Scapulothoracic and scapholunate dissociation in the ipsilateral upper limb of a trauma victim

Scapulothoracic dissociation is a rare and complex injury pattern with varied presentation.Here we describe a case of a 32-year-old male who presented with scapulothoracic dissociation associated with brachial plexus injury,along with scapholunate dissociation.We also propose an injury mechanism that might link the two injury patterns,suggesting that the association might be more than by chance.The patient was managed according to established trauma care and resuscitation protocols followed by open reduction and internal fixation of the clavicle fracture,and fixation of scapholunate dissociation and had a successful outcome at follow-up.     

Sternalis muscle,what every anatomist and clinician should know

The sternalis muscle is a well documented but rare muscular variation of the anterior thoracic wall. It lies between the superficial fascia and the pectoral fascia and is found in about 8% of the population. It presents in several morphological variants both unilaterally and bilaterally and has no apparent physiological function. There is still much disagreement about its nerve supply and embryological origin. With the advent of medical imaging and thoracic surgery the clinical importance of this muscle has been re‐emphasized. It has been implicated in misdiagnosis of breast masses on routine mammograms owing to its parasternal location and relative unfamiliarity among radiologists. When undetected before any thoracic surgery, it has the potential to interfere with and prolong such procedures. When present and detected preoperatively it can be used as a muscular flap in reconstructive surgeries of the breast and neck. This article will present the sternalis muscle with special emphasis on its morphology, homology, and clinical significance. Clin. Anat. 27:866–884, 2014. © 2014 Wiley Periodicals, Inc.     

应用钛板、钛网行胸骨柄肿瘤切除胸壁重建术13例临床分析

目的探讨胸骨柄肿瘤切除术后,应用钛板、钛网行胸壁重建术的临床效果及患者的生活质量。方法回顾性分析13例2012年1月至2016年12月期间中山医院收治的原发性、继发性胸骨柄肿瘤病例,其中男8例,女5例,中位年龄56岁(41~72岁),原发性胸骨柄肿瘤11例,纵膈肿瘤侵犯胸骨柄1例,乳腺癌转移至胸骨柄1例。行外科手术切除肿瘤后即刻应用钛板、钛网行胸壁重建修复。以欧洲五维健康量表(EQ-5D)和EQ-5D直观模拟评分量表(ED-VAS)评估患者术前、术后3个月时的生活质量,并于术后3个月拍摄CT。以Wilcoxon秩和检验进行数据分析。结果所有患者手术均顺利完成,12例围手术期无严重并发症、无死亡,切口一期愈合,术后恢复好;1例术后出现反常呼吸,予呼吸机支持,术后9 d反常呼吸消失。13例患者术后3个月的CT显示钛板、钛网无移位,无变形。均无明显上肢功能障碍。中位随访时间为25个月(7~41个月),1例软骨肉瘤患者因复发于术后11个月死亡。EQ-5D评分中疼痛或不适一项,术前为(1.85±0.80)分,术后为(1.15±0.38)分,差异具有统计学意义(P=0.013)。其余4个维度手术前、后得分差异无统计学意义(P>0.05)。术前EQ-5D问卷总分为(7.08±2.02)分,术后为(5.45±0.52)分,差异具有统计学意义(P=0.010)。术前ED-VAS得分(85.69±7.58)分,术后为(92.54±2.53)分,差异具有统计学意义(P=0.008)。结论钛板、钛网应用于胸骨柄肿瘤切除即刻胸壁重建,是安全有效的方法,可提高患者生活质量。     

Advantages of the triangularis sterni muscle of the mouse for investigations of synaptic phenomena

The triangularis sterni muscle (TS) of the mouse is a thin trapezoidal sheet of fibres in which individual neuromuscular junctions are easily observed with Nomarski optics. Thus, microelectrodes are readily positioned to accurately record various synaptic phenomena. For example, miniature end-plate currents were easily recorded with a focally positioned extracellular electrode and the end-plate sensitivity to acetylcholine averaged 2062 mV/ nC. In addition, the intercostal nerves segmentally innervate the TS. Electrophysiologic and histologic analysis showed that each nerve innervates a sharply defined territory of the muscle surface. These preliminary observations suggest that the TS may be ideal for studies of synaptic function and the processes underlying synapse stabilization in the mammal.     

Homology of the manubrium ofMrazekia brevicauda and the polar filament of other Microsporidia

The genusMrazekia differs from other Microsporidia in its unusual spores which are about ten times as large as other microsporidian spores and contain a rod-like structure, called the manubrium, instead of the classical polar filament. Ultrastructure and development of the manubrium have been studied and compared with the polar filament of other Microsporidia. It was found that the manubrium and polar filament correspond in many structural and developmental details. They are therefore considered to be homologous structures.This investigation is dedicated to Prof. G. Piekarski on the occasion of his 70th anniversary. Supported by Deutsche Forschungsgemeinschaft (Go 165/11)     

The Transmanubrial Approach for Cervicothoracic Junction Lesions : Feasibility,Limitations, and Advantages

Objective

We report on the technical feasibility and limitations of the transmanubrial approach for cervicothoracic junction (CTJ) lesions and emphasize the advantage of bisecting the upper part of the manubrium in an inverted Y-shape.

Methods

Thirteen patients who underwent the fourteen transmanubrial approach for various CTJ lesions were enrolled during 2005-2014. For the evaluation of the accessibility for the CTJ lesion, we analyzed the two parallel line defined as a straight line parallel to the inferior and superior plateau of the upper and lower healthy vertebrae, the angle of the two parallel lines and the distance from the sternal notch to lines at the sternum on preoperative magnetic resonance images. Surgical limitations and perspectives, as well as postoperative clinical outcomes were evaluated retrospectively.

Results

The CTJ lesions were six metastases, three primary bone tumors, two herniated discs, and one each of a traumatic dislocation with syrinx formation and tuberculous spondylitis and ossification of the posterior longitudinal ligament. If two parallel lines pass below the sternal notch, the manubriotomy should be inevitably performed. The mean preoperative Visual analogue scale score was 8 (range, 5-10), which improved to 4 (range, 0-6) postoperatively. Seven cases showed an increase in Frankel score postoperatively.

Conclusion

The spatial relationship between the sternal notch and the two parallel lines to the lesion was rational to determine the feasibility of manubriotomy. The transmanubrial approach for CTJ lesions can achieve favorable clinical outcomes by providing direct decompression of lesion and effective reconstruction.     

胸骨柄松质骨结合钛网植骨在颈椎前路术中应用的可行性研究

目的:测量国人胸骨柄标本及无明显退变的颈椎X线侧位片,探讨胸骨柄内松质骨结合钛网植骨在颈椎前路手术中的应用.方法:40具胸骨柄标本测量,测量指标有:胸骨柄长,胸骨柄最大宽,胸骨柄最小宽,胸骨柄厚,胸骨柄前皮质厚,胸骨柄后皮质厚,计算胸骨柄体积.后将胸骨柄长、胸骨柄最大宽、最小宽每边减去4mm,胸骨柄前、后皮质骨减去1mm作为胸骨柄内松质骨取骨区(以下简称供区)边界,并计算胸骨柄内供区的体积.然后测量106例无明显退变的中立位颈椎侧位X线片:C2-3-C7-T1椎间隙和C3-C7椎体高度,并计算常规颈椎前路术中单间隙、双间隙、三间隙椎间盘切除,一个椎体加两个椎间盘及两个椎体加三个椎间盘切除所需钛网长度和钛网内所需植骨体积.探讨供区内松质骨是否满足临床需要.结果:胸骨柄体积为17735.51±5231.93 mm3,供区松质骨体积为8982.83±2437.56 mm3,颈椎前路术中单间隙,双间隙,三间隙椎间盘切除,一个椎体加两个椎间盘和两个椎体加三个椎间盘切除所需钛网长度和钛网内所需植骨体积分别为:5.27～6.38 mm,11.38～12.35 mm,16.64～18.45 mm,23.36～26.26 mm,41.06～43.75 mm;413～508 mm3,852～979mm3,1307～1460mm3,1748～1952mm3,3105～3277mm3.因此颈椎前路常用的任意一种术式中,钛网内所需盛骨体积均明显小于供区体积.结论:胸骨柄内松质骨结合钛网支撑可满足大多数颈椎前路融合术中的植骨需求.与自体髂骨植骨相比,操作更简单方便,不影响患者早期功能锻炼和负重行走.     

中国北方成年人由胸骨长度推算身高的回归方程

收集中国北方28具(男15、女13)汉族成年人尸体材料,调查了尸体身高、胸骨全长、胸骨柄长、及胸骨体长的均值,并计算了胸骨的长度与身高的相关系数。胸骨全长、胸骨柄长及胸骨体长与身高的相关系数,男女合计分别为0.8630、0.7122、0.8395,表明皆为高度相关。其中男、女分别计算男性分别为0.7157、0.5789、0.5669,女性分别为0.6111、0.5630、0.6122,表明除男性胸骨全长高度相关外,其余皆为中度相关。在相关的基础上,又算出由胸骨长度估计身高的9个回归方程式。由胸骨全长推算身高的回归方程式,较由胸骨柄长和胸骨体长推算身高的回归方程式,有较高的相关系数和较低的标准估计误差。由胸骨体长推算也较由胸骨柄长推算为佳。由骨的长度来推算身高,所用骨的长度越长,相关系数越高,标准估计误差越低,其推算的身高越接近于实际。     

Corpus Sterni Reinforcement Improves the Stability of Primary Sternal Closure in High-Risk Patients

Purpose To compare standard sternal closure techniques with reinforcement longitudinal wire placement in the corpus sterni in high-risk patients undergoing open-heart surgery via median sternotomy. Methods The subjects of this study were 71 high-risk patients, 32 (45%) of whom underwent sternal closure by conventional methods (group 1) and 39 (55%) of whom underwent sternal closure with corpus sterni reinforcement. The patients were followed up for a mean period of 90 days. Results In group 2, none of the patients had sternal dehiscence and no revision was required, but in group 1, five (15.5%) patients had sternal dehiscence. This difference was significant between the groups (P = 0.024), but there were no significant differences in mediastinitis and mortality (P > 0.05). Conclusions Our findings suggest that primary sternal closure with longitudinal wire reinforcement on both sides of the corpus sterni will decrease the risk of infection and improve wound-healing in parallel with a decrease in sternal dehiscence.     

Radiology of postnatal skeletal development

Thirty-six manubriosternal composites from skeletally immature cadavers were examined morphologically and radiographically. Sternebral ossification followed certain patterns. The manubrium (first sternebra) usually had one primary ossification center and one or two smaller centers. These usually were caudad to the major center (longitudinally bifid). The second sternebra invariably had only one ossification center. The third and fourth sternebrae had latitudinal (right-left) bifid ossification centers, undoubtedly a result of the original formation of the sternum from two longitudinal mesenchymal anlagen. Occasionly the fourth sternebra exhibited longitudinally bifid ossification. The usual pattern was ossification of four sternebrae, although a fifth was intermittently present. The xiphisternum (not a true sternebra) was infrequently ossified.