Measurement of Clavicular Symmetry in Healthy Subjects Using Tomographic Database of Public Hospitals.

Objective This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women.

Measurement of Clavicular Symmetry in Healthy Subjects Using Tomographic Database of Public Hospitals / Mensuração de simetria clavicular em indivíduos saudáveis utilizando-se de banco de dados tomográficos de hospitais públicos

Abstract Objective This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women.

Resumo Objetivo Realizar avaliação imagiológica com intuito de comprovar a existência ou não de simetria entre as clavículas de indivíduos saudáveis da cidade de Curitiba/PR, aliada à identificação de possíveis fatores de influência no comprimento clavicular. Método Foram analisadas tomografias computadorizadas de tórax de 211 pacientes sem fratura ou malformações na clavícula (100 mulheres e 111 homens). A maior diagonal clavicular foi medida em ambos os lados e o software gerou automaticamente a máxima distância em milímetros. Foram utilizadas frequências relativas e absolutas para descrever variáveis qualitativas e a média e intervalo de 95% de confiança para as quantitativas. As comparações foram feitas com o teste t de Student e correlações calculadas pelo coeficiente de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados Verificou-se diferença significativa entre o comprimento das clavículas (direita 143.58mm e esquerda 145.72mm, p = 0.037), indicando assimetria. Em média, o lado esquerdo é 3.71mm maior. A assimetria foi significativa tanto para homens quanto para mulheres (p < 0.001). A diferença média foi de 4.13mm para homens e 3.23mm para mulheres. 73% da amostra apresentou <5mm de diferença, enquanto 23.7% apresentou 5-10mm e 3.3% apresentou >10mm de assimetria. Conclusão Não foi possível encontrar simetria nas clavículas da população de Curitiba/PR. Em média, a clavícula esquerda é maior que a direita, com diferenças de 3.71mm na amostra geral, 3.23mm para mulheres e 4.13mm para homens. O único fator significativo foi o sexo, com homens tendo maiores comprimentos claviculares e maiores diferenças em comparação às mulheres.

Research progress in the diagnosis and treatment of the glenoid fractures / 中华创伤骨科杂志

The anatomy of the shoulder joint is complex. Glenoid fractures, intra-articular fractures of the shoulder, are relatively rare and often accompanied by serious injury. At present, there has been no consensus on the optimal strategies for their treatment. Insufficient knowledge and improper treatment of the surgeons may seriously affect the shoulder function of the patients to harm their quality of life. Therefore, proper handling of such fractures is a major challenge in clinic. In recent years when high-energy injuries are increasing and functional recovery after shoulder fracture is emphasized by more and more patients, great efforts have been put into the research into such fractures by orthopedic surgeons. This reviews expounds on the anatomy, diagnosis, classification and treatment of glenoid fractures, aiming to provide useful reference for the orthopaedic surgeons who deal with glenoid fractures.

Clinical analysis of 11 cases of iliopsoas muscle hematoma compressing lumbar plexus nerve / 中国基层医药

Objective:To investigate the etiology, clinical manifestations, treatment methods, and prognosis of patients with iliopsoas muscle hematoma compressing the lumbar plexus.Methods:The clinical data of 11 cases of iliopsoas muscle hematoma oppressing the lumbar plexus nerve admitted to The Affiliated Hospital of Southwest Medical University between March 2014 and May 2018 were analyzed.Results:Eleven patients, consisting of 10 men and 1 woman, aged (36.36 ± 6.74) years were analyzed. Causes of iliopsoas muscle hematoma oppressing the lumbar plexus nerve included coagulation abnormality ( n = 8) and trauma ( n = 3). Iliopsoas muscle hematoma occurred on the left side in 7 cases and on the right side in 4 cases. Among them, 11 cases had bleeding in the middle area, 8 cases in the lower area, and 2 cases in the upper area. The involved lumbar plexus nerve included the femoral nerve ( n = 11), lateral femoral cutaneous nerve ( n = 6), and obturator nerve ( n = 2). Eleven cases underwent causative treatment ( n = 11). Three-month follow-up results showed that the hematomas were completely absorbed in 11 cases, and the bone and joint activities were normal. The sensory and motor functions were restored in 10 cases. The sensory function was restored, but the recovery of motor function was poor in 1 patient. All 11 cases returned to normal after 1 year. Conclusion:The main causes of iliopsoas muscle hematoma are coagulation dysfunction and trauma. The femoral nerve and lateral femoral cutaneous nerve in the lumbar plexus are easily affected, which can cause lower limb sensory and motor disorders. As for iliopsoas muscle hematoma caused by coagulation abnormality, coagulation factors should be supplemented to correct coagulation function. As for iliopsoas muscle hematoma caused by trauma, early surgical treatment should be performed to relieve nerve compression. Timely treatment of iliopsoas muscle hematoma can generally acquire a good prognosis.

ANATOMICAL STUDY OF VOLAR FACE OF DISTAL RADIUS AND COMPARISON WITH THE SHAPE OF LOCKING VOLAR PLATES.

Objective: To evaluate the volar cortical angle (VCA), the variation in lateral and intermediate columns, the shape and pattern of the watershed line (WL) of the distal radius and its correlation with locking volar plates available. Methods: 27 human cadaveric radial bones of the Department of Morphology and nine locking volar plates of six different companies were analyzed. VCA were measured from lateral and intermediate columns and their corresponding values on plates, as well as comparing the relief of radius and plates. In the WL analysis, we compared the standard format found on the radius and its equivalent on plates and divided into four types: biconvex, convex, ulnar convex and plan. Results: VCA varied between columns of the distal radius extremity. The mean in the lateral column was 153.40 degrees and 146.06 degrees in the intermediate. Four of nine plates showed no variation in volar angulation. From 27 distal radius, 13 showed convex pattern and 12 had biconvex, whereas most plates (seven of the nine analyzed) were biconvex drawing. Conclusion: Radial bone anatomy was variable. The intermediate column was, on average, steeper than lateral column. Synthes®-2 plate presented the closest design to the anatomy of the distal end of the radial bone, followed by Newclip®-2 plate. Level of Evidence II, Anatomic and Descriptive Study.

Objetivos: Avaliar o ângulo palmar cortical (APC) da extremidade distal do rádio, sua variação nas colunas lateral e intermédia, o formato e o padrão da watershed line (WL) e sua correlação com as placas volares bloqueadas disponíveis no mercado. Métodos: Foram analisados 27 ossos rádios do Departamento de Morfologia e nove placas de seis fabricantes diferentes. Medimos os APCs das colunas lateral e intermédia dos rádios e seus correspondentes nas placas, além de compararmos o relevo do terço distal do rádio e das placas. Quanto a WL, comparamos o formato nas peças e seu equivalente nas placas, sendo classificados em quatro tipos: biconvexo, convexo, convexo ulnar e plano. Resultados: O APC variou entre as colunas do rádio, sendo a média da coluna lateral 153,40° e, da intermédia 146,06°. Quatro das nove placas não apresentaram variação na angulação volar. Dos 27 rádios, 13 apresentaram padrão convexo e 12 biconvexo, enquanto a maioria das placas (sete das nove analisadas) tinham desenho biconvexo. Conclusão: A anatomia dos rádios foi variável entre as peças, sendo a coluna intermédia mais inclinada que a coluna lateral. A placa Synthes ® -2 foi a que apresentou relevo mais próximo dos achados anatômicos da extremidade distal do rádio, seguida pela Newclip ® -2. Nível de Evidência II, Estudo Anatômico Descritivo.

Panoramic radiography and cone-beam computed tomography to measure distances between root apexes and anatomical structures / Radiografía panorámica y tomografía computarizada de haz cónico para medir distancias entre ápices radiculares y estructuras anatómicas

Aim: To compare the accuracy of the panoramic radiography with cone-beam computed tomography (CBCT) scans in measuring the distances between root apexes and the adjacent anatomical structures including the maxillary sinus and the mandibular canal. Material and Methods: A total of 200 CBCT scans (100 maxillary and 100 mandibular) from patients who also had corresponding panoramic radiography were selected. Linear measurements (in mm) presenting centralized image were made between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus, and between the apexes of the mandibular teeth and the superior border of the mandibular canal by using specific software for panoramic radiography and the measurements on the coronal sections in CBCT scans. Data were submitted to inferential statistical analysis and Student's t-test for comparison between measurements. Results: CBCT scans were significantly more accurate than panoramic radiography to measure the distances between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus (p<0.05) and between the apexes of the mandibular teeth and the superior border of the mandibular canal or mental foramen (p<0.05). Conclusion: CBCT scans present more accurate measurements than panoramic radiography.

Objetivo: Comparar la precisión de la radiografía panorámica con las exploraciones de la tomografía computarizada dental de haz en cónico (CBCT) para medir las distancias entre los vértices radiculares y las estructuras anatómicas adyacentes, incluidos el seno maxilar y el canal mandibular. Material y Métodos: Se seleccionaron un total de 200 tomografías CBCT (100 maxilares y 100 mandibulares) de pacientes que además tenían la correspondiente radiografía panorámica. Se realizaron mediciones lineales (en mm) que presentaban imagen centralizada entre los ápices de los dientes maxilares y la pared inferior del seno maxilar, y entre los ápices de los dientes mandibulares y el borde superior del canal mandibular mediante software específico para radiografía panorámica. y las mediciones en las secciones coronales en escaneos CBCT. Los datos se sometieron a análisis estadístico inferencial y prueba t de Student para comparación entre mediciones. Resultados: Las exploraciones CBCT fueron significativamente más precisas que la radiografía panorámica para medir las distancias entre los ápices de los dientes maxilares y la pared inferior del seno maxilar (p<0,05) y entre los ápices de los dientes mandibulares y el borde superior de los dientes mandibulares. canal o agujero mentoniano (p<0.05). Conclusión: Las exploraciones CBCT presentan mediciones más precisas que la radiografía panorámica.

Anatomical study of volar face of distal radius and comparison with the shape of locking volar plates / Estudo anatômico da face volar da extremidade distal do rádio e comparação com o formato das placas volares bloqueadas

ABSTRACT Objective: To evaluate the volar cortical angle (VCA), the variation in lateral and intermediate columns, the shape and pattern of the watershed line (WL) of the distal radius and its correlation with locking volar plates available. Methods: 27 human cadaveric radial bones of the Department of Morphology and nine locking volar plates of six different companies were analyzed. VCA were measured from lateral and intermediate columns and their corresponding values on plates, as well as comparing the relief of radius and plates. In the WL analysis, we compared the standard format found on the radius and its equivalent on plates and divided into four types: biconvex, convex, ulnar convex and plan. Results: VCA varied between columns of the distal radius extremity. The mean in the lateral column was 153.40 degrees and 146.06 degrees in the intermediate. Four of nine plates showed no variation in volar angulation. From 27 distal radius, 13 showed convex pattern and 12 had biconvex, whereas most plates (seven of the nine analyzed) were biconvex drawing. Conclusion: Radial bone anatomy was variable. The intermediate column was, on average, steeper than lateral column. Synthes®-2 plate presented the closest design to the anatomy of the distal end of the radial bone, followed by Newclip®-2 plate. Level of Evidence II, Anatomic and Descriptive Study.

RESUMO Objetivos: Avaliar o ângulo palmar cortical (APC) da extremidade distal do rádio, sua variação nas colunas lateral e intermédia, o formato e o padrão da watershed line (WL) e sua correlação com as placas volares bloqueadas disponíveis no mercado. Métodos: Foram analisados 27 ossos rádios do Departamento de Morfologia e nove placas de seis fabricantes diferentes. Medimos os APCs das colunas lateral e intermédia dos rádios e seus correspondentes nas placas, além de compararmos o relevo do terço distal do rádio e das placas. Quanto a WL, comparamos o formato nas peças e seu equivalente nas placas, sendo classificados em quatro tipos: biconvexo, convexo, convexo ulnar e plano. Resultados: O APC variou entre as colunas do rádio, sendo a média da coluna lateral 153,40° e, da intermédia 146,06°. Quatro das nove placas não apresentaram variação na angulação volar. Dos 27 rádios, 13 apresentaram padrão convexo e 12 biconvexo, enquanto a maioria das placas (sete das nove analisadas) tinham desenho biconvexo. Conclusão: A anatomia dos rádios foi variável entre as peças, sendo a coluna intermédia mais inclinada que a coluna lateral. A placa Synthes ® -2 foi a que apresentou relevo mais próximo dos achados anatômicos da extremidade distal do rádio, seguida pela Newclip ® -2. Nível de Evidência II, Estudo Anatômico Descritivo.

Plantar approach for Lisfranc injury: an anatomical study and preliminary clinical application / 中华创伤骨科杂志

Objective:To explore the safety, efficacy and preliminary clinical application of the single plantar approach or in combination with the dorsalis pedis approach in the treatment of Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions.Methods:(1) Six fresh cadaveric specimens of adult foot were collected and dissected through the plantar approach in order to determine the skin incision of the plantar approach and the safe area for plate-screw internal fixation, including start-stop points and courses of plantar nerves, blood vessels, tendons and ligaments, followed by plate-screw fixation on the specimens. (2) After feasibility of the plantar approach was confirmed by our anatomical study, it was used to treat the 3 patients who were admitted to Department of Orthopedics, The Third Hospital Affiliated to Southern Medical University between September 2020 and November 2021 for Lisfranc injury with severe necrosis due to dorsalis pedis skin contusion or metatarsal base avulsion fracture. They were 2 males and one female, with an average age of 51 years (from 34 to 68 years). The preliminary clinical efficacy was evaluated in terms of visual analogue scale (VAS), midfoot score of American Orthopaedic Foot and Ankle Surgeons (AOFAS), Maryland score, Kofoed score, fracture healing at the last follow-up and postoperative complications.Results:(1) Regarding the anatomical exposure range, the metatarsal side of the first metatarsal wedge joint was exposed medially and the metatarsal side of the third metatarsal wedge joint was exposed laterally; the peroneus longus tendon, Lisfranc plantar ligament and interosseous ligament were explored. X-ray films after the simulated operation showed satisfactory plate positions. (2) As for the preliminary clinical application, all patients were followed up for 6 to 14 months (mean, 11 months). At the last follow-up, the VAS score ranged from 0 to 1 (mean, 0.5), AOFAS score from 85 to 92 (mean, 89), Maryland score from 93 to 96 (mean, 95), and Kofoed score from 92 to 95 (mean, 94). There were no early complications such as fascial compartment syndrome, skin necrosis or infection. All fractures got united, with no complications like traumatic arthritis, muscle atrophy or screw loosening.Conclusion:Testified by the anatomical study, the plantar approach can be used to treat Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions, leading to safe, effective and satisfactory clinical outcomes.

An applied research on precise sustentacular screw placement based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali / 中华创伤骨科杂志

Objective:To evaluate our novel path based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali for precise sustentacular screw placement in the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ.Methods:The anterior lateral wall of the calcaneus was divided into the anterior-superior zone S 1, the anterior-inferior zone S 2, the posterior-superior zone S 3 and the posterior-inferior zone S 4 for demarcation of the screw insertion points by our method of Four Zones, and into the front, middle and rear sections by our method of Three Sections for demarcation of the screw target points. The specimens were scanned by CT and modeled by Mimics. On the 3D virtual model of the calcaneus, one screw was placed from each zone of the anterior lateral wall of the calcaneus to the sustentaculum tali body. The screw placement target for S 1 and S 2 was the medial intersection point P 1 of the front and middle sections of the sustentaculum tali, and that for S 3 and S 4 was the medial intersection point P 2 of the middle and rear sections of the sustentaculum tali. It was observed whether the screws were placed in the bone channel. A total of 72 patients were included who had been admitted to Department of Orthopaedics, Suqian Hospital Affiliated to Xuzhou Medical University for calcaneal fractures of Sanders types Ⅱ and Ⅲ from January 2017 to January 2021. They were divided into an anatomical division group and a 3D printing group according to their screw placement method for the sustentaculum tali. In the anatomical division group of 32 patients subjected to screw placement based on our anatomical division, there were 25 males and 7 females, aged from 24 to 60 years; in the 3D printing group of 40 patients subjected to screw placement assisted by 3D printing, there were 31 males and 9 females, aged from 25 to 58 years. The disparities between the parameters of sustentacular screw placement and the actual values were compared in the anatomical division group, and the total number of screws, screws on average, distribution of screws, and accuracy of screw placement were compared between the 2 groups. Results:All the screws which were virtually placed in the specimens of the calcaneus from S 1 and S 2 to P 1 and from S 3 and S 4 to P 2 passed through the bony channel, with no perforation into the tarsal sinus. There was no significant difference in the general date between the anatomical division group and the 3D printing group, showing they were comparable ( P > 0.05). In the anatomical division group, a total of 52 screws were placed to the sustentaculum tali with an average of (1.63 ± 0.48) screws per patient, and 2 screws were placed in 20 patients, yielding an accuracy rate of screw placement of 92.3% (48/52). There were no statistically significant differences between the parameters and the actual values of screw placement in the anatomical division group ( P > 0.05). In the 3D printing group, a total of 63 screws were placed to the sustentaculum tali with an average of (1.58 ± 0.49) screws per patient, and 2 screws were placed in 23 patients, yielding an accuracy rate of screw placement of 93.7% (59/63). There were no significant differences in the above comparisons between the anatomical division group and the 3D printing group ( P > 0.05). Conclusion:In the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ, the sustentacular screw placement based on our anatomical division of the anterior lateral wall of the calcaneus and the sustentaculum tali can lead to similar clinical accuracy as 3D printing-assisted screw placement does.

Modified pararectus abdominis approach for anterior plate fixation of sacral fracture: a clinical anatomy study / 中华创伤骨科杂志

Objective:To investigate the safety and feasibility of modified pararectus abdominis approach in the anterior plate fixation of sacral fractures.Methods:In 5 fresh adult cadavers (3 males and 2 females), gross anatomy was performed on one pelvic side using a modified pararectus abdominis approach to clarify the anatomical structures around the approach. On the other side of the pelvis, the anterior structures of the sacrum were exposed in simulated anterior plate fixation of sacral fracture via the modified pararectus abdominis approach. The exposed anatomic range of the approach, and the locations and courses of lumbosacral trunk nerve and iliac vessels were observed and recorded.Results:(1) The modified pararectus abdominis approach exposed the whole S1 vertebral body from the sacroiliac joint to the medial side, the L5 vertebral body cephalally, the S1 foramina in the true pelvis, and the same structures laterally as a traditional pararectus abdominis approach did. (2) Via the modified pararectus abdominis approach, exploration and decompression of the lumbosacral plexus (from L4 to S1) (including S1 foraminoplasty) were performed under direct vision to decompress the nerve entrapment from anterior compressed fracture fragments and hyperplastic callus. (3) There was a safe surgical area in anterior L5 and S1 where a plate could be safely fixed to the S1 vertebral body. (4) Since the maximum vertical distance from the lumbosacral trunk nerve lifted above the periost to the sacral ala was 1.4 cm (range, from 1.2 to 1.5 cm), a plate could be safely placed from the subperiosteum to the S1 vertebral body to fix the fracture.Conclusions:The modified pararectus abdominis approach is safe and feasible for exploration and decompression of lumbosacral nerves in the anterior sacral region (from L4 to S1) because it has significant advantages in vision and operation. It also broadens the range of anterior sacral plate fixation because a sacral fracture displacement can be reduced under direct vision and a plate can be fixated to the S1 vertebral body along the alae sacralis and across the sacroiliac joint to the iliac bone.

The pectoralis quartus and chondro-epitrochlearis combined muscle variation: description and surgical relevance.

The authors describe a rare unilateral muscle variation in the thoracic wall combining the pectoralis quartus and chondro-epitrochlearis muscles. A routine dissection was performed in the upper right limb of a male adult cadaver with approximately 35-50 years of age, embalmed in formalin 10%. An accessory muscle, the pectoralis quartus, was identified and was associated with a tendon that was inserted in the medial humeral epicondyle, characteristic of the chondro-epitrochlearis muscle tendon. Such variations have significant clinical relevance to orthopedics, mastology, neural and vascular surgery, and other specialties, for surgical approaches in both the axillary and brachial regions.

Persistent median artery inside the carpal tunnel: description and surgical implications.

The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.

Validation of visual instrument for location and measurement of pain intensity / Validação de instrumento visual para localização e mensuração da intensidade da dor

ABSTRACT BACKGROUND AND OBJECTIVES: There are very few instruments in the literature that allow for the precise identification of neuropathic pain, that are easy to apply and can represent the pain intensity and location within the plexus path, as well as be used for pain management. The objective of this study was to validate a visual instrument made from a color scale and a body diagram to locate and measure the pain intensity in adults with brachial plexopathy. METHODS: This exploratory study used a quantitative approach. The sample was composed of 35 patients presenting brachial plexus pain and who underwent surgery. The instrument is composed of a four-color scale and a body diagram. Each patient identified a color on the scale for each pain intensity and then colored the representative pain area in the diagram using one or more colors. Criterion validation was used to prove the correlation between the scores obtained by the instrument and the surgical reports, which were used as the external criterion. RESULTS: A significant agreement was observed between the representation of pain in the diagram and the surgical report in all nerve trunks. CONCLUSION: The instrument was found to be useful for locating the pain and measuring its intensity in patients with brachial plexopathy.

RESUMO JUSTIFICATIVA E OBJETIVOS: Na literatura são escassos os instrumentos que permitem identificar precisamente a dor neuropática, sejam de fácil aplicação, possam representar a intensidade e a localização da dor dentro do trajeto plexular e ser utilizados no manejo da dor. O objetivo deste estudo foi validar um instrumento visual composto por escala de cores e diagrama corporal para localização e mensuração da intensidade da dor em adultos com plexopatia braquial. MÉTODOS: Estudo exploratório, com abordagem quantitativa. A amostra foi composta por 35 pacientes com plexobraquialgia submetidos a tratamento cirúrgico. Foi utilizado um instrumento imagético composto por uma escala de quatro cores e um diagrama corporal. Os pacientes identificaram na escala uma cor para cada intensidade de dor e coloriram no diagrama a sua área representativa, utilizando uma ou mais cores. A validação de critério foi utilizada para comprovar a correlação entre os escores do instrumento criado e os laudos cirúrgicos que corresponderam ao critério externo. RESULTADOS: Observou-se concordância significativa entre a representação da dor no diagrama corporal e o laudo cirúrgico em todos os troncos nervosos. CONCLUSÃO: O instrumento imagético se mostrou útil para localização e mensuração da intensidade da dor em pacientes com plexopatia braquial.

[The key points to comprehend the pelvic fascia].

Pelvic fascia is considered to be one controversial human anatomic structure. According to the characteristics of specialized surgery, colorectal surgeons, gynecologic surgeons and urologic surgeons respectively marked the pelvic fascia, but the naming is not unified. For some specific anatomic structures (such as pelvic plexus), different scholars have different descriptions of their positions. The lack of standard anatomic terms makes it difficult to understand the corresponding anatomic structures, and also hinders the communication between disciplines. Combined with autopsy research, surgical observation and literature review, we discussed the common puzzles of pelvic clinical anatomy. The main points of this article are as follows. (1) Urogenital fascia and vesicohypogastric fascia are the components of visceral fascia. (2) The visceral fascia and fascia propria of rectum are two separate layers. (3) The pelvic plexus is located on the outside of the confluence of visceral fascia and Denonvilliers' fascia. (4) To understand the pelvic lateral ligament from the perspective of layers. (5) To understand pelvic fascia from a holistic perspective.

The pectoralis quartus and chondro-epitrochlearis combined muscle variation: description and surgical relevance

The authors describe a rare unilateral muscle variation in the thoracic wall combining the pectoralis quartus and chondro-epitrochlearis muscles. A routine dissection was performed in the upper right limb of a male adult cadaver with approximately 35-50 years of age, embalmed in formalin 10%. An accessory muscle, the pectoralis quartus, was identified and was associated with a tendon that was inserted in the medial humeral epicondyle, characteristic of the chondro-epitrochlearis muscle tendon. Such variations have significant clinical relevance to orthopedics, mastology, neural and vascular surgery, and other specialties, for surgical approaches in both the axillary and brachial regions.

[Morphological observation on the anterior ciliary vessels in the horizontal rectus muscles of patients with concomitant horizontal strabismus].

Objective: To observe the number of blood vessels and the anatomical characteristics of the anterior ciliary vessels (ACVs) in the horizontal rectus muscles of patients with concomitant horizontal strabismus. Methods: Cross-sectional study. From July 2016 to September 2019 patients with concomitant horizontal strabismus treated by realignment surgeries in Xiamen Eye Center of Xiamen University were included. Patients who had previous operations on eyes were excluded. The high resolution surgical imaging of ACVs in the horizontal rectus muscles was performed during operation. The photos of ACVs in muscles were tagged and observed to compare the distribution of the various numbers of blood vessels and morphological characteristics of the ACVs in the medial and lateral rectus muscles. In addition, muscle tissues about 4 mm with an intact sheath were gained from patients undergoing the muscle resection. The muscle sections were stained with hematoxylin-eosin staining, and the arteriovenous properties and their distribution in muscles and fascia tissues were observed. The chi-square test was used for statistical analysis. Results: A total of 387 patients with concomitant horizontal strabismus (176 with esotropia, 211 with exotropia) were enrolled in this study, among whom 198 were male and 189 were female. The age ranged from 1 to 68 years (median, 13 years). Photos of ACVs in 742 horizontal rectus muscles from 383 patients were observed. Of the 351 medial rectus muscles, 24 (6.8%) contained 1 major (or bundle of) ACV, 163 (46.4%) contained 2 major (or bundles of) ACVs, and 164 (46.7%) contained 3 or more major (or bundles of) ACVs. Of the 391 lateral rectus muscles, 161 (41.2%) contained 1 major (or bundle of) ACV, 156 (39.9%) contained 2 major (or bundles of) ACVs, and 74 (18.9%) contained 3 or more major (or bundles of) ACVs. The distribution of ACVs in the medial and lateral rectus muscles was statistically different (χ(2)=133.87, P<0.01). According to the number and morphological characteristics of vessels, the ACVs in the medial and lateral rectus muscles were divided into 4 and 3 categories, respectively, as well as various types and subtypes. The rate of patients whose both eyes had the same type of ACVs in the medial or lateral rectus muscles was 31.6% (25/79) and 26.1% (29/111), respectively, and there was no significant difference (χ(2)=0.69, P=0.41). However, the ACVs of the same type from both eyes of the same patient were not identical in morphology. The ACVs in the medial and lateral rectus muscles with collateral circulation accounted for 3.7% (13/351) and 24.3% (95/391), respectively, and the difference was statistically significant (χ(2)=63.07, P<0.01). The hematoxylin-eosin staining of the medial lateral rectus tissues from 4 patients showed that the ACVs contained arteries and veins. The vessels in the medial rectus muscles were distributed in muscle tissue and fascia tissue, while the vessels in the lateral rectus muscles were only distributed in fascia tissue. Conclusions: Compared with the lateral rectus muscles, there are about 50% medial rectus muscles contain more than 3 major (or bundles of) vessels in patients with concomitant horizontal strabismus. The accompanying patterns of arteries and veins of ACVs are varied. ACVs are distributed in muscle tissue of the medial rectus muscles and in fascia tissue of the medial and lateral rectus muscles. (Chin J Ophthalmol, 2020, 56: 197-204).

Persistent median artery inside the carpal tunnel: description and surgical implications

The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.

Learning musculoskeletal anatomy through new technologies: a randomized clinical trial / Aprendizagem de anatomia musculoesquelética por meio de novas tecnologias: um ensaio clínico randomizado / Aprendizaje de la anatomía musculoesquelética a través de las nuevas tecnologías: ensayo clínico aleatorizado

Objective: to investigate the influence of the application of new methodologies on learning and the motivation of students of the Anatomy discipline. Method: randomized, longitudinal, prospective, intervention study. Sixty-two students were recruited to assess the impact of different methodologies. The sample was randomized to compare the results of teaching with a 3D atlas, ultrasound and the traditional method. The parameters were assessed through a satisfaction evaluation questionnaire and anatomical charts. Repeated measures ANOVA was used to determine statistical significance. Results: in terms of the usefulness of the seminars, 98.1% of the students considered them to be very positive or positive, stating that they had stimulated their interest in anatomy. The students who learned with the 3D atlas improved their understanding of anatomy (p=0.040). In general, the students improved their grades by around 20%. Conclusion: the traditional method combined with new technologies increases the interest of students in human anatomy and enables them to acquire skills and competencies during the learning process.

Objetivo: investigar a influência da aplicação de novas metodologias na aprendizagem e a motivação de alunos da disciplina de Anatomia. Método: estudo de intervenção, prospectivo, longitudinal e randomizado. Um total de 62 alunos foram recrutados para se avaliar o impacto de diferentes metodologias. Eles foram distribuídos de forma aleatória para comparar os resultados de ensino usando o atlas 3D, o ultrassom e o método tradicional. Os parâmetros foram medidos por meio de um questionário de avaliação de satisfação do aluno e uma prova usando lâminas anatômicas. O teste ANOVA de medidas repetidas foi usado para determinar significância estatística. Resultados: relativo à satisfação dos alunos, 98,1% consideraram muito positivo ou positivo o uso dos seminários, além de afirmarem que o seminário havia estimulado seu interesse pela anatomia. Os alunos submetidos ao método com o atlas 3D apresentaram uma melhora em sua compreensão de anatomia (p=0,040). De forma geral, os alunos melhoraram suas pontuações em aproximadamente 20%. Conclusão: o método tradicional, junto com as novas tecnologias, contribui para aumentar o interesse dos alunos pela Anatomia Humana assim como na aquisição de habilidades e competências em seu processo de aprendizagem.

Objetivo: investigar la influencia de la aplicación de nuevas metodologías en el aprendizaje y en la motivación de los alumnos en la asignatura Anatomia. Método: estudio de intervención, prospectivo, longitudinal y aleatorizado. Fueron convocados 62 alumnos para evaluar el impacto de diferentes metodologías. Se los dividió aleatoriamente para comparar resultados entre enseñanza con atlas 3D, ultrasonido y metodología tradicional. Los parámetros fueron analizados mediante un cuestionario de evaluación de satisfacción y láminas anatómicas. Se usó ANOVA de medidas repetidas para determinar la significancia estadística. Resultados: el 98,1% de los alumnos consideraron muy positiva o positiva la utilización de los seminarios, afirmaron asimismo que el seminario había estimulado su interés por la anatomía. Los alumnos que realizaron el aprendizaje con atlas 3D mejoraron su compresión de la anatomía (p=0,040). En general, los alumnos mejoraron sus puntajes en alrededor del 20%. Conclusión: el método tradicional con el agregado de las nuevas tecnologías permite a los alumnos incrementar su interés por la Anatomía Humana, así como adquirir habilidades y competencias en su proceso de aprendizaje.

[Preoperative evaluation using multi-slice spiral CT angiography of right-side colon vascular in laparoscopic radical operation for right colon cancer].

Objectives: To examine the value of multi-slice spiral CT angiography (MSCTA) in the analysis of anatomical variation and structural classification of right colon vessels. Methods: From August 2015 to August 2017, 198 patients (96 of whom underwent laparoscopic radical resection of right colon cancer) at Department of General surgery of Peking University First Hospital were retrospectively collected, and the results of abdominal enhanced CT scan were collected and three-dimensional reconstruction of blood vessels was performed. There were 104 males and 94 females. The age was 64(27) years (M(Q(R)), range: 19 to 87 years). Right gastroepiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein (RCV), superior right colonic vein, ileocolon artery or vein (ICA or ICV), middle colon artery or vein (MCA or MCV) and Henle trunk were observed and recorded respectively. The anatomical relationship between the positions of blood vessels, the length of Henle trunk and surgical trunk were measured. Results: ICV and ICA were the most constant anatomic structures. The ICV/ICA of all patients came directly from SMV/SMA, 36.9% (73/198) ICV going in front of SMV and 63.1% (125/198) behind SMV. 72.2% (143/198) of the patients had RCV imported into Henle trunk and the rest into SMV. Middle colonic vein (MCV) could be observed in 81.3% (161/198) of the cases. 81.4% (131/161) of MCV were imported into SMV, 16.8% (27/161) into Henle trunk, 1.2% (2/161) into the first jejunal vein and 0.6% (1/161) into the splenic vein. Henle trunk was divided into 4 types, among which the occurrence probability of gastric node and pancreatic trunk was the highest. The dry length of Henle trunk was (0.82±0.39) cm (range: 0.37 to 1.68 cm). The length of surgical trunk was (2.54±0.83) cm (range: 1.57 to 3.95 cm). Accuracy of MSCTA results was 96.9%(93/96). Conclusions: Anatomical variation of blood vessels in the right colon is common. Abdominal CT angiography can accurately determine the anatomical structure of the blood vessels in the right colon.

An alternative method for the comparative study of coronary vessels: repletion and diaphanization experience in seven animal models / Repleción y diafanización como una alternativa para el estudio comparativo de los vasos coronarios: experiencia en siete modelos animales

Coronary arteries establish a complex blood vessel system, right and left coronary arteries commonly originate from the aortic sinuses and divide into multiple branches that supply the heart with several important variations between species. Diaphanization is a preservative technique which allows internal structures visualization, maintaining the three-dimensionality of the specimen. In this study, human (Homo sapiens), goat (Capra aegagrus hircus), bovine (Bos Taurus), equine (Equus caballus), porcine (Sus scrofa domesticus), canine (Canis lupus familiaris) and feline (Felis silvestris catus) coronary arteries were injected with selfcuring methyl-methacrylate and posteriorly diaphanized. The coronary vasculature was adequately observed in all models while keeping the three-dimensional relation with surrounding cardiac structures, except for septal arteries which were not visualized. As incidental findings, anatomical variations in canine and human hearts were observed. Repletion-diaphanization is a useful blended method to visualize the morphology of superficial coronary arteries. It could be a valuable tool in anatomical teaching and research, but further research needs to be done to prove its effectiveness in different vessel systems.

Las arterias coronarias son un complejo de vasos sanguíneos que usualmente se originan en los senos aórticos y que al dividirse en múltiples ramas suplen los requerimientos metabólicos del tejido cardiaco; cabe aclarar que la anatomía de estas estructuras posee variaciones importantes entre especies. La diafanización es una técnica de preservación que permite observar estructuras internas de un espécimen sin dañar su tridimensionalidad. En este estudio las arterias coronarias del corazón humano (Homo sapiens), caprino (Capra aegagrus hircus), bovino (Bos Taurus), equino (Equus caballus), porcino (Sus scrofa domesticus), canino (Canis lupus familiaris) y felino (Felis silvestris catus), fueron repletadas con metil-metacrilato y posteriormente diafanizados. Se observa la irrigación coronaria de cada uno de los corazones y su relación con las demás estructuras cardiacas, exceptuando las arterias septales. Como hallazgos incidentales se observaron variaciones anatómicas en los corazones canino y humano. Finalmente, esta técnica resultó de utilidad para evaluar la anatomía coronaria, lo que puede ser valioso para educación e investigación. Posteriores investigaciones deben ser realizadas para probar su utilidad en otros sistemas vasculares.