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 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 investigate the microanatomic basis of thepudendalthigh flap and provide the anatomic basis for clinical application. Methods Skin microdissection of the pudendal regions was performed on 11 adult cadavers (22 sides). Then, the clinical way was simulated to obtain the flaps, and the vessels and nerves contained in them were surveyed. After that, the tissues in the deep part were dissected, and the vessels and nerves were traced back to their origins. The notes were taken. Results The blood supply to the pudenal regions was plentiful and constant. The initiation point of the superficial external pudendal artery was 2.14+ 0.23 mm in diameter; one branch of it was the inguinal branch and the other branch was the perineal branch. Their diameters were 1.38+0.34mm and 1.21+0.24 mm. The initiation point of the posterior labial or scrotum arteries was 1.13+0.24 mm in diameter, and the lateral branch was 0.67+0.33 mm in diameter. The anterior cutaneous branch of the obturator artery was 1.68+ 0.11 mm in diameter. The position of all the blood vessels was relatively constant, especially the external pudendal artery and the lateral branch of the posterior scrotal artery. Many of the blood vessels passed through the areas of the pudendum and the thigh, anastomosed with each other. Three groups of the vascular net passed through the upper, middle and lower parts of the flap. Three main groups of the innervation were as the following: the ramus femoralis nervi genitofemoralis, the cutaneous branches of the ilioinguinal nerve, and the postnerve of the scrotum or the labia vulvae. Conclusion The pudendalthigh flaphas an abundant blood supply, and its dissection is convenient with an easy incision; the donor site is covert. The pudendalthigh skin flap has the following advantages for the sexual organ reconstruction: the skin flap can have a good sensation and a good shape, and the operative procedure is easy to perform.
Objective To study the microsurgical anatomy of the facial nerve (FN ) trunk and provide some important morphometric data about facialhypoglossal nerve anastomosis (FHA). Methods Bilateral microsurgical dissection was performed on the heads of 9 cadarers fixed with formalinwith three different methods. In the first method, the posterior belly of the digastric muscle was used as a mark, and the FN trunk was identified on the medial side ofthis muscle. In the second method, dissection was initiated at the parotid gland, the FN trunk was identified at its entrance into the parotid gland. In the third method, the styloid process was identified and traced back to the stylomastoid foramen (SMF). The FN trunk was identified on its emergence from the SMF. In every dissection, the whole FN trunk was exposed; its diameter and depth at the the SMF and its length were measured; its relationship, with other structures was studied. Results The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.57±0.60mm. The mean minimal distance of the FN trunk from the skin surface in this area was 22.62±2.88 mm. The length of the FN trunk was 15.71±1.97 mm. The distance between the bifurcation and the mastoidale was 18.20±4.41 mm. The distance between the bifurcation and the mandibular angle was 39.91±8.38 mm. The distance between the mastoidale and the SMF was 17.91±2.68 mm. The branches fromthe FN trunk proximal to its bifurcation were the posterior auricular nerve, the digastric muscle nerve and the stylohyoid muscle nerve.Conclusion The third method to expose the FN trunk on its emergence from the SMFis safe and reliable. It is feasible to use only part of the hypoglossal nerve fibers for anastomosis with the FN trunk.
OBJECTIVE To introduce a skin flap containing the middle cutaneous branch of the medial plantar artery. METHODS Microanatomic study was performed on 8 fresh cadaveric feet, the arteries were dissected and infused with methylene blue to observe their vascular distribution and the skin area supplied by the middle cutaneous branch. Furthermore, the clinical application was reported. A local pedicled flap containing the middle cutaneous branch was used to repair the soft tissue defects of the foot in 7 patients, and free cutaneous graft was used to repair the skin defects of the fingers in 6 patients. RESULTS The results showed that the medical plantar artery gave off 3 cutaneous branches to supply the medial aspect of the foot, among which the middle branch was the largest one and anastomosed with the other two branches. The skin flaps used clinically were all survived completely. CONCLUSION Medial plantar cutaneous graft had a reliable blood supply, and it’s one of the best choice in repairing small to middle sized skin defects of the foot and the fingers.
ObjectiveTo summarize the present status and progress of vascular anatomy and preoperative design technology of the anterolateral thigh flap. MethodsThe relative researches focused on vascular anatomy and preoperative design technology of the anterolateral thigh flap were extensively reviewed, analyzed, and summarized. ResultsVascular anatomy of the anterolateral thigh flap has been reported by numerous researchers, but perforators' location, origin, course, and the variation of the quantity have been emphasized. Meanwhile, the variation of descending branch, oblique branch, and lateral circumflex femoral artery has also been widely reported. Preoperative design technology of the anterolateral thigh flap includes hand-held Doppler, Color Doppler, CT angiography (CTA), magnetic resonance angiography, digital subtraction angiography, and digital technology, among which the hand-held Doppler is most widely used, and CTA is the most ideal, but each method has its own advantages and disadvantages. ConclusionThere is multiple variation of vascular anatomy of the anterolateral thigh flap. Though all kinds of preoperative design technologies can offer strong support to operation of anterolateral thigh flap, a simple, quick, precise, and noninvasive technology is the direction of further research.
PURPOSE:To evaluated the luminal characteristics of the elderly central retinal vessels in the anterior optic nerves. METHODS:Serial sections of 15 central retinal arteries(CRA)and 23 central retinal veins (CRA)of 18 eyes of the aged 60 to 82 years old without anatomic malformation were examined by image analysis to investigate their luminal dimensional differences at the sites of lamina cribrosa and just anterior and posterior to it. RESULTS:The average values of the mean area of the CRA in the prelaminar,laminar,retrolaminar portions were separately(12.70,17.40,18.00)times;10-3mm2 and the mean perimetric length 0.56,0.56,0.57mm.No significant difference was detected in these three sites.The average values of the mean area of the CRV were respectively(7.00,5.40,7.90)）times;10-3mm2 and the mean perimetric length 0.44,0.38,0.41mm.There were marked differences between the prelaminar value and the laminar one,and between the laminar value and retrolaminar one by comparison. CONCLUSION:The CRA has a uniform radius from prelaminar to retrolaminar positions,and tube radius of the CRV at the level of the lamina cribrosa is the least. （Chin J Ocul Fundus Dis,1997,13: 213-214 ）
ObjectiveTo investigate the morphological characteristics of the glenohumeral joint (including the glenoid and coracoid) in the Chinese population and determine the feasibility of designing coracoid osteotomy based on the preoperative glenoid defect arc length by constructing glenoid defect models and simulating suture button fixation Latarjet procedure. MethodsTwelve shoulder joint specimens from 6 adult cadavers donated voluntarily were harvested. First, whether the coracoacromial ligament and conjoint tendon connected was anatomically observed and their intersection point was identified. The vertical distance from the intersection point to the coracoid, the maximum allowable osteotomy length starting from the intersection point, and the maximum osteotomy angle were measured. Next, the anteroinferior glenoid defect models of different degrees were randomly constructed. The arc length and area of the glenoid defect were measured. Based on the arc length of the glenoid defect of the model, the size of coracoid oblique osteotomy was designed and the actual length and angle of the coracoid osteotomy were measured. A limited osteotomy suture button fixation Latarjet procedure with the coracoacromial ligament and pectoralis minor preservation was performed and the position of coracoid block was observed. ResultsAll shoulder joint specimens exhibited crossing fibers between the coracoacromial ligament and the conjoint tendon. The vertical distance from the tip of the coracoid to the coracoid return point was 24.8-32.2 mm (mean, 28.5 mm). The maximum allowable osteotomy length starting from the intersection point was 26.7-36.9 mm (mean, 32.0 mm). The maximum osteotomy angle was 58.8°-71.9° (mean, 63.5°). Based on the anteroinferior glenoid defect model, the arc length of the glenoid defect was 22.6-29.4 mm (mean, 26.0 mm); the ratio of glenoid defect was 20.8%-26.2% (mean, 23.7%). Based on the coracoid block, the length of the coracoid osteotomy was 23.5-31.4 mm (mean, 26.4 mm); the osteotomy angle was 51.3°-69.2° (mean, 57.1°). There was no significant difference between the arc length of the glenoid defect and the length of the coracoid osteotomy (P>0.05). After simulating the suture button fixation Latarjet procedure, the highest points of the coracoid block (suture loop fixation position) in all models located below the optimal center point, with the bone block concentrated in the anteroinferior glenoid defect position. ConclusionThe size of the coracoid is generally sufficient to meet the needs of repairing larger glenoid defects. The oblique osteotomy with preserving the coracoacromial ligament may potentially replace the traditional Latarjet osteotomy method.
Rotator cuff injuries are often associated with long head of biceps tendon (LHBT) lesions, which are more common in middle-aged and older adults. With the continuous updating of diagnosis and treatment techniques and treatment concepts in recent years, many patients can receive effective diagnosis and treatment. This article starts from the anatomy, etiology, diagnosis and treatment progress of rotator cuff and LHBT, and details the related research progress of rotator cuff injury combined with LHBT at home and abroad. This paper focuses on the significance of paying attention to LHBT lesions while dealing with rotator cuff injuries, aiming to improve clinicians’ understanding of rotator cuff injuries combined with LHBT lesions, explore accurate and effective diagnosis and treatment systems, so as to choose the best treatment method.
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.