Various tissue flaps are currently used to repair the defect and injury of bone and joint. In this paper, based upon a series of anatomical studied, the author presents anatomical guidelines and principles for the selection of vaseularized bone flaps. Under these guidelines, the applied anatomical essential for vaseularized transplantation of ilium, scapula, fibula, costa, tibia, radius, ulna, humerus, femur and clavicle are provided.
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 evaluate the influence of the location of retinal vessel trunk on neuroretinal rim width of inferior and superior sectors of optic disc, and explore its role in the diagnosis of glaucomatous optic nerve lesion. Methods The photographs of ocular fundus from 459 patients with clear location of retinal vessel trunk, including large disc in 131, medium disc in 145, horizontally oval disc in 75, and small disc in 108 were evaluated. Independent-sample t test was used to compare the difference of the superior and inferior rim widths between the higher-vessel group and the lower-vessel group, and to compare the difference of superior and inferior vessel distances between the narrow-superior-rim-width group and the narrow inferior-rim-width group. Results In most of the patients, or the ones with large and small disc, the ratio of superior rim width to summation of superior and inferior rim widths in the higher-vessel group（0.467plusmn;0.051，0.445plusmn;0.040，0.508plusmn;0.056）were less than which in the lowervessel group（0.500plusmn;0.066，0.474plusmn;0.062，0.546plusmn;0.048）, and the differences were significant（P=0.000, 0.045, 0.018）; the ratio of superior vessel distance to summation of superior and inferior vessel distance in the narrow-superior-rim-width group（0.510plusmn;0.051，0.508plusmn;0.055，0.512plusmn;0.036）were less than which in the narrow-inferior-rim-width group（0.528plusmn;0.045，0.533plusmn;0.048，0.534plusmn;0.045）, and the differences were significant（P=0.000, 0.046, 0.022）. Conclusions The position of optic disc vessel trunk influences its superior and inferior rim width. The rim closer to vessel trunk position has narrower width than which comparatively far away from the position. In patients with large, medium, horizontally oval optic disc, glaucoma optic nerve lesion would be considered if the optic disc has the shape of narrower inferior rim, broader superior rim, and vessel location in the superior half of the disc. In the ones with small disc, the optic disc with the shape of narrower superior rim, broader inferior rim, and vessel location in the inferior half of the disc may suggest glaucoma optic nerve lesion. (Chin J Ocul Fundus Dis, 2007, 23: 118-121)
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.
ObjectiveTo exclusively compare the short-and long-term outcomes of hepatic resection (HR) patients with multifocal tumors meeting the Milan criteria between locating in same and different sections. MethodsA total of 219 consecutive HR patients with multifocal tumors meeting the Milan criteria were divided into group SS (n=97, same section) and group DS (n=122, different sections) according to their anatomical location (Couinaud's segmentation). ResultsThe 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in the group SS than those in the group DS (P < 0.05). The subgroup analysis showed that patients with 2 tumors and those undergoing en bloc resection were associated with better OS and RFS (P < 0.05). ConclusionsFor HCC patients with multifocal tumors meeting the Milan criteria, those with tumors locating in same hepatic section may have better longterm survival and lower HCC recurrence rates than those locating in different sections after HR.
Anatomical venous distribution around the lower esophagus, gastric cardia and fundus in 100 adult cadavers had been observed. The results showed that the occurrence rate of the left gastric and the right gastric veins were 96% and 92% respectively. Venous distribution in the lesser curvature of the stomach can be classified into five types: the left gastric vein type, the right gastric vein type,the left gastric vein dominant type, the right gastric vein dominant type, and the balance type (of the left and the right gastric veins). The retrogastric veins were found in 73.6% of 100 cadavers showed portacaval anastomoses. From March 1976 to March 1992, we had treated with transthoracic interruption of portoazygous circulation, 52 cases of portal hypertension resulting in bleeding du to rupture of esophageal and venriculi fundus varices ( male 43, female 9). Among the 41 emergency operations, 2 cases died (4.9%), and bleedings were controlled by emergency surgery in 92.6% of cases. 44 of the 50 cases (88%) were followed up. The recurrence of bleeding occured in 5 cases, with a long-term bleeding rate of 11.4%. The authors suggest that anatomical factors might be the reason of inadequacy of portaoazygous interruption, and claim the advantages of transthoracic interruption of portoazygous circulation.
Objective To measure the anatomical parameters related to lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation, and to assess the feasibility and safety of the approach. Methods A total of 300 lumbar vertebral bodies of 60 patients were randomly selected, and vertebral augmentation were simulated 600 times on X-ray and CT image with unilateral conventional transpedicle approach (control group) and unilateral transverse process-pedicle approach (experimental group). The distance between the entry point and the midline of the vertebral body, the puncture inner inclination angle, the safe range of the puncture inner inclination angle, and the puncture success rate were measured and compared between the left and right with the same approach, and between the two approaches. Results The distance between the entry point and the midline gradually increased from L1 to L5 on both sides in the 2 groups. In the control group, the right sides distance of L1 and L2 was much longer than the left sides, and the right sides distance of L1, L2, and L5 was much longer than the left sides in the experimental group (P<0.05); the distance of the experimental group between the entry point and the midline was much longer than the control group regardless of the sides from L1 to L5 (P<0.05). In the experimental group, the right maximum inner inclination angle from L1 to L5, the right middle inner inclination angle from L1 to L5, and the right minimum inner inclination angle from L1, L2, L4, L5 were significantly larger than the left side (P<0.05). The maximum inner inclination angle and the middle inner inclination angle presented increased tendency, the tendency of minimum inner inclination angle was ambiguous, however, the all inner inclination angles were much larger than those in control group among the different lumbar levels(P<0.05). There was no significant difference of the safe range of the puncture inner inclination angle between 2 sides in 2 groups at L1 to L5 (P<0.05); the safe range angle in experimental group at L5 was significantly smaller than that in control group (P<0.05). The difference in total puncture success rate of all lumbar levels was significant between the experimental group and the control group (χ2=172.252, P=0.000); the puncture success rates of the experimental group were higher than those in the control group form L1 to L4 (P<0.05), but no significant difference was found in the puncture success rate between 2 groups at L5 (P>0.05). Conclusion Compared with the unilateral conventional transpedicle approach, the entry point of the unilateral transverse process-pedicle approach is localized outside, the puncture inclination angle is wider, and the puncture success rate is higher. It shows that the unilateral transverse process-pedicle approach is safer and more reliable than the unilateral conventional transpedicle approach.
ObjectiveTo help junior radiologists and surgeons better interpret MRI images of rectal cancer.MethodThe guidelines, expert consensus and research progress on the application of MR imaging in rectal cancer in recent years were reviewed.ResultsRectal MR had the ability to accurately evaluate a number of important findings that may impact patient’ management, including distance of the tumor to the mesorectal fascia, presence of extramural vascular invasion, and presence of lymph nodes.ConclusionsRectal MRI is an important basis for clinical staging and multidisciplinary diagnosis and treatment of rectal cancer. Surgeons and radiologists must master the key imaging anatomical basis and clinical practice points in order to accurately interpret the image information of MRI in rectal cancer.