Objective To study the hook of hamate bone by anatomy and iconography methods in order to provide information for the cl inical treatment of injuries to the hook of hamate bone and the deep branch of ulnar nerve. Methods Fifty-two upper l imb specimens of adult corpses contributed voluntarily were collected, including 40 antisepticized old specimens and 12 fresh ones. The hook of hamate bone and its adjacent structure were observed. Twentyfour upper l imbs selected randomly from specimens of corpses and 24 upper l imbs from 12 healthy adults were investigated by computed tomography (CT) three-dimensional reconstruction, and then related data were measured. The measurement results of24 specimens were analyzed statistically. Results The hook of hamate bone is an important component of ulnar carpal canal and carpal canal, and the deep branch of ulnar nerve is located closely in the inner front of the hook of hamate bone. The flexor tendons of the forth and the l ittle fingers are in the innermost side, closely l ie next to the outside of the hook of hamate bone. The hamate bone located between the capitate bone and the three-cornered bone with wedge-shaped. The medial-, lateral-, and front-sides are all facies articularis. The hook of hamate bone has an approximate shape of a flat plate. The position migrated from the body of the hamate bone, the middle of the hook and the enlargement of the top of the hook were given the names of “the basis of the hook”, “the waist of the hook”, and “the coronal of the hook”, respectively. The short path of the basement are all longer than the short path of the waist. The long path of the top of the hook is the maximum length diameter of the hook of hamate bone, and is longer than the long path of the basement and the long path of the waist. The iconography shape and trait of the hook of hamate bone is similar to the anatomy result. There were no statistically significant differences (P gt; 0.05) between two methods in the seven parameters as follows: the long path of the basement of the hook, the short path of the basement of the hook, the long path of the waist of thehook, the short path of the waist of the hook, the long path of the top of the hook, the height of the hook, of hamate bone, and the distance between the top and the waist of the hook. Conclusion The hook of hamate bone can be divided into three parts: the coronal part, the waist part, and the basal part; fracture of the hamate bone can be divided into fracture of the body, fracture of the hook, and fracture of the body and the hook. Facture of the hook of hamate bone or fracture unnion can easily result in injure of the deep branch of ulnar nerve and the flexor tendons of the forth and the l ittle fingers. The measurement results of CT threedimensional reconstruction can be used as reference value directly in cl inical treatments.
Objective To provide the anatomical basis for the appl ication of the superficial inferior epigastric artery flap. Methods Ten cadavers which were immersed in formal in less than 6 months and were perfused by red latex were used in this study. There were 8 males and 2 females with an average age of 58 years (range, 35-78 years). The origin, course, branch,distribution, diameter, pedicle length, and neighbour of superficial inferior epigastric artery and vein were observed in the 2 sides of inguinal region. Results In these series of 10 cadaver (20 sides) dissections, the superficial inferior epigastric artery was identified in 18 sides, which average cal iber was 1.48 mm with a mean vascular pedicle length of 4.80 cm. In 11 sides, the superficial inferior epigastric artery arose aspart of a common trunk with one or more other vessels; in other 7, it originated from the femoral. There were 4 branch modes of superficial inperior epigastric artery: single trunks (5 sides), double ramification (3 sides), single lateral ramification (7 sides), and single medial ramification (3 sides). The superficial inferior epigastric vein was observed in 20 sides, which average cal iber was 2.33 mm with a mean sides pedicle length of 5.45 cm. In 8 sides, the venous drainage was as an individual vein; in 12 sides, both patterns were observed (a pair of venae comitantes and an individual vein). Conclusion The inferior epigastric artery flap can be appl ied to microsurgical flap transfer, potentially in breast reconstruction, phalloplasty, reconstruction of head, neck and four l imbs defects.
Objective To obtain the anatomical data of the insertions of the lateral collateral l igament (LCL), popl iteus tendon (PT), and popl iteofibular l igament (PFL) for the posterolateral corner of the knee (PLC) reconstruction. Methods Thirty human cadaveric knees were chosen to observe the structure of PLC, including 14 males and 16 females with an averageage of 55 years (range, 45-71 years ). The insertions of LCL, PT, and PFL were identified, then the distances from the centers of the insertions to specific bony landmarks were measured, which were lateral epicondyle, the most proximal point on the styloid process and the most anterior point on the anterior surface of the fibular head. Normal ization processing of the actual numerical values from each knee was performed. Results The center of the LCL insertion was at the site of (1.27 ± 3.10) mm proximal and (2.99 ± 1.29) mm posterior to the lateral epicondyle of the femur respectively, and the center of the PT insertion was at the site of (8.85 ± 3.38) mm distal and (3.83 ± 1.95) mm posterior to the lateral epicondyle of the femur respectively. The center of the LCL insertion was at the site of (10.56 ± 2.17) mm distal and (7.51 ± 1.81) mm anterior to the nearest point of the fibular styloid respectively, and the center of the PFL insertion was at the sites of (1.31 ± 0.55) mm distal and (0.49 ± 1.36) mm anterior to the nearest point of the fibular styloid respectively. The cross-sectional area of the insertions of femur was (44.96 ± 13.29) mm2 for the LCL and (52.52 ± 11.93) mm2 for the PT, respectively; the cross-sectional area of the insertions of fibula was (35.93 ± 11.21) mm2 for the LCL and (14.71 ± 6.91) mm2 for the PFL, respectively. Conclusion The LCL, PT, and PFL have a consistent pattern of insertion.
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.
To provide anatomical evidences for the blood supply compound flap based on fibular head to rebuild internal malleolus. Methods The morphology of vessels and bones in donor site and in recipient site was observed. The materials for the study were l isted as follows: ① Forty desiccative adult tibias (20 left and 20 right respectively) were used to measure the basilar width, middle thickness, anterior length, posterior length and introversion angle of internal malleolus; ② Forty desiccative adult fibulas (20 left and 20 right respectively) were used to measure the middle width and thickness, as well as the extraversion angle of articular surface of fibular head; ③ Thirty adult lower l imb specimens which perfused with red rubber were used to observe the blood supply relationships between the anterior tibial recurrent vessels and fibular head, and internal anterior malleolar vessels inside recipient site. Results The internal malleolus had a basilar width of (2.6 ± 0.2) cm, a middle thickness of (1.3 ± 0.2) cm, an anterior length of (1.4 ± 1.9) cm and a posterior length of (0.6 ± 0.1) cm. Its articular facet was half-moon. Its introversion angle was (11.89 ± 3.60)°. The fibular head had a middle thickness of (1.8 ± 0.6) cm, a middle width of (2.7 ± 0.4) cm. Its articular facet was toroid, superficial and cavate in shape, and exposed inwardsly and upwardsly, and had a extraversion angel of (39.2 ± 1.3)°. The anterior tibial recurrent artery directly began from anterior tibial artery, accounting for 93.3%. Its initiation point was (4.5 ± 0.7) cm inferior to apex of fibular head. Its main trunk ran through the deep surface of anterior tibial muscle, and ran forwards, outwards and upwards with sticking to the lateral surface of proximal tibia. Its main trunk had a length of (0.5 ±0.2) cm and a outer diameter of (2.0 ± 0.4) mm. Its accompanying veins, which had outer diameters of (2.1 ± 0.5) mm and (2.6 ± 0.4) mm, entry into anterior tibial vein. It constantly gave 1-2 fibular head branches which had a outer diameter of (1.7 ± 1.3) mm at (1.0 ± 0.4) cm from the initiation point. The internal anterior malleolar artery which began from anterior tibial artery or dorsal pedal artery had a outer diameter of (1.6 ± 0.4) mm. Its accompanying veins had outer diameters of (1.3 ± 0.5) mm and (1.1 ± 0.4) mm. Conclusion The blood supply compound flap based on fibular head had a possibil ity to rebuild internal malleolus. Its articular facet was characterized as the important anatomical basis to rebuild internal malleolus.
To investigate the anatomic feature of the posterior hip joint capsule and its distributional difference of collagen fibers and to probe the optimization of the capsulotomy which can reserve the best strength part. Methods Ten adult cadaver pelvises (6 males and 4 females, aged 28-64 years) fixed with formal in were used. Ten right hips were used for anatomical experiment of hip joint capsule. The posterior hip joint capsules were divided into 3 sectors(I-III sectors ) and 9 parts (IA-C, IID-F, IIIG-I). The average thickness of each part was measured and the ischiofemorale l igaments were observed. Five capsules selected from ten left hips were used for histological experiment. The content of collagen fibers in sector I and sector II was analyzed by Masson’s staining. Two fresh frozen specimens which were voluntary contributions were contrasted with the fixed specimens. The optimal incision l ine of the posterior capsule was designed and used. Results The thickness in the posterior hip joint capsule [IA (2.30 ± 0.40), IB (4.68 ± 0.81), IC (2.83 ± 0.69), IID (2.80 ± 0.79), IIE (4.22 ± 1.33), IIF (2.50 ± 0.54), IIIG (1.57 ± 0.40), IIIH (2.60 ± 0.63), IIII (1.31 ± 0.28) mm] had no uniformity (P lt; 0.01). The IIIG part and the IIII part were thinner than the IB part and the IIE part (P lt; 0.01). Two weaker parts located at obturator externus sector (sector III), the ischiofemorale l igament trunk went through two thicker parts (IB and IIE). The distribution of the collagen fibers in sector I and sector II(IA 20.34% ± 5.14%, IB 48.79% ± 12.67%, IC 19.87% ± 5.21%, IID 17.57% ± 3.56%, IIE 46.76% ± 11.47%, IIF 28.65% ± 15.79%) had no uniformity (P lt; 0.01). The content of collagen fibers in IB part and IIE part were more than that of other parts (P lt; 0.01). There were no statistically significant difference in the distribution feature of the thickness and the ischiofemorale l igaments between the fresh frozen specimens and the fixed specimens. The optimal incision l ine C-A-B-D-E of the posterior capsule was designed and put into cl inical appl ication. The remaining capsular flap comprise the most of the ischiofemorale l igament trunk and the part of gluteus minimus. Conclusion Although enhanced posterior soft tissue repairin total hip arthroplasty was investigated deeply and obtained great development, but the postoperative dislocation rate was not el iminated. It is significant for optimizing the capsulotomy to reserve the best strength part of the posterior capsule and to bring into full play the function of the ischiofemorale l igaments.