ObjectiveTo describe the path of the infrapatellar branch of the saphenous nerve (IBSN) using the medial joint line, anterior tibial tuberosity (ATT), tibial collateral ligament and a horizontal line parallel to the medial joint line that passes over the ATT, as reference points, in order to help surgeons to diminish the likelihood of injuring this nerve branch during reconstruction of the anterior cruciate ligament (ACL) using flexor tendons.MethodsTen frozen knees that originated from amputations were examined. Through anatomical dissection performed with the specimens flexed, we sought to find the IBSN, from its most medial and proximal portion to its most lateral and distal portion. Following this, the anatomical specimens were photographed and, using the ImageJ software, we determined the distance from the IBSN to the medial joint line and to a lower horizontal line going through the ATT and parallel to the first line. We also measured the angle of the direction of the path of the nerve branch in relation to this lower line.ResultsThe mean angle of the path of the nerve branch in relation to the lower horizontal line was 17.50 ± 6.17°. The mean distance from the IBSN to the medial joint line was 2.61 ± 0.59 cm and from the IBSN to the lower horizontal line, 1.44 ± 0.51 cm.ConclusionThe IBSN was found in all the knees studied. In three knees, we found a second branch proximal to the first one. The direction of its path was always from proximal and medial to distal and lateral. The IBSN was always proximal and medial to the ATT and distal to the medial joint line. The medial angle between its direction and a horizontal line going through the ATT was 17.50 ± 6.17°.
ObjectiveThe main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions.Method100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively.ResultsNerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2).ConclusionKnowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.
Resumo: Este é o primeiro de dois artigos, em que se discorre sobre o contexto em que as análises de sensibilidade devem ser realizadas (parte I) e a execução da análise de sensibilidade probabilística no Microsoft Excel (parte II). A análise de custo-efetividade (ACE) e suas variantes são metodologias de análise econômica completa, que apresentam um grau de incerteza inerente à construção de modelos de decisão analítica. Assim, é fundamental demonstrar a adequação e robustez dos resultados obtidos por meio da análise de sensibilidade. Dois métodos de análise de sensibilidade são amplamente utilizados em estudos de ACE: I-análise univariada determinística, que avalia um parâmetro por vez do modelo matemático, alterando o seu valor dentro de um intervalo pré-especificado, e II-análise de sensibilidade probabilística, que é capaz de levar em conta todos os parâmetros do modelo de uma única vez, respeitando a distribuição estatística que corresponde à natureza de cada parâmetro. Nesse primeiro artigo, descrevemos o conceito de análise de sensibilidade probabilística de maneira pragmática no contexto dos estudos de custo-efetividade e ilustramos o racional por trás das duas principais curvas de distribuição estatística utilizadas na farmacoeconomia, curvas Gama e Beta, e como calcular os seus hiperparâmetros.
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