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At least 523 records · Page 29Linked to original sources
PubMed2006

Three-dimensional rotational X-ray navigation for needle guidance in percutaneous vertebroplasty: an accuracy study.

STUDY DESIGN: The position of a needle tip displayed on a navigation system after transpedicular introduction into a vertebral body is compared with the real position of the needle tip when using a direct navigation coupling between a three-dimensional rotational X-ray (3DRX) system and a navigation system. OBJECTIVES: To assess whether the needle tip position displayed by the navigation system corresponds to the real needle position and to quantitatively determine needle navigation accuracy in a clinically relevant setting. SUMMARY OF BACKGROUND DATA: Image-guided navigation has reportedly increased the accuracy and safety of pedicle screw insertion and decreased complication rates. In former studies, the result of image-guided navigation was mainly compared qualitatively with the result of conventional fluoroscopy-guided procedures. Previously, a direct navigation coupling between a 3DRX system and a standard navigation system was introduced that bypasses the need for explicit patient-to-image registration necessary for image-guided orthopedic surgery. In a phantom experiment, the reported accuracy of navigation with the coupling to a 3DRX system was approximately 1 mm. However, in a clinical setting, additional errors can be introduced. METHODS: Twenty-three needles were placed transpedicularly into vertebral bodies of embalmed human trunks using 3DRX-guided navigation. The navigated needle tip positions were compared with the real needle tip positions manually extracted from 3DRX volumes acquired after completion of the introduction. RESULTS: The average distance between the navigated needle tip and the real position of the needle tip extracted from a postprocedure 3DRX volume was 2.5 +/- 1.5 mm. CONCLUSIONS: Accuracy of 3DRX-guided navigation is 2.5 +/- 1.5 mm in a clinically relevant setting, which is less than the accuracy determined in phantom experiments.

Aged, 80 and over↗
PubMed2007

High-field magnetic resonance imaging of meniscoids in the zygapophyseal joints of the human cervical spine.

STUDY DESIGN: Prospective in vitro study of meniscoids in the cervical zygapophysial joints. OBJECTIVES.: To assess the use of high-field magnetic resonance imaging (MRI) as a potential tool for evaluating meniscoids of the cervical zygapophysial joints. SUMMARY OF BACKGROUND DATA: Pain originating from the cervical spine is a frequent condition. It has been suggested that pathologic conditions of meniscoids within the zygapophysial joints may cause pain. METHODS: Six zygapophysial joints from one embalmed human body were investigated with a 3.0-T MR unit, equipped with a microimaging-set. MRIs were correlated with microanatomical sections. RESULTS: High-quality images of the meniscoids were obtained for all joints examined. There was a good correlation between the anatomic features derived from MRI and the microanatomical sections. CONCLUSIONS: High-field MRI was successfully implemented as a noninvasive method for imaging the meniscoids in cervical zygapophysial joints. The results of this in vitro study indicate that high-field MRI may be feasible in evaluating patients with cervical pain possibly related to meniscoid pathology.

Anatomy, Cross-Sectional↗
PubMed2006

Intrathecal movement and tension of the lumbosacral roots induced by straight-leg raising.

OBJECTIVE: To obtain quantitative biomechanical data on the effects of different angles of straight-leg raising on intrathecal movements and tensions in the lumbosacral nerve roots in human cadavers. DESIGN: Eight embalmed human cadavers with no gross spinal pathology and no limitations in hip motion were used. We performed reverse straight-leg raising by hanging the left leg down from the table with the knee extended while measuring the movement and tension of nerve roots L2, L3, L4, L5, and S1 in 10-degree intervals for straight-leg raising from 0 to 70 degrees. RESULTS: The mean intrathecal movements at 70 degrees were 0.55 mm, 0.54 mm, 0.96 mm, 1.54 mm, and 2.31 mm for roots L2, L3, L4, L5, and S1, respectively. The movements were statistically significant at >50 degrees for root L5 and at >40 degrees for root S1 (P < 0.05). The tension in the nerve roots with increasing angle of straight-leg raising increased from roots L2 to S1. The mean tensions at 70 degrees of straight-leg raising were 141.25 g, 168.75 g, 228.75 g, 280.00 g, and 493.75 g for roots L2, L3, L4, L5, and S1, respectively. The difference in tension was significant at >70 degrees for roots L2, L3, and L4 roots, at >40 degrees for root L5 root, and at >10 degrees for root S1 (P < 0.05). CONCLUSIONS: The intrathecal movement and tension of the lumbosacral roots induced by straight-leg raising were <2.5 mm and <500 g, respectively. The movement and tension induced by straight-leg raising tended to be greater in more distal segmental roots.

Biomechanical Phenomena↗
PubMed2004

Forearm compartment syndrome: anatomical analysis of surgical approaches to the deep space.

Forearm compartment syndrome is a surgical emergency that usually requires release of the superficial muscle compartments. In some clinical situations it is imperative to also explore the deep muscle compartments. There are no anatomical guides for surgical exploration of the deep compartments that would minimize collateral damage to surrounding vessels, nerves, and muscles. Surgical injury in the setting of ischemia, especially vascular injury, compounds the tissue damage that has already occurred. The authors evaluated four surgical approaches (three volar and one dorsal) to the deep forearm by performing detailed anatomical dissections on 10 embalmed and plastinated cadavers. They used a scoring system to rate the approaches for their ability to visualize the deep space without causing iatrogenic injury to superficial muscles, arteries, and nerves. In the volar forearm, an ulnar approach to the deep space is simple, causes the least iatrogenic surgical injury, and provides access to the deep volar forearm structures. The plane of dissection is between the flexor carpi ulnaris and the flexor digitorum superficialis. Dividing one or two distal segmental branches of the ulnar artery to the distal flexor digitorum superficialis exposes the pronator quadratus. Lifting the ulnar neurovascular bundle with the flexor digitorum superficialis in the middle third of the forearm exposes the flexor digitorum profundus and the flexor pollicis longus. This approach to the deep space requires no sharp dissection. In the dorsal forearm, a midline approach between the extensor digitorum communis and the extensor carpi radialis brevis is simple and safe.

Adult↗
PubMed2005

Organization and microscopic anatomy of the adult human facial nerve: anatomical and histological basis for surgery.

BACKGROUND: Despite the progress in microsurgical repair of the facial nerve, the results remain unpredictable and the structural anatomy of the facial nerve poorly understood. The aim of this study was to show how the connective tissue and the nerve fibers are distributed in a serial cross-section of the facial nerve from its origin to its termination. METHODS: Sixty facial nerves from 30 embalmed adult human cadavers were dissected for micro-anatomic study. The facial nerves were serially sectioned every 2 mm from the apparent origin and were prepared for light microscopy study. The endoneural fascicular arrangement was observed, the number of myelinated fibers was counted, and connective tissue was explored. RESULTS: There was an absence of real fascicular organization of the facial nerve in the pontocerebellar cistern and in the internal acoustic meatus. The real fascicular organization with perineurium and epineurium appeared from the geniculate ganglion. The number of fascicles increased in a proximo-distal way, and their diameter diminished. In the extratemporal part, some nerves had a low number of fascicles (two to six), and others had a high number of fascicles (seven to 15). The number of fascicles changed along the course of the facial nerve, especially in the extratemporal part. CONCLUSIONS: The truly fascicular structure appeared after the geniculate ganglion, and the rate of connective tissue progressed in a proximo-distal way. The high numbers of fascicles and the great structural variability of each facial nerve segment constitute a difficulty in nerve repair.

Adult↗
PubMed2005

Anatomy of Y-shaped configurations in the subscapular arterial system and clinical application to harvesting flow-through flaps.

BACKGROUND: A flow-through flap is useful in cases where the recipient artery must not be sacrificed. The aim of this study was to investigate Y-shaped configurations in the subscapular arterial system that can safely be used in harvesting a flow-through flap from the scapular region. METHODS: Sixteen dissections of the subscapular arterial system were carried out in eight embalmed cadavers. The origins and external diameters of branches in the subscapular arterial system were recorded. The distances between the origins of each branch were measured. RESULTS: The branches that showed a consistent presence and had a reliable diameter of more than 1.0 mm were the circumflex scapular artery, the bony branch of the circumflex scapular artery, the thoracodorsal artery, the angular branch, and branches to the serratus anterior and latissimus dorsi muscles. It was demonstrated that using the Y-shaped configuration between these branches enables the harvesting of a flow-through flap in various length versions of the Y-shaped vascular pedicles. A significant anatomical variation (i.e., both the thoracodorsal and circumflex scapular artery arose directly from the axillary artery) was found in three of 16 dissections. In this vascular variation, sacrificing the axillary artery must be avoided, so Y-shaped pedicles using the origin of the thoracodorsal or circumflex scapular artery cannot be created. On the basis of these results, flow-through flaps using this arterial system were applied in 10 patients for reconstruction of lower extremities, and satisfactory results were obtained. CONCLUSIONS: The results of our study are available for determining preoperatively and intraoperatively which Y-shaped configuration to use in harvesting a flow-through flap from the scapular region.

Adolescent↗
PubMed2003

Innervation of calf muscles in relation to calf reduction.

Plump and muscular calves, a so-called radish-like leg, embarrass young women and cause a feeling of inferiority in Korea. Damage to motor nerves innervating a muscle makes the muscle paralyzed and dystrophic, with loss of muscle volume. The authors studied the morphometry of the motor branches of the tibial nerve innervating the gastrocnemius and soleus muscle and sensory medial sural cutaneous nerve in popliteal fossa. Dissection and exploration of the tibial nerve were performed in the popliteal fossae of 70 legs (of 18 males and 17 females) of embalmed Korean cadavers. The main branch of the tibial nerve innervating medial and lateral gastrocnemius muscle originated 3 cm above and below the popliteal crease. The medial gastrocnemius muscle had an additional nerve (49%). The medial sural cutaneous nerve came off the nerve into the medial gastrocnemius muscle (30%) and diverged 5.5 mm from the tibial nerve. The nerve into the soleus muscle originated from the nerve innervating the lateral gastrocnemius muscle (30%) and was 12.3 mm away from it. Surgeons should keep in mind that the medial sural cutaneous nerve originates from the nerve to medial gastrocnemius in 30% and the nerve to soleus muscle originates from the nerve to lateral gastrocnemius in 30%.

Cadaver↗
PubMed2003

The effect of an attachable lateral support plate on the stability of intertrochanteric fracture fixation with a sliding hip screw.

BACKGROUND: Use of a sliding hip screw (SHS) alone for some unstable intertrochanteric femur fractures can allow excessive medial shaft displacement during impaction. This study evaluated the effect of an attachable lateral support plate on these fractures after loading. METHODS: Unstable, three-part intertrochanteric fractures were created in 10 matched pairs of embalmed femurs that were instrumented with 135-degree SHSs with or without an attachable lateral support plate. Under physiologic loading, inferior and lateral head displacements and lag screw sliding distances were measured. RESULTS: After 10,000 cycles at 750 N, all measurements for femurs with the lateral support plate were significantly less than for the femurs with the SHS alone: mean lateral difference was 1.7 mm (34%) (p < 0.05), mean inferior difference was 3.0 mm (38%) (p < 0.05), and mean lag screw sliding difference was 4.5 mm (58%) (p < 0.05). CONCLUSION: The addition of an attachable lateral support plate to an SHS significantly decreased displacement of the femoral head after cyclic loading.

Bone Screws↗
PubMed2004

Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating.

BACKGROUND: Bicondylar tibial plateau fractures are complex injuries, historically associated with high complication rates. The purpose of this study was: 1) to evaluate the clinical use L.I.S.S plating system for stabilization of bicondylar tibial plateau fractures. 2) To compare the biomechanics of this plating system with a double plate construct. METHODS AND MATERIALS: Thirty-eight patients who sustained a complex tibial plateau fracture (OTA type 41C) at one of three level-one trauma centers were stabilized using the Less Invasive Stabilization System (L.I.S.S.). The cohort of patients was evaluated clinically and radiographically for outcomes at a mean 15 months. In phase 2 of this study a model of a bicondylar tibial plateau fractures was made in six matched pairs of embalmed, human tibia and randomized to fixation with either a L.I.S.S plate or a standard double plate construct. The tibias were then subjected to an axial cyclic load of 500N for 10 cycles (3Hz) to approximate 2 months in vivo and displacements measured. RESULTS: Thirty-six of /38 (95%) patients united at 4 months after surgery with no loss of fixation nor infection. Two patients underwent prophylactic autogenous bone grafting for bone loss and united by 3 months postgrafting. Significant loss of knee range of motion (<90) was seen in five patients.Biomechanically, no differences in permanent inferior displacement of the medial fragment were found in initial axial loading and after 10 cycles between the two plate constructs. However, when loaded to 500N the L.I.S.S plate construct demonstrated almost twice the displacement of the medial fragment compared with the dual plate construct. No specimen lost fixation during cycling. CONCLUSION: The L.I.S.S plating system provides stable fixation of complex bicondylar tibial plateau fractures allowing early range of knee motion with favorable clinical results.

Adult↗
PubMed2005

Cyclic loading of sacroiliac screws in Tile C pelvic fractures.

BACKGROUND: To investigate the stiffness and strength of completely unstable pelvic fractures fixated both anteriorly and posteriorly under cyclic loading conditions, the authors conducted a randomized, comparative, cadaveric study. METHODS: In 12 specimens, a Tile C1 pelvic fracture was created. The authors compared the intact situation to anterior plate fixation combined with one or two sacroiliac screws. In 2,000 measurements, each pelvis was loaded with a maximum of 400 N. The translation and rotation stiffness of the fixations were measured using a three-dimensional video system. Furthermore, the load to failure and the number of cycles before failure were determined. RESULTS: Both translation and rotation stiffness of the intact pelvis were superior to the fixated pelvis. No difference in stiffness was found between the techniques with one or two sacroiliac screws. However, a significantly higher load to failure and significantly more loading cycles before failure could be achieved using two sacroiliac screws compared with one screw. CONCLUSION: Although the combination of anterior plate fixation combined with two sacroiliac screws is not as stable as the intact pelvis, in this study, embalmed aged pelves could be loaded repeatedly with physiologic forces. Given the fact that the average trauma patient is younger and given the fact that the quality (or grip) of the fixation was a significant covariable for longer endurance of the fixation, this suggests that direct postoperative weight bearing could be possible if these results are confirmed in further research.

Bone Screws↗
PubMed1992

Modelling mechanically stable muscle architectures.

This paper presents a planar architectural model for an activated skeletal muscle, with mechanical equilibrium throughout the muscle belly. The model can predict the shape of the muscle fibres and tendinous sheets as well as the internal pressure distribution in the central longitudinal plane (perpendicular to the tendinous sheets) of uni- and bipennate muscle bellies. Mechanically stable solutions for muscle architectures were calculated by equating the pressure developed by curved muscle fibres with the pressure under a curved tendinous sheet. The pressure distribution under a tendinous sheet is determined by its tension, its curvature and the tensile stress of the attached muscle fibres. Dissections showed a good resemblance of the architecture of embalmed muscles with those from our simulations. Calculated maximum pressures are in the same order of magnitude as pressure measurements from the literature. Our model predicts that intramuscular blood flow can be blocked during sustained contraction, as several experimental studies have indeed demonstrated. The volume fractions of muscle fibres and interfibre space in the muscle belly were also calculated. The planar models predict a too low volume fraction for the muscle fibres (about 45% for the bipennate models with a straight central aponeurosis, and about 60% for the simulated unipennate muscle). It is discussed how, in a real muscle, this volume problem can be solved by a special three-dimensional arrangement of muscle fibres in combination with varying widths of the tendinous sheets.

Animals↗
PubMed2004

Superficial palmar arch: an arterial diameter study.

Although anatomical variations in the arterial pattern of the hand have been the subject of many studies, information on the diameter of the superficial palmar arch contributing vessels and its branches are rarely found in the literature. The objective of the current study was to evaluate these arterial variations, with special attention to the diameter of the superficial palmar arch contributing vessels and its major branches. Forty-six hands from male embalmed human cadavers were evaluated, 21 right hands and 25 left hands. Complete arches were present in 43% on the right and in 52% on the left. Arches were completed by the median artery in two cases. Variations were more common at the radial side of the arch and on left hands. Comparison of vessel diameters revealed the radial artery to be significantly larger than the ulnar artery but the ulnar artery to be larger than the superficial branch of the radial artery. The diameters of the common digital arteries were not different with regard to complete or incomplete arches, or with regard to the presence of the median artery.

Arteries↗
PubMed2005

Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff.

The I-gel airway is a novel supraglottic airway that uses an anatomically designed mask made of a gel-like thermoplastic elastomer. We studied the positioning and mechanics of this new device in 65 non-embalmed cadavers with 73 endoscopies (eight had repeat insertion), 16 neck dissections, and six neck radiographs. A full view of the glottis (percentage of glottic opening score 100%) occurred in 44/73 insertions, whereas only 3/73 insertions had epiglottis-only views. Including the eight repeat insertions with a different size, a glottic opening score of > 50% was obtained in all 65 cadavers. The mean percentage of glottic opening score for the 73 insertions was 82% (95% confidence interval 75-89%). In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. We found that the I-gel effectively conformed to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation.

Epiglottis↗
PubMed1993

Disc movements over the condylar head. Radiographical study on autopsy materials.

A radiographical study has been performed to evaluate the movement of the disc posterior band over the condylar head during mandibular opening. Six formal free embalmed subjects were selected as 'normal'. Micro stainless steel balls were used as landmarks both into the bone and into the disc for X-ray identification. The data was processed at each phase of movement in selected planes. The true coordinates of each disc landmark gave the potential to calculate the linear length of their path and any distance change between them. It can be concluded that there is a 5% width reduction during the opening movement and it also suggests strongly that a fair amount of translation movement between the disc and the condyle occurs in the lower compartment.

Cadaver↗
PubMed1991

Dural sinuses in the camel and their extracranial venous connections.

The dural sinuses of one-humped camel (Camelus dromedarius) and their connections with veins of the head and neck were described and, whenever possible, were compared with other domestic animals emphasizing species differences. Information obtained from gross dissection of embalmed camel heads was correlated with latex injected vascular casts, as well as venographs. Although the disposition of the dural sinuses, in general, was similar to those of other domestic animals, they were somewhat complex in the camel. An important venous flow mechanism which functions in the thermoregulation of the brain in the camel was described. The venous drainage of the nasal cavity and its surrounding areas had five connections with the ophthalmic plexus and the cavernous sinus: (1) the infraorbital vein----ophthalmic plexus; (2) the medial superior palpebral vein----ophthalmic plexus; (3) the medial inferior palpebral vein----ophthalmic plexus; (4) the angularis oculi----frontal----supraorbital----dorsal external ophthalmic----emissary vein of the foramen orbitorotundum----cavernous sinus; and (5) the deep facial vein----ventral external ophthalmic----emissary vein of the foramen orbitorotundum----cavernous sinus.

Animals↗
PubMed1991

Development and variation of the lateral vertebral foramen of the atlas in dogs.

Postnatal development and variation of the bony cranial border of the lateral vertebral foramen (LVF) of the atlas was studied in 96 dogs. Developmental ossification was investigated in 8 known-aged Miniature Schnauzer pups, after each atlas was prepared either as an alizarin-red stained clearing or as a dried cleaned bone. Variation was investigated in 63 atlases from mature dogs and by study of radiographs from 25 mature dogs of various breeds. The soft tissue structures passing through the LVF and attaching to its cranial border were dissected in an additional 2 embalmed and 2 fresh cadavers. In 2-week-old pups, the LVF was represented by a notch in the cranial margin of the bony arch of the atlas, with a cartilage bar completing the foramen cranially. Between 6 and 16 weeks the bar forming the cranial bony border of the LVF ossified in its preexisting cartilage anlage. In mature dogs, the LVF was present in the craniolateral aspect of the arch of the atlas and was recognized on lateral radiographs. The vertebral artery and vein, and first cervical nerve passed through the LVF and the atlantooccipital joint capsule and dorsal membrane attached to the cranial border of the LVF. In one dog the cranial border of the LVF of the atlas was incompletely ossified bilaterally. This developmental variant was compared with variations in man and other mammals, and with proatlas neural arch derivatives.

Animals↗
PubMed2006

Anatomical variations of the common carotid artery bifurcation.

BACKGROUND: The correlation of the common carotid artery (CCA) bifurcation and its surrounding structures is poorly described. The aim of this study was to describe the anatomy of the CCA bifurcation relative to its surrounding structures. METHOD: We dissected a total of 67 carotid specimens from 36 embalmed cadavers. CCA bifurcation occurred at the superior border of thyroid cartilage in 39% and at the body of hyoid bone in 40% of specimens. RESULTS: The superior thyroid artery arose more commonly from the CCA (52.3%) than the external carotid artery (46.2%). The vagus nerve was posterior to the carotid bifurcation in 40 (60%), posterior-lateral in 24 (36%), posterior-medial in 2 (3%) and anterior-lateral in 1 specimen (1.5%). The hypoglossal nerve was closer to the CCA bifurcation when the CCA bifurcated at the level of the hyoid bone than when it bifurcated at the superior border of the thyroid cartilage (P < 0.05). The correlation of the common facial vein and the carotid artery was highly variable. CONCLUSION: The presence of a high CCA bifurcation should caution surgeons that the hypoglossal nerve lies in closer proximity and is more vulnerable. Preoperatively documenting the level of the CCA bifurcation may be helpful in identifying those patients at increased risk of iatrogenic injury.

Aged↗
PubMed2005

Some variations of the musculus flexor digitorum brevis.

The aim of the present study was to investigate variations of the musculus flexor digitorum brevis. We examined 33 feet in total from 15 embalmed adult cadavers and three lower extremities. Of the 33 feet examined, 18 differed from the classical description given in anatomical textbooks. The muscle belly for the fifth toe was much smaller than the others in 12 feet and was missing in six feet. Two cases had extreme variations. In the left foot of one female cadaver, the flexor digitorum brevis was formed by a superficial and deep head, which had three muscle bellies and four tendons. In the right foot, a separated muscle belly for the fifth toe was very thin and originated from the intermuscular septum as a flat fascia under the flexor digitorum brevis. In another case (male), three heads (lateral, intermediate and medial) formed the quadratus plantae and the lateral and intermediate heads fused with the flexor digitorum brevis. Variation of the flexor digitorum brevis may be important clinically because of reconstruction of the heel pad by flexor digitorum brevis musculocutanous flap transfer.

Cadaver↗