Objective To investigate the anatomic and histological properties of carpal ligaments. Methods 34 cadaver specimens of adult wrists were prepared, of which 32 were fixed in formalin and 2 were fresh. We dissected the specimens and observed the origination, insertion, course, spatial relationship of carpal ligaments with the radiocarpal joint capsule and neighboring relationship with each other. The width and thickness of middle segment of each carpal ligament as well as the length were measured. 8 cadaver specimens of adult wrists were dissected and encircled by paraffin wax. Partial carpal ligaments were sectioned and stained with hematoxylin and eosin. Then they were put under a light microscope for observation. Results The radioscaphoid, radioscaphocapitate and radiolunate ligaments were found to have similar tissue structures. They were composed of wavy and tendinous collagen fiber fascicles, among which a small amount of loose tissue was found to be intermingled with vessels. The radioscapholunate ligament was mainly composed of loose connective tissue with no bulky tendinous collagen fiber fascicles, few fiber fascicles but rich vessel bundles. The palmar, dorsal and proximal regions of the scapholunate interosseous ligament and the lunotriquetrum interosseous ligament had different histological properties. The difference was especially obvious in the proximal regions compared with the dorsal and palmar regions. The dorsal regions of the 2 ligaments were mainly composed of bulky and bunchy transverse collagen fiber fascicles while the palmar region was composed of oblique ones. The proximal regions of the 2 ligaments were mainly composed of fibrocartilage with no vessels or nerves. At the joining part between the radioscapholunate ligament and the scapholunate interosseous ligament, the vessel bundles of the radioscapholunate ligament were noticed to penetrate the scapholunate interosseous ligament in the palmar region. Conclusions The major ligaments of the wrist are palmar. The palmar ligaments are stronger than dorsal ligaments. Many adjacent ligaments oriented in a V- shaped configuration, which can strengthen the wrist stability. Most of the carpal ligaments are mainly composed of dense and bulky collagen fiber fascicles, but the radioscapholunate ligament is mainly composed of loose connective tissue blending with rich vessels, which fulfill the function of supplying blood. The proximal regions of the scapholunate and lunotriquetrum interosseous ligaments are mainly composed of fibrocartilage structure with no vessels among them.

Objective To explore the biomechanical influences of cystic degeneration in different locations on femoral head and guide the appropriated surgical treatment to preserve the femoral head. Methods First scanning a upper femur specimen with spinal CT, dealing the two-dimensional image with Efilm software, identifying the outline of the femoral head by range estimation, inputting coordinate value of the femur into the computer to build up three-dimensional finite element model of the upper femur by Ansys-5.7 software, then simulating necrosis and cystic degeneration of 1 cm diameter by analogue computer, at last putting three kinds of pressure on the femoral head respectively to analyse the stress distribution and the stress/strength ratio and predict the collapse of the femoral head. Results The tension concentration was obvious when the necrosis and cystic degeneration was beneath the loading area or medial or lateral to the loading area in the femoral head, the stress/strength ratio of the cancellous bone beneath the articular surface was high which tends to cause collapse of the femoral head. When the necrosis and cystic degeneration located in the inferior parts of the femoral head, the strain concentration was not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was normal and the femoral head had little danger of collapse. When the focus located in the anterior or posterior part of the femoral head, its upper edge displayed tension concentration but not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was lower than normal and the danger of collapse was little. Conclusion When the necrosis and cystic degeneration is beneath the loading area or medial or lateral to the loading area in the femoral head, the focus should be cleared thoroughly and the vascularised bone flap should be implanted ideally with abutment against the subchondral plate to prevent the collapse of the femoral head. If the necrotic range is large involved the loading area and its medial or lateral sides, the vascularised bone flap should be implanted beneath the loading area.

Objective To investigate the course of the mandibular branch of the facial nerve and to discuss its clinical significant in the rhytidectomy. Methods The distribution of the mandibular branch was observed in 30 halves of the fifteen candaveric specimens (ten antiseptic cadaveric specimens and five fresh cadaveric specimens). Results The mandibular branch could be divided into the isolated branch type and shared branch type, after it exited from the parotid gland. 63.33 % mandibular branch was found (2.1?0.7) cm superior to the palpable edge of the mandibular bone; 23.33 % mandibular branch was along the edge of the bone; and 13.33 % was found (1.8?0.5)cm inferior to the palpable edge of the bone. Conclusion The distribution of the mandibular branch locates in the area that is a digit superior and inferior to the lower border of the mandibular bone, which arises from the angle of the mandibular bone. The dissection beneath the SMAS-platysma should be with caution of the injury of the ramification of mandibular branch in the anterior border of the masseter muscle.[

OBJECTIVE To study the anatomical dimension of the path to the petrous apex via the infralabyrinthine approach. METHODS Thirty dry temporal bones were dissected along the internal carotid canal. The distances from the vertical portion of the facial nerve to the genu of the internal carotid canal,the vertical portion of the facial nerve to the petrous apex,the genu of the internal carotid canal to the posterior surface of the petrous bone were measured. Ten heads of adult cadaver were dissected to gain access to the petrous apex via the infralabyrinthine approach. The horizontal and vertical dimensions of the approach window created were measured. RESULTS The vertical portion of the facial nerve to the lap of the internal carotid canal was (13.26?1.66)mm,portion of the facial nerve to the petrous apex was (34.48?1.07)mm,the lap of the internal carotid canal to the posterior surface of the petrous bone was (9.68?1.53)mm. The mean dimensions of the window in dissected bones were(5.76?3.38)mm vertically and (6.42?2.65)mm horizontally. Thirteen sides had been doing well with the infralabyrinthine approach. CONCLUSION The possibility of those anatomical variations should be considered when the infralabyrinthine approach is being planned to manage the petrous apex lesion. The infralabyrinthine approach is useful to the patients with good hearing.

Objective To explore the arterial origin and the artery distribution to the brachial plexus and its clinical significance. Methods 1)To observe the zonal pattern of arteries supplying brachial plexus in three fresh cadavers by means of modified lead-oxide and gelatin infusion and radiologic development. 2)To observe the arterial origin and distribution under microscope in 10 cadavers embalmed which were injected with red latex from the common carotid artery. Results The brachial plexus was supplied by branches of the subclavian-axillary axis (SAA), and these branches anastomose each other, according to their distribution feature, the supplied neural structures were divided into three zones. The first zone including the nerve roots from intervertebral foramina to the trunks and this region of the brachial plexus were supplied by the vertebral artery and the deep cervical artery. The second zone including the divisions and the main region of the cords of the brachial plexus were supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The dorsal scapular artery was usually thick and contributed to blood supply of a large region. There were 2.7 (1-5) direct branches of the subcalvian artery on the average which have relatively smaller diameter. The third zone including the distal portion of the cords and the terminal branches of the brachial plexus were supplied by direct branches of the axillary artery. The mean number of these branches was 3.4 (1-6). Conclusion The brachial plexus has plenty of vascular supply which can be divided into three zones. Every vasa nervorum tends to divide into a distal branch and a proximal branch shortly after they enter the brachial plexus. The branches from vasa nervorum communicates without changing their diameter which is called "real connection", and the blood supplied from the three zones can compensate each other, which provide a rich longitudinal blood supply to the brachial plexus. This study provides an anatomical basis for vascularized brachial plexus replacement.

Objective To study the surgical approach of the jugular foramen and the clinical anatomy of the transmastoid endoscoPy-assisted jugular foramen surgery.Method The transmastoid endoscopy-assisted jugular foramen surgery was simulated in 15 adult cadaveric specimens(3O side). The main anatomic mark in the surgical approach was studied,and the distance between the important stmcture to the glomus jugular has been measured. Results The distance between the glomus jugular and the Vertlcal segmental of the facial nerve,the anterior wall of the glomus jugular to the facial nerve,the glomus jugular to the posterior semicircular canal and tympanic cavity were(3.58±1.32)mm,(5.07±2.93)mm,(4.68±3.47)mm and(0.14±4.32)mm.In 30 cases,the top of the glomus jugular inferior the tympanic cavty in 5cases, 7 cases behind the facial nerve and the tympanic, 16 cases the facial Berve is m the middle of the glomus iugular. 2 cases is near the inferior wall of internal auditory meatus.the cranial nerve and blood vessel in the jugular foramen is clearly to be show. Conclusion It is a samPle and little damaged way to use the transmastoid endoscopy-assisted jugular foramen surgery and it is hopeful to Protect function of the facial Berve,acoustic nerve and the post-cranial nerve.

BACKGROUND: Although hand urgical doctors have drawn the attentions to carpal diseases mainly manifesting as carpalinstability, it is still expected to carry on the researches on biomechanical properties of Chinese carpal ligaments. OBJECTIVE: To understand the biomechanical properties of partial carpal ligaments so as to provide experimental evidence for the development ofclinical hand surgery. DESIGN: A simple specimen study.SETTING:Department of Orthopaedics,Kunming General Hospital of Chengdu Military Area Command of Chinese PLA,and Institute of Clinical Anatomy, First Military Medical University of Chinese PLA.PARTICIPANTS: Sixteen fresh specimens from Chinese adult wrists were obtained from the Departmentof Anatomy, First MilitaryMedical University of Chinese PLA and the experiment was performed in the Laboratory of Biomechanics. INTERVENTIONS:The partial carpalligaments were stretched till fragmentation of ligaments by using the SWD-10materialtesting machine, at the rated velocity of 5 mm per minute so as to determine the biomechanical properties of carpal ligaments. MAIN OUTCOME MEASURES:The tolerated maximum tension and rigidity during fragmentation of radioscaphoid ligament,radioscaphocapitate (RSC) ligament, radiolunate ligament, ulnolunate (UL) ligament, ulnotriquetral(UT) ligament,ulnar bursa,scapholunate interosseous(SLI) ligament,and lunotriquetral interosseous(LTI) ligament. RESULTS: Among the ligaments attached between distal radioulnar bone and carpal bone, the maximum tension and rigidity of UL ligament were the strongest, (219.2 ±55.4) N and (65.5 ± 19.6) N/mm2, of UT ligament and ulnar bursa were the weakest, (54.0 ±25.5) N, (17.8 ± 6.0) N/mm2and (58.7 ± 17.6) N, (13.4 ±4.7) N/mm2 respectively, of SLI ligament was stronger, (286. 1 ±90.8) N, (95.5 ±40.0) N/mm2, and of LTI ligament were more stronger, (375.3 ± 52.6)N, (179.0 ± 39.0 N/mm2.CONCLUSION: Among carpal ligaments, the maximum tension and rigidity of proximal row of intercarpal ligaments were stronger than those of the ligaments attached between distal radioulnar bone and carpal bone. Of proximal row of intercarpal ligaments,the maximum tension and rigidity of LTI ligament were stronger than those of SLI ligament. Of the ligaments attached between distal radioulnar bone and carpal bone,the maximum tension and rigidity of UL ligament were the strongest.

Objective To discuss the TARP (transoral pharyngeal atlanto axioal reduction plate,TARP) stress distribution under the condition of atlantoaxial dislocation treatment with the TARP system and explore the possible suggestion for the further innovation of the TARP system.Methods A fixed Finite Element model was constructed for transoral atlantoaxial reduction plate system based on the CT digital data of the China Digital Human NO.1.The internal structure changes and the stress distribution of TARP system under different loads were imitated and analyzed.Results The results showed that,after the fixation of the TARP system,different parts of the atlantoaxial had different stress under anteflexion,extension,lateral bending and rotation,the internal fixation parts located mainly at the mid-part of the TARP(0.159 × 108 ～0.732 × 108 Pa) and the root of the screw(0.214 × 109 ～0.958 × 109 Pa).Beside that,when using anteflexion,the stress mainly focused on the articular surface of the atlantoaxial(0.512 × 107 Pa).As for extension,the stress mainly focused on the part between the lateral mass and anterior arch (0.582 × 107 Pa).While lateral bending or rotation,the stress mainly focused on the axial screw nailing path (0.287 × 109 Pa and 0.241 × 109 Pa).Conclusions Although different parts of the TARP plate have different stress,its maximum stress lied in the root of the screw.The stress of plate mainly focused on the mid - part,no matter in what state of motion,therefore,the root of the screw and the mid-part of the plate bore the biggest stress,their strength decided the fatigue property of the TARP system.

In addition to the three existing types of skin flaps, supplied by the cutaneous, the myocutaneous and the arterio-reticular vessels, a new type of free skin flap pedicled by the vessels of intermuscular septum was designed. The intermuscular septal arteries are easy to dissect and have relatively longer pedicles. The skin flaps taken from the limbs supplied by these arteries are suitable for grafting in their natural location.The intermuscular septal arteries of the arms and the thighs were studied and measured on 70 adult cadavers and 9 corrosion preparations. The arteries studied were: the superior ulnar collateral arteries, the intermuscular branches of the perforating arteries and the saphenous branches of the highest genicular arteries. The skin flaps supplied by these arteries were studied with regard to their application in surgery and these vessels were believed to be convenient for the microvascular anastomosis during grafting.The practical value of the skin flaps taken from the medial and lateral sides of the arm, the lateral side of the thigh and the medial side of the leg were discussed.

OBJECTIVETo explore the method of the treatment for hallux valgus with the proximal crescentic osteotomy of the first metatarsal bone, combining with distal lateral soft tissue release.

METHODSFrom January 2008 to December 2012, 21 cases 21 hallux valgus feet were treated by operative procedure, included 1 male (1 foot) and 20 females (20 feet), with the mean age of 52 years (range, 36-68 years). Among all patients were followed up for 12 to 26 months, with the mean 16 months. The preoperative, post-operative and final follow-up X-ray films of all patients were collected. The hallux valgus angle, intermetatarsal angle and distal metatarsal articular angle were measured and analyzed. The surgical outcome was evaluated combined with the AOFAS score.

RESULTSThe average hallux valgus angle decreased from 42.3° ± 1.8° preoperatively to 14.5° ± 1.8 postoperatively, the average intermetatarsal angle did from 21.9° ± 1.7 to 9.1° ± 1.8°, and the average distal metatarsal articular angle did from 14.9° ± 1.8 to 7.2° ± 1.5, respectively. There were significant differences between the preoperative and postoperative roentgenographic index. AOFAS score was improved from 44.0 ± 1.8 preoperatively to 83.9 ± 2.2 at the final follow-up.

CONCLUSIONSThe proximal crescentic osteotomy of the first metatarsal bone combined distal soft tissue reconstruction obtained satisfactory results in severe hallux valgus patients with big intermetatarsal angle.

Adult ; Aged ; Dermatologic Surgical Procedures ; methods ; Female ; Hallux Valgus ; surgery ; Humans ; Male ; Metatarsal Bones ; surgery ; Middle Aged ; Osteotomy ; methods