Cadaveric study; To describe the characteristics of the nerve and its relationship with the lumbar intervertebral disc and psoas major muscle. Nerve injury is an understudied complication of extreme lateral interbody fusion. A detailed description of the nerve anatomy would be helpful for surgeons to minimize the risk of this complication. The lumbar plexus and lumbar sympathetic nerve of 10 embalmed male cadavers were dissected, and the distribution, number, and spatial orientation of the nerves on the L1/2 to L4/5 intervertebral discs were examined. Metal wires were applied along nerve paths through the psoas major muscle. The position of the nerves was examined on CT. In zone III at L1/2 and L4/5, no nerves were found. In zone II and zone III at L2/3, no lumbar plexus was found, and only the ramus communicans passed through. At the L1-L5 level, the density of nerves in the posterior half of the psoas major muscle was greater than that in the anterior half. The lumbar plexus was found in all of zone IV. The genitofemoral nerve emerges superficially and anteriorly from the medial border of the psoas major at the L3-4 level, but at the L1/2 level, the sympathetic trunk is located in zone II. The remaining disc-level sympathetic trunks appear in zone I. No nerves were found in zone III of the L1/2 or L4/5 disc. In zones II and III of L2/3, the lumbar plexus appears safe. The genitofemoral nerve travels through zones II and III of L3/4. The distribution density of nerves in the posterior half of the psoas major muscle was greater than that in the anterior half of that muscle at the L1-L5 level.
尸体研究；描述神经的特征及其与腰椎间盘和腰大肌的关系。神经损伤是极外侧椎体间融合术的一种未被充分研究的并发症。对神经解剖的详细描述将有助于外科医生最大限度地降低这种并发症的风险。我们解剖了 10 具已防腐处理的男性尸体的腰丛神经和腰交感神经，并检查了 L1/2 至 L4/5 椎间盘上神经的分布、数量和空间方向。沿着穿过腰大肌的神经路径应用金属丝。通过 CT 检查神经的位置。在 L1/2 和 L4/5 的 III 区，没有发现神经。在位于 L2/3 的 II 区和 III 区，没有发现腰椎神经丛，只有公羊肌穿过。在 L1-L5 水平，腰大肌后半部的神经密度高于前半部。第 IV 区均有腰神经丛。在 L3-4 水平，股神经从腰大肌内侧边缘的浅表和前方出现，但在 L1/2 水平，交感神经干位于 II 区。在 L1/2 或 L4/5 椎间盘的 III 区没有发现神经。在 L2/3 的 II 区和 III 区，腰椎神经丛显得很安全。股神经穿过 L3/4 的 II 区和 III 区。在 L1-L5 水平，腰大肌后半部的神经分布密度高于腰大肌前半部。
{"title":"Anatomical study of the relationship between the lumbar intervertebral disc, nerves, and psoas major.","authors":"Hongqi Sun, Chaohui Fan, Xinying Zhou, Zhiyang Zheng, Zezheng Liu, Qingchu Li, Qinghao Zhao","doi":"10.1002/ca.24177","DOIUrl":"https://doi.org/10.1002/ca.24177","url":null,"abstract":"<p><p>Cadaveric study; To describe the characteristics of the nerve and its relationship with the lumbar intervertebral disc and psoas major muscle. Nerve injury is an understudied complication of extreme lateral interbody fusion. A detailed description of the nerve anatomy would be helpful for surgeons to minimize the risk of this complication. The lumbar plexus and lumbar sympathetic nerve of 10 embalmed male cadavers were dissected, and the distribution, number, and spatial orientation of the nerves on the L1/2 to L4/5 intervertebral discs were examined. Metal wires were applied along nerve paths through the psoas major muscle. The position of the nerves was examined on CT. In zone III at L1/2 and L4/5, no nerves were found. In zone II and zone III at L2/3, no lumbar plexus was found, and only the ramus communicans passed through. At the L1-L5 level, the density of nerves in the posterior half of the psoas major muscle was greater than that in the anterior half. The lumbar plexus was found in all of zone IV. The genitofemoral nerve emerges superficially and anteriorly from the medial border of the psoas major at the L3-4 level, but at the L1/2 level, the sympathetic trunk is located in zone II. The remaining disc-level sympathetic trunks appear in zone I. No nerves were found in zone III of the L1/2 or L4/5 disc. In zones II and III of L2/3, the lumbar plexus appears safe. The genitofemoral nerve travels through zones II and III of L3/4. The distribution density of nerves in the posterior half of the psoas major muscle was greater than that in the anterior half of that muscle at the L1-L5 level.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inger Mechlenburg, Sepp De Raedt, Hakim C Achterberg, Maiken Stilling, Lone Rømer, Kjeld Søballe, Marleen de Bruijne
The dysplastic hip is characterized by incomplete coverage of the femoral head, resulting in increased risk of early osteoarthritis. The morphological variation of the hip joint is diverse and clear differences exist between females and males. The aim of this observational study was therefore to investigate the relationship between the morphology of the hip, sex, and hip dysplasia using a three-dimensional model. Statistical shape models of the combined femur and pelvic bones were created from bilateral hips of 75 patients. Using manual angle measurements and regression analysis, the characteristic shape differences associated with sex and hip dysplasia were determined. The model showed clear differences associated with sex and hip dysplasia. We found that the acetabular anteversion in females was significantly higher (p < 0.0001) than in males while no significant difference in acetabular anteversion was found between normal and dysplastic hips (p = 0.11). The model showed that decreased acetabular anteversion resulted in the appearance of the cross-over sign and the prominent ischial spine sign commonly associated with retroversion. Sex could be predicted with an area under the curve of 0.99 and hip dysplasia could be predicted with an area under the curve of ≥0.73. Our findings suggest that retroversion is a result of decreased anteversion of the acetabulum and is primarily associated with sex. This finding should be taken into account during the reorientation of the acetabulum in the surgical treatment of hip dysplasia.
{"title":"Morphology of the dysplastic hip and the relationship with sex and acetabular version.","authors":"Inger Mechlenburg, Sepp De Raedt, Hakim C Achterberg, Maiken Stilling, Lone Rømer, Kjeld Søballe, Marleen de Bruijne","doi":"10.1002/ca.24174","DOIUrl":"https://doi.org/10.1002/ca.24174","url":null,"abstract":"<p><p>The dysplastic hip is characterized by incomplete coverage of the femoral head, resulting in increased risk of early osteoarthritis. The morphological variation of the hip joint is diverse and clear differences exist between females and males. The aim of this observational study was therefore to investigate the relationship between the morphology of the hip, sex, and hip dysplasia using a three-dimensional model. Statistical shape models of the combined femur and pelvic bones were created from bilateral hips of 75 patients. Using manual angle measurements and regression analysis, the characteristic shape differences associated with sex and hip dysplasia were determined. The model showed clear differences associated with sex and hip dysplasia. We found that the acetabular anteversion in females was significantly higher (p < 0.0001) than in males while no significant difference in acetabular anteversion was found between normal and dysplastic hips (p = 0.11). The model showed that decreased acetabular anteversion resulted in the appearance of the cross-over sign and the prominent ischial spine sign commonly associated with retroversion. Sex could be predicted with an area under the curve of 0.99 and hip dysplasia could be predicted with an area under the curve of ≥0.73. Our findings suggest that retroversion is a result of decreased anteversion of the acetabulum and is primarily associated with sex. This finding should be taken into account during the reorientation of the acetabulum in the surgical treatment of hip dysplasia.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sharmeen Adnan, Patrick Michael, Amanda C. Benson, Junhua Xiao
Digital technologies are changing how anatomy is taught tremendously. However, little is known about the effective integration of multimodal digital resources when concurrently provided in an anatomy course. To address this question, an array of digital anatomy resources including Augmented Reality (AR) and Virtual Reality (VR) anatomy resources were concurrently trialed by a total of 326 undergraduate and postgraduate students across three undergraduate (systemic anatomy, neuroanatomy, and regional anatomy) and one postgraduate anatomy (applied musculoskeletal anatomy) curricula in 2022. A five-point Likert scale learning and teaching survey was conducted to evaluate students' experiences, preferences, and perceptions. Most undergraduate (81% systemic anatomy, 76% neuroanatomy, and 87% regional anatomy) and postgraduate (97%) participants across the four cohorts felt confident in studying anatomy using digital resources and the majority (>80% undergraduate and >90% postgraduate) found the multimodal digital anatomy resources interactive and stimulating. The response showed that undergraduate (77% systemic anatomy, 81% neuroanatomy, and 97% regional anatomy) and postgraduate students (92%) consistently enjoyed their experience of using multimodal digital anatomy resources and thought that these resources enhanced their interest in studying anatomy. However, there are significant differences in ratings of specific digital resources among the junior (first-year undergraduates) and senior (third-year undergraduates and postgraduates) students. The virtual dissection table was uniformly preferred by the four cohorts of students across the board. Interestingly, however, VR anatomy and radiographic-based digital anatomy resources received diverse ratings. VR anatomy was valued most by junior undergraduate students (84%) who studied systemic anatomy compared to their senior counterparts (73%) who studied regional anatomy, whereas radiographic-based digital anatomy resources were more valued by the postgraduate students (93%) compared to undergraduates (65% systemic anatomy, 73% neuroanatomy, and 48% regional anatomy). This study identifies that while students uniformly appreciate the value of multimodal digital anatomy teaching, there is a clear difference in their perceptions towards individual resources, likely in a course-specific manner. We conclude that the selection and adoption of digital anatomy tools must be tailored as part of course design and that digital anatomy tools should be used in combination to provide an effective learning experience for students.
{"title":"Junior and senior students possess differential preferences towards multimodal digital anatomy resources","authors":"Sharmeen Adnan, Patrick Michael, Amanda C. Benson, Junhua Xiao","doi":"10.1002/ca.24175","DOIUrl":"10.1002/ca.24175","url":null,"abstract":"<p>Digital technologies are changing how anatomy is taught tremendously. However, little is known about the effective integration of multimodal digital resources when concurrently provided in an anatomy course. To address this question, an array of digital anatomy resources including Augmented Reality (AR) and Virtual Reality (VR) anatomy resources were concurrently trialed by a total of 326 undergraduate and postgraduate students across three undergraduate (systemic anatomy, neuroanatomy, and regional anatomy) and one postgraduate anatomy (applied musculoskeletal anatomy) curricula in 2022. A five-point Likert scale learning and teaching survey was conducted to evaluate students' experiences, preferences, and perceptions. Most undergraduate (81% systemic anatomy, 76% neuroanatomy, and 87% regional anatomy) and postgraduate (97%) participants across the four cohorts felt confident in studying anatomy using digital resources and the majority (>80% undergraduate and >90% postgraduate) found the multimodal digital anatomy resources interactive and stimulating. The response showed that undergraduate (77% systemic anatomy, 81% neuroanatomy, and 97% regional anatomy) and postgraduate students (92%) consistently enjoyed their experience of using multimodal digital anatomy resources and thought that these resources enhanced their interest in studying anatomy. However, there are significant differences in ratings of specific digital resources among the junior (first-year undergraduates) and senior (third-year undergraduates and postgraduates) students. The virtual dissection table was uniformly preferred by the four cohorts of students across the board. Interestingly, however, VR anatomy and radiographic-based digital anatomy resources received diverse ratings. VR anatomy was valued most by junior undergraduate students (84%) who studied systemic anatomy compared to their senior counterparts (73%) who studied regional anatomy, whereas radiographic-based digital anatomy resources were more valued by the postgraduate students (93%) compared to undergraduates (65% systemic anatomy, 73% neuroanatomy, and 48% regional anatomy). This study identifies that while students uniformly appreciate the value of multimodal digital anatomy teaching, there is a clear difference in their perceptions towards individual resources, likely in a course-specific manner. We conclude that the selection and adoption of digital anatomy tools must be tailored as part of course design and that digital anatomy tools should be used in combination to provide an effective learning experience for students.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ca.24175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Einat Kedar, D. Ezra, Ruth Pelleg-Kallevag, D. Stein, Nathan Peled, H. May, Israel Hershkovitz
The cervical spine manifests a wide shape variation. However, the traditional methods to evaluate the cervical spine curve were never tested against its actual shape. The study's main aim was to determine whether the shape classification of the cervical spine, based on traditional angular measurements, coincides with each other and with the shape captured by the 2D landmark-based geometric morphometric method. The study's second aim was to reveal the associations between the cervical spine shape and the demographic parameters, the head's position, and the spine's sagittal balance. CT scans of the cervical spine of 163 individuals were evaluated to achieve these goals. The shape was assessed by measuring the C2-C7 Cobb angle (CA), the C2-C7 posterior tangent angle (PTA), the curvedness of the arch, and by a 2D landmark-based geometric morphometric method. The position of the head and the sagittal balance of the spine were evaluated by measuring the foramen magnum-C2 Cobb angle (FMCA) and the T1 slope angle (T1SA), respectively. Based on the size of the angle measured, each individual was classified into one of the three cervical 'shape groups' (lordotic, straight, and kyphotic). We found that cervical lordosis was the dominant shape regardless of the measuring methods utilized (46.6%-54.6%), followed by straight neck (28.2%-30.1%), and kyphosis (15.3%-25.2%); however, about a third of the 163 individuals were classified into a different shape group using the CA and PTA methods. The cervical spine angle was sex-independent and age-dependent. The T1SA was significantly correlated with CA and PTA (r = 0.640 and r = 0.585, respectively; p < 0.001). In conclusion, the cervical spine shape evaluation is method-dependent and varies with age.
颈椎的形状变化很大。然而，评估颈椎曲线的传统方法从未根据颈椎的实际形状进行过测试。本研究的主要目的是确定基于传统角度测量方法的颈椎形状分类是否与基于二维地标的几何形态测量方法所捕捉到的形状相吻合。研究的第二个目的是揭示颈椎形状与人口统计学参数、头部位置和脊柱矢状平衡之间的关联。为了实现这些目标，研究人员对 163 人的颈椎 CT 扫描进行了评估。通过测量 C2-C7 Cobb 角 (CA)、C2-C7 后切角 (PTA)、颈椎弓的弯曲度以及基于二维地标的几何形态计量方法来评估颈椎的形状。通过测量枕骨大孔-C2 Cobb角（FMCA）和T1斜角（T1SA），分别评估了头部的位置和脊柱的矢状平衡。根据测量到的角度大小，每个人都被分为三个颈椎 "形状组"（前凸、平直和后凸）。我们发现，无论采用哪种测量方法，颈椎前凸都是最主要的形状（46.6%-54.6%），其次是直颈（28.2%-30.1%）和驼背（15.3%-25.2%）；然而，在采用 CA 和 PTA 方法的 163 人中，约有三分之一的人被归入了不同的形状组。颈椎角度与性别无关，与年龄有关。T1SA 与 CA 和 PTA 有明显相关性（分别为 r = 0.640 和 r = 0.585；p < 0.001）。总之，颈椎形状的评估与方法有关，并随年龄而变化。
{"title":"Capturing the cervical spine shape: Angular measurements versus geometric morphometric methods.","authors":"Einat Kedar, D. Ezra, Ruth Pelleg-Kallevag, D. Stein, Nathan Peled, H. May, Israel Hershkovitz","doi":"10.1002/ca.24166","DOIUrl":"https://doi.org/10.1002/ca.24166","url":null,"abstract":"The cervical spine manifests a wide shape variation. However, the traditional methods to evaluate the cervical spine curve were never tested against its actual shape. The study's main aim was to determine whether the shape classification of the cervical spine, based on traditional angular measurements, coincides with each other and with the shape captured by the 2D landmark-based geometric morphometric method. The study's second aim was to reveal the associations between the cervical spine shape and the demographic parameters, the head's position, and the spine's sagittal balance. CT scans of the cervical spine of 163 individuals were evaluated to achieve these goals. The shape was assessed by measuring the C2-C7 Cobb angle (CA), the C2-C7 posterior tangent angle (PTA), the curvedness of the arch, and by a 2D landmark-based geometric morphometric method. The position of the head and the sagittal balance of the spine were evaluated by measuring the foramen magnum-C2 Cobb angle (FMCA) and the T1 slope angle (T1SA), respectively. Based on the size of the angle measured, each individual was classified into one of the three cervical 'shape groups' (lordotic, straight, and kyphotic). We found that cervical lordosis was the dominant shape regardless of the measuring methods utilized (46.6%-54.6%), followed by straight neck (28.2%-30.1%), and kyphosis (15.3%-25.2%); however, about a third of the 163 individuals were classified into a different shape group using the CA and PTA methods. The cervical spine angle was sex-independent and age-dependent. The T1SA was significantly correlated with CA and PTA (r = 0.640 and r = 0.585, respectively; p < 0.001). In conclusion, the cervical spine shape evaluation is method-dependent and varies with age.","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140661510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yikuan Du, Xiaolin Cai, Ye Zheng, Aoxue Long, Mengting Zhang, Mianhai Chen, Weichui Zhang, Jinfeng Zhu, Jinhua Guo, Chun Yang
As the cornerstone of medicine, the development of anatomy is related to many disciplines and fields and has received extensive attention from researchers. How to integrate and grasp the cutting-edge information in this field quickly is a challenge for researchers, so the aim of this study is to analyze research in anatomy using CiteSpace and VOSviewer in order to identify research hotspots and future directions. To offer a fresh viewpoint for assessing the academic influences of researchers, nations, or institutions on anatomy, and to examine the development of hotspots in anatomical study and to forecast future trends. A total of 4637 anatomy-related publications from 2013 to 2023 were collected from Web of Science Core Collection databases. Their temporal distribution, spatial distribution, cited authors, co-cited journals, keywords, and disciplinary connections in the literature were analyzed using CiteSpace and VOSviewer, and a knowledge graph was constructed. The temporal distribution shows a general fluctuation in the amount of literature published from 2013 to 2023. In spatial distribution, the total number of published articles was highest in the United States, the United Kingdom, and China, the United States leading. Tubbs, Rhoton, Iwanaga, and LaPrade are important authors in anatomy. Clinical Anatomy, Surgical and Radiologic Anatomy, and Journal of Anatomy were the most highly cited journals. Analysis of keywords and citation emergence showed that the research hotspots and trends in anatomy focused mainly on anatomy education, digital technology, and surgical management. At the same time, anatomy showed a trend toward multidisciplinary crossover, developing closer relationships with molecular biology, immunology, and clinical medicine. Current research in anatomy focuses on innovative reform of the educational model and the application and promotion of digital technology. Also, multidisciplinary cross-fertilization is an inevitable trend for the future development of anatomy.
{"title":"Research advances and trends in anatomy from 2013 to 2023: A visual analysis based on CiteSpace and VOSviewer","authors":"Yikuan Du, Xiaolin Cai, Ye Zheng, Aoxue Long, Mengting Zhang, Mianhai Chen, Weichui Zhang, Jinfeng Zhu, Jinhua Guo, Chun Yang","doi":"10.1002/ca.24168","DOIUrl":"10.1002/ca.24168","url":null,"abstract":"<p>As the cornerstone of medicine, the development of anatomy is related to many disciplines and fields and has received extensive attention from researchers. How to integrate and grasp the cutting-edge information in this field quickly is a challenge for researchers, so the aim of this study is to analyze research in anatomy using CiteSpace and VOSviewer in order to identify research hotspots and future directions. To offer a fresh viewpoint for assessing the academic influences of researchers, nations, or institutions on anatomy, and to examine the development of hotspots in anatomical study and to forecast future trends. A total of 4637 anatomy-related publications from 2013 to 2023 were collected from Web of Science Core Collection databases. Their temporal distribution, spatial distribution, cited authors, co-cited journals, keywords, and disciplinary connections in the literature were analyzed using CiteSpace and VOSviewer, and a knowledge graph was constructed. The temporal distribution shows a general fluctuation in the amount of literature published from 2013 to 2023. In spatial distribution, the total number of published articles was highest in the United States, the United Kingdom, and China, the United States leading. Tubbs, Rhoton, Iwanaga, and LaPrade are important authors in anatomy. <i>Clinical Anatomy</i>, <i>Surgical and Radiologic Anatomy</i>, and <i>Journal of Anatomy</i> were the most highly cited journals. Analysis of keywords and citation emergence showed that the research hotspots and trends in anatomy focused mainly on anatomy education, digital technology, and surgical management. At the same time, anatomy showed a trend toward multidisciplinary crossover, developing closer relationships with molecular biology, immunology, and clinical medicine. Current research in anatomy focuses on innovative reform of the educational model and the application and promotion of digital technology. Also, multidisciplinary cross-fertilization is an inevitable trend for the future development of anatomy.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140666792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Komune, Satoshi Matsuo, Osamu Akiyama, Yuhei Sangatsuda, Daisuke Kuga, Yusuke Miyamoto, Tomoharu Suzuki, Daisuke Murakami, Koji Yoshimoto, J. Iwanaga, R. S. Tubbs, Takashi Nakagawa
Endoscopic endonasal skull base surgery is increasingly prevalent, with its scope expanding from pathogens in the midline region to those in the paramedian region. Maximizing anterior sphenoidectomy is important for the median approach, and lateralizing the pterygopalatine fossa is crucial for the paramedian approach. Maximizing the surgical corridor in the nasal cavity and minimizing damage to neurovascular structures are vital for establishing a surgical field with minimal bleeding, ensuring safe, precise, and gentle procedures. However, the relationship between the maxillofacial and skull base bones in endoscopic endonasal skull base surgery is difficult to understand because these bones are intricately articulated, making it challenging to visualize each bone's outline. Understanding important bones and their related neurovascular structures is essential for all skull base surgeons to maximize the surgical corridor and minimize iatrogenic injury to neurovascular structures. This study aimed to elucidate the role of the palatine bone from a microsurgical anatomical perspective. Three dry skulls were used to demonstrate the structure of the palatine bone and its relationship with surrounding bones. A formalin-perfused cadaveric head was dissected to show the related neurovascular structures. The arteries and veins of the cadaveric heads were injected with red- and blue-colored silicon. Dissection was performed using a surgical microscope and endoscope. In addition, the utilization of the palatine bone as a landmark to identify neurovascular structures, which aids in creating a wider surgical field with less bleeding, was shown in two representative cases. The palatine bone consists of unique complex structures, including the sphenoidal process, ethmoidal crest, pterygopalatine canal, and sphenopalatine notch, which are closely related to the sphenopalatine artery, maxillary nerve, and its branches. The ethmoidal crest of the palatine bone is a well-known structure that is useful for identifying the sphenopalatine foramen, controlling the sphenopalatine artery and nerve, and safely opening the pterygopalatine fossa. The sphenoidal process of the palatine bone is a valuable landmark for identifying the palatovaginal artery, which is a landmark used to safely and efficiently expose the vidian canal. The sphenoidal process is easily cracked with an osteotome and removed to expose the palatovaginal artery, which runs along the pharyngeal groove, just medial to the vidian canal. By opening the pterygopalatine canal (also known as the greater palatine canal), further lateralization of the periosteum-covered pterygopalatine fossa contents can be achieved. Overall, the sphenoidal process and ethmoidal crest can be used as important landmarks to maximize the surgical corridor and minimize unnecessary injury to neurovascular structures.
{"title":"The importance of the palatine bone for endoscopic endonasal skull base surgery.","authors":"N. Komune, Satoshi Matsuo, Osamu Akiyama, Yuhei Sangatsuda, Daisuke Kuga, Yusuke Miyamoto, Tomoharu Suzuki, Daisuke Murakami, Koji Yoshimoto, J. Iwanaga, R. S. Tubbs, Takashi Nakagawa","doi":"10.1002/ca.24170","DOIUrl":"https://doi.org/10.1002/ca.24170","url":null,"abstract":"Endoscopic endonasal skull base surgery is increasingly prevalent, with its scope expanding from pathogens in the midline region to those in the paramedian region. Maximizing anterior sphenoidectomy is important for the median approach, and lateralizing the pterygopalatine fossa is crucial for the paramedian approach. Maximizing the surgical corridor in the nasal cavity and minimizing damage to neurovascular structures are vital for establishing a surgical field with minimal bleeding, ensuring safe, precise, and gentle procedures. However, the relationship between the maxillofacial and skull base bones in endoscopic endonasal skull base surgery is difficult to understand because these bones are intricately articulated, making it challenging to visualize each bone's outline. Understanding important bones and their related neurovascular structures is essential for all skull base surgeons to maximize the surgical corridor and minimize iatrogenic injury to neurovascular structures. This study aimed to elucidate the role of the palatine bone from a microsurgical anatomical perspective. Three dry skulls were used to demonstrate the structure of the palatine bone and its relationship with surrounding bones. A formalin-perfused cadaveric head was dissected to show the related neurovascular structures. The arteries and veins of the cadaveric heads were injected with red- and blue-colored silicon. Dissection was performed using a surgical microscope and endoscope. In addition, the utilization of the palatine bone as a landmark to identify neurovascular structures, which aids in creating a wider surgical field with less bleeding, was shown in two representative cases. The palatine bone consists of unique complex structures, including the sphenoidal process, ethmoidal crest, pterygopalatine canal, and sphenopalatine notch, which are closely related to the sphenopalatine artery, maxillary nerve, and its branches. The ethmoidal crest of the palatine bone is a well-known structure that is useful for identifying the sphenopalatine foramen, controlling the sphenopalatine artery and nerve, and safely opening the pterygopalatine fossa. The sphenoidal process of the palatine bone is a valuable landmark for identifying the palatovaginal artery, which is a landmark used to safely and efficiently expose the vidian canal. The sphenoidal process is easily cracked with an osteotome and removed to expose the palatovaginal artery, which runs along the pharyngeal groove, just medial to the vidian canal. By opening the pterygopalatine canal (also known as the greater palatine canal), further lateralization of the periosteum-covered pterygopalatine fossa contents can be achieved. Overall, the sphenoidal process and ethmoidal crest can be used as important landmarks to maximize the surgical corridor and minimize unnecessary injury to neurovascular structures.","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The plantar aponeurosis (PA) is an elastic longitudinal band that contributes to the generation of a propulsive force in the push‐off phase during walking and running through the windlass mechanism. However, the dynamic behavior of the PA remains unclear owing to the lack of direct measurement of the strain it generates. Therefore, this study aimed to visualize and quantify the PA behavior during two distinct foot postures: (i) neutral posture and (ii) windlass posture with midtarsal joint plantarflexion and metatarsophalangeal joint dorsiflexion, using computed tomography scans. Six healthy adult males participated in the experiment, and three‐dimensional reconstruction of the PA was conducted to calculate its path length, width, thickness, and cross‐sectional area. This study successfully visualized and quantified the morphological changes in the PA induced by the windlass mechanism, providing a precise reference for biomechanical modeling. This study also highlighted the interindividual variability in the PA morphology and stretching patterns. Although the windlass posture was not identical to that observed in the push‐off phase during walking, the observed PA behavior provides valuable insights into its mechanics and potential implications for foot disorders.
足底肌腱（PA）是一条弹性纵带，在步行和跑步过程中通过卷扬机制在推起阶段产生推动力。然而，由于缺乏对其产生的应变的直接测量，PA 的动态行为仍不清楚。因此，本研究旨在对两种不同足部姿势下的 PA 行为进行可视化和量化：(i)中立姿势和(ii)中跗关节跖屈和跖趾关节背屈的辘轳姿势。六名健康成年男性参加了实验，并对 PA 进行了三维重建，以计算其路径长度、宽度、厚度和横截面积。这项研究成功地将辘轳机制引起的 PA 形态变化可视化和量化，为生物力学建模提供了精确的参考。这项研究还强调了 PA 形态和伸展模式的个体差异。虽然辘轳姿势与行走时推开阶段观察到的姿势并不完全相同，但观察到的 PA 行为为其力学提供了宝贵的见解，并对足部疾病具有潜在的影响。
{"title":"Direct visualization and measurement of the plantar aponeurosis behavior in foot arch deformation via the windlass mechanism","authors":"Yuka Matsumoto, Naomichi Ogihara","doi":"10.1002/ca.24171","DOIUrl":"https://doi.org/10.1002/ca.24171","url":null,"abstract":"The plantar aponeurosis (PA) is an elastic longitudinal band that contributes to the generation of a propulsive force in the push‐off phase during walking and running through the windlass mechanism. However, the dynamic behavior of the PA remains unclear owing to the lack of direct measurement of the strain it generates. Therefore, this study aimed to visualize and quantify the PA behavior during two distinct foot postures: (i) neutral posture and (ii) windlass posture with midtarsal joint plantarflexion and metatarsophalangeal joint dorsiflexion, using computed tomography scans. Six healthy adult males participated in the experiment, and three‐dimensional reconstruction of the PA was conducted to calculate its path length, width, thickness, and cross‐sectional area. This study successfully visualized and quantified the morphological changes in the PA induced by the windlass mechanism, providing a precise reference for biomechanical modeling. This study also highlighted the interindividual variability in the PA morphology and stretching patterns. Although the windlass posture was not identical to that observed in the push‐off phase during walking, the observed PA behavior provides valuable insights into its mechanics and potential implications for foot disorders.","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140626634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robin Baudouin, Angélique Amelot, Isabelle Huynh‐Charlier, Quentin Lisan, Stéphane Hans, Philippe Charlier
PurposeThe preserved head of King Henri IV of France (life 1553–1610, reign 1589–1610) has survived to the present day thanks to high‐quality embalming and favorable conservation conditions. The aim of this study was to examine Henry IV's upper resonant cavities and mastoids using an original and innovative forensic three‐dimensional segmentation method.MethodsThe paranasal sinuses and mastoid cells of King Henri IV of France were studied by cross‐referencing available biographical information with clinical and flexible endoscopic examination and computed tomography (CT‐scan) imaging. The paranasal sinuses and mastoid cells were delineated and their volumes were assessed using ITK‐SNAP 4.0 software (open‐source). Graphical representations were created using Fusion 360® (Autodesk Inc., San Rafael, CA, USA) and MeshMixer® (Autodesk Inc., San Rafael, CA, USA).ResultsParanasal sinus tomodensitometry revealed abnormalities in shape and number. Henri IV of France suffered from sinus aplasia. Neither the left sphenoid nor left frontal sinus contrasted sharply, and a remarkable pneumatization of the right clinoid processes extended throughout the height of the right pterygoid process. The total volumes of Henri IV's mastoid air‐cells were estimated at 27 and 26 mL, respectively, for the right and left sides, exceeding the normal mean and the maximum of modern subjects by a wide margin. No sign of chronic ear or sinus condition was found.ConclusionsAn innovative method has been developed in forensic medicine to establish hypotheses about the growth and respiratory conditions of the face.
目的法国国王亨利四世（1553-1610 年出生，1589-1610 年在位）保存至今的头颅得益于高质量的防腐处理和良好的保存条件。本研究的目的是使用一种原始、创新的法医三维分割方法来检查亨利四世的上共鸣腔和乳突。方法通过交叉引用现有的传记信息、临床和灵活的内窥镜检查以及计算机断层扫描（CT 扫描）成像，对法国国王亨利四世的副鼻窦和乳突细胞进行了研究。使用 ITK-SNAP 4.0 软件（开源）对副鼻窦和乳突细胞进行了划定和体积评估。使用 Fusion 360® (Autodesk Inc., San Rafael, CA, USA) 和 MeshMixer® (Autodesk Inc., San Rafael, CA, USA) 绘制了图形。法国亨利四世患有鼻窦发育不良。左侧蝶窦和左侧额窦都没有明显的对比，右侧蝶骨突的显著气化延伸至右侧翼突的整个高度。据估计，亨利四世乳突气室的总体积在左右两侧分别为 27 毫升和 26 毫升，大大超过了正常人的平均值和现代人的最大值。没有发现任何慢性耳部或鼻窦疾病的迹象。
{"title":"Three‐dimensional reconstruction of King Henri IV's paranasal sinuses and mastoid cells","authors":"Robin Baudouin, Angélique Amelot, Isabelle Huynh‐Charlier, Quentin Lisan, Stéphane Hans, Philippe Charlier","doi":"10.1002/ca.24172","DOIUrl":"https://doi.org/10.1002/ca.24172","url":null,"abstract":"PurposeThe preserved head of King Henri IV of France (life 1553–1610, reign 1589–1610) has survived to the present day thanks to high‐quality embalming and favorable conservation conditions. The aim of this study was to examine Henry IV's upper resonant cavities and mastoids using an original and innovative forensic three‐dimensional segmentation method.MethodsThe paranasal sinuses and mastoid cells of King Henri IV of France were studied by cross‐referencing available biographical information with clinical and flexible endoscopic examination and computed tomography (CT‐scan) imaging. The paranasal sinuses and mastoid cells were delineated and their volumes were assessed using ITK‐SNAP 4.0 software (open‐source). Graphical representations were created using Fusion 360® (Autodesk Inc., San Rafael, CA, USA) and MeshMixer® (Autodesk Inc., San Rafael, CA, USA).ResultsParanasal sinus tomodensitometry revealed abnormalities in shape and number. Henri IV of France suffered from sinus aplasia. Neither the left sphenoid nor left frontal sinus contrasted sharply, and a remarkable pneumatization of the right clinoid processes extended throughout the height of the right pterygoid process. The total volumes of Henri IV's mastoid air‐cells were estimated at 27 and 26 mL, respectively, for the right and left sides, exceeding the normal mean and the maximum of modern subjects by a wide margin. No sign of chronic ear or sinus condition was found.ConclusionsAn innovative method has been developed in forensic medicine to establish hypotheses about the growth and respiratory conditions of the face.","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140626956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammadali M. Shoja, Tara Tritsch, R. Shane Tubbs
During the 14th century CE, a pivotal shift took place in the world of medicine as its epicenter transitioned from the Middle East to Europe. The emergence of the European Renaissance sparked skepticism regarding the significance of Avicenna's contributions to the advancement of medicine. This paper explores how the rise of secularization and the Renaissance in Europe marked significant cultural transformations, fostering the spread of literacy. These societal shifts influenced the trajectory of medical thought, and Avicenna's “Canon of Medicine” received both praise and condemnation amidst the evolving intellectual landscape. In this context, Lorenz Fries composed his “Defense of Avicenna,” a testament to his profound admiration for Avicenna's legacy. This paper presents an English translation of Fries' 1530 work, and introduces Fries and Avicenna's “Canon,” contextualizing Fries' defense within the broader rejection of Arab-language medical texts in the 16th century. It also explores Avicenna's influence on European medicine and anatomy during the Renaissance and highlights the enduring relevance of his contributions to the annals of science. Fries' defense underscores Avicenna's methodological acumen and emphasizes the importance of a robust theoretical foundation in medical practice. Avicenna's integration of Aristotelianism with Platonism highlighted the necessity of a rigorous method informed by theory in medical analysis. Fries' defense remains relevant today, particularly in advocating for systematic medical analysis against subjective approaches. Avicenna's medical philosophy seems nested within a larger, hopeful attempt to resolve the tensions between science or naturalism and religion or spiritualism. The rejection of Avicenna reflects broader conflicts between Aristotelian and Neoplatonic traditions, suggesting a complex interplay of secularization and theological influences in shaping medical thought during the Renaissance.
{"title":"Lorenz Fries on the defense of Avicenna, the prince of physicians: Addressed to the medics of Germany (1530)","authors":"Mohammadali M. Shoja, Tara Tritsch, R. Shane Tubbs","doi":"10.1002/ca.24169","DOIUrl":"10.1002/ca.24169","url":null,"abstract":"<p>During the 14th century CE, a pivotal shift took place in the world of medicine as its epicenter transitioned from the Middle East to Europe. The emergence of the European Renaissance sparked skepticism regarding the significance of Avicenna's contributions to the advancement of medicine. This paper explores how the rise of secularization and the Renaissance in Europe marked significant cultural transformations, fostering the spread of literacy. These societal shifts influenced the trajectory of medical thought, and Avicenna's “Canon of Medicine” received both praise and condemnation amidst the evolving intellectual landscape. In this context, Lorenz Fries composed his “Defense of Avicenna,” a testament to his profound admiration for Avicenna's legacy. This paper presents an English translation of Fries' 1530 work, and introduces Fries and Avicenna's “Canon,” contextualizing Fries' defense within the broader rejection of Arab-language medical texts in the 16th century. It also explores Avicenna's influence on European medicine and anatomy during the Renaissance and highlights the enduring relevance of his contributions to the annals of science. Fries' defense underscores Avicenna's methodological acumen and emphasizes the importance of a robust theoretical foundation in medical practice. Avicenna's integration of Aristotelianism with Platonism highlighted the necessity of a rigorous method informed by theory in medical analysis. Fries' defense remains relevant today, particularly in advocating for systematic medical analysis against subjective approaches. Avicenna's medical philosophy seems nested within a larger, hopeful attempt to resolve the tensions between science or naturalism and religion or spiritualism. The rejection of Avicenna reflects broader conflicts between Aristotelian and Neoplatonic traditions, suggesting a complex interplay of secularization and theological influences in shaping medical thought during the Renaissance.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140610956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Damian Dudkiewicz, Maciej Lis, Artem Yakovliev, Jakub Hołda, Filip Bolechała, Marcin Strona, Paweł Kopacz, Mateusz K. Hołda
The complex anatomy of the aortic root is of great importance for many surgical and transcatheter cardiac procedures. Therefore, the aim of this study was to provide a comprehensive morphological description of the nondiseased aortic root. We morphometrically examined 200 autopsied human adult hearts (22.0% females, 47.9 ± 17.7 years). A meticulous macroscopic analysis of aortic root anatomy was performed. The largest cross-section area of the aortic root was observed in coaptation center plane (653.9 ± 196.5 mm2), followed by tubular plane (427.7 ± 168.0 mm2) and basal ring (362.7 ± 159.1 mm2) (p < 0.001). The right coronary sinus was the largest (area: 234.3 ± 85.0 mm2), followed by noncoronary sinus (218.7 ± 74.8 mm2) and left coronary sinus (201.2 ± 78.08 mm2). The noncoronary sinus was the deepest, followed by right and left coronary sinus (16.4 ± 3.2 vs. 15.9 ± 3.1 vs. 14.9 ± 2.9 mm, p < 0.001). In 68.5% of hearts, the coaptation center was located near the aortic geometric center. The left coronary ostium was located 15.6 ± 3.8 mm above sinus bottom (within the sinus in 91.5% and above sinutubular junction in 8.5%), while for right coronary ostium, it was 16.2 ± 3.5 mm above (83.5% within sinus and 16.5% above). In general, males exhibited larger aortic valve dimensions than females. A multiple forward stepwise regression model showed that anthropometric variables might predict the size of coaptation center plane (age, sex, and heart weight; R2 = 31.8%), tubular plane (age and sex; R2 = 25.6%), and basal ring (age and sex; R2 = 16.9%). In conclusion, this study presents a comprehensive analysis of aortic-root morphometry and provides a platform for further research into the intricate interplay between structure and function of the aortic root.
{"title":"Aortic root morphometry revisited—Clinical implications for aortic valve interventions","authors":"Damian Dudkiewicz, Maciej Lis, Artem Yakovliev, Jakub Hołda, Filip Bolechała, Marcin Strona, Paweł Kopacz, Mateusz K. Hołda","doi":"10.1002/ca.24165","DOIUrl":"10.1002/ca.24165","url":null,"abstract":"<p>The complex anatomy of the aortic root is of great importance for many surgical and transcatheter cardiac procedures. Therefore, the aim of this study was to provide a comprehensive morphological description of the nondiseased aortic root. We morphometrically examined 200 autopsied human adult hearts (22.0% females, 47.9 ± 17.7 years). A meticulous macroscopic analysis of aortic root anatomy was performed. The largest cross-section area of the aortic root was observed in coaptation center plane (653.9 ± 196.5 mm<sup>2</sup>), followed by tubular plane (427.7 ± 168.0 mm<sup>2</sup>) and basal ring (362.7 ± 159.1 mm<sup>2</sup>) (<i>p</i> < 0.001). The right coronary sinus was the largest (area: 234.3 ± 85.0 mm<sup>2</sup>), followed by noncoronary sinus (218.7 ± 74.8 mm<sup>2</sup>) and left coronary sinus (201.2 ± 78.08 mm<sup>2</sup>). The noncoronary sinus was the deepest, followed by right and left coronary sinus (16.4 ± 3.2 vs. 15.9 ± 3.1 vs. 14.9 ± 2.9 mm, <i>p</i> < 0.001). In 68.5% of hearts, the coaptation center was located near the aortic geometric center. The left coronary ostium was located 15.6 ± 3.8 mm above sinus bottom (within the sinus in 91.5% and above sinutubular junction in 8.5%), while for right coronary ostium, it was 16.2 ± 3.5 mm above (83.5% within sinus and 16.5% above). In general, males exhibited larger aortic valve dimensions than females. A multiple forward stepwise regression model showed that anthropometric variables might predict the size of coaptation center plane (age, sex, and heart weight; <i>R</i><sup>2</sup> = 31.8%), tubular plane (age and sex; <i>R</i><sup>2</sup> = 25.6%), and basal ring (age and sex; <i>R</i><sup>2</sup> = 16.9%). In conclusion, this study presents a comprehensive analysis of aortic-root morphometry and provides a platform for further research into the intricate interplay between structure and function of the aortic root.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ca.24165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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