supratrochlear vein and artery, the angles between the supratrochlear artery and vein and the supraorbital rim were detected, and the distances from the supratrochlear artery and vein to the anterior median l ine on the horizontal l ine of supraorbital rim were measured. Results The distance from the supratrochlear artery and supratrochlear vein to the anterior median l ine on thehorizontal l ine of the supraorbital rim was (16.2 ± 2.1) mm and (9.7 ± 3.1) mm, respectively, indicating there was a significant difference (P lt; 0.05). The angle between the supratrochlear vein and artery and the supraorbital rim was (83.3 ± 6.4)° and (80.5 ± 4.2)°, respectively, indicating there was no significant difference (P gt; 0.05). Two asymmetric supratrochlear veins were observed around the area of anterior median l ine in every specimen, one was far from the anterior median l ine (group A) and the other was close to or even on the l ine (group B). The distance from the supratrochlear veins to the anterior median l ine on the horizontal l ine of the supraorbital rim was (11.0 ± 1.9) mm in group A and (7.9 ± 3.2) mm in group B, showing there was a significant difference between two groups (P lt; 0.05). For all the specimens, the supratrochlear vein ran laterally along the medial anterior median l ine of the supratrochlear artery (one side was just on the anterior median l ine). The distance from the supratrochlear veins to the supratrochlear arteries on the horizontal l ine of the supraorbital rim was (6.6 ± 3.2) mm, (5.5 ± 2.0) mm in group A and (7.9 ± 3.9) mm in group B, indicating the difference between two groups was significant (P lt; 0.05). Conclusion The pedicle of the paramedian forehead flap should be wide enough (1.5-2.0 cm), the lateral boundary of the pedicle should be the supratrochlear artery while the medial boundary should be the supratrochlear vein.
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.
目的:研究樞椎椎弓根關節突復合體的解剖結構特征,探討該解剖概念的臨床意義。方法:觀察80具樞椎干骨標本椎弓根關節突部位的解剖結構特征。并隨機抽取其中20具標本,在椎弓骨背側表面做樞椎經椎弓根螺釘固定及經關節(C1-2)螺釘固定釘道投影畫線,另2具標本按兩種螺釘內固定方式設置直徑3.5 mm釘道,并螺旋CT掃描多平面重建(MPR)釘道斷面影像,了解兩種釘道與椎弓根關節突結構的解剖關系。回顧性分析25例外傷致樞椎椎弓根關節突部位骨折的CT資料,包括其中12例樞椎螺釘內固定術后CT,研究該部位骨折特點及釘道所在的斷面解剖。結果:樞椎解剖學上,無嚴格定義下完整的椎弓根。而樞椎椎弓根關節突作為復合體,具有解剖結構上整體性特征,其周圍界線清楚。外傷致樞椎椎弓根關節突復合體骨折可分為椎弓根上關節突骨折、關節突間部骨折及單純上關節突骨折。樞椎經椎弓根螺釘固定及經關節(C1-2)螺釘內固定的釘道均通過椎弓峽部中心,但起點不同,走向不同。結論:樞椎椎弓根關節突復合體作為臨床解剖概念,具有解剖結構的完整性。明確該解剖概念及各構件對該區域骨折分類與螺釘內固定手術具有指導作用。