肋骨的解剖学、影像学测量及肋骨解剖钢板的研制和生物力学测定

发布时间：2018-01-12 13:03

本文关键词：肋骨的解剖学、影像学测量及肋骨解剖钢板的研制和生物力学测定　出处：《中南大学》2007年硕士论文　论文类型：学位论文

【摘要】： 第一章肋骨的解剖学与影像学测量目的：在对胸廓外科学分区基础上，挑选第6肋进行解剖学与影像学测量，对两种方法测量结果进行比较，为研制肋骨解剖型钢板提供技术参数。方法：选取6具成人胸廓湿标本(男3、女3)，观察标本大体形态、肋间肌及肋间血管神经走行。以各肋骨肋角连线和肋沟消失点连线即体表投影相当于脊柱旁线偏外侧和腋前线为分界，将胸廓分为前区(AA)、侧区(LA)和后区(PA)。挑选骨折多发的第6肋作为研究对象，用影像学和解剖学两种方法测量各标本双侧第6肋肋横突结合部的长度、宽度、厚度；横突和肋结节在冠状面所成角度，水平面所成角度，肋结节长度，肋结节与肋骨所成角度；各区肋骨的弧度，各区肋骨的长度即弧长，各区肋骨中点宽度、厚度、骨皮质的厚度、肋沟宽度；前后扭转角度。结果：整个胸廓是一个复杂的三维立体结构，肋间血管走行于肋沟，肋沟消失于腋前线处。第6肋肋骨弧长以侧区最大167.28±1.98mm，弧度以后区最大133.14±3.61°，肋骨宽度以侧区最大14.57±0.62mm，厚度以前区最大6.86±0.30mm，皮质厚度以侧区最大4.54±0.16mm，后区肋沟最宽6.23±0.26mm，前区无肋沟，，后扭转角24.14±0.49°大于前扭转角，P＜0.05。肋横突结合部长度为14.48±0.200mm，宽度为11.60±0.35 mm，厚度为14.86±0.24 mm，肋结节长度为15.02±0.32mm；横突与肋结节冠状面成角143.09±1.86°，水平面成角144.21±1.56°，肋结节与肋骨水平面成角166.07±1.88°。CT和解剖学两种测量方法测量的结果无显著统计学差异。结论：(1)本研究在已有的肋骨外科学分区研究基础之上，选择性对第6肋各区段进行了解剖学与影像学研究，为设计并研制各区段解剖学钢板提供实验依据，也为其他肋骨的研究打下基础。 (2)解剖学和影像学两种测量方法无统计学差异，临床上术前可用CT三维重建对肋骨进行较准确的测量，以满足手术的需要。第二章肋骨解剖钢板的研制和生物力学测定目的：根据解剖学与影像学研究结果，设计并生产第6肋各区解剖钢板，并对钢板生物力学特性进行评价，为进一步临床应用提供理论依据。方法：选用普通不锈钢，按照解剖学和影像学测量结果，设计加工成第6肋各区普通解剖钢板和锁定解剖钢板。取8具成人(5男，3女)胸廓湿标本的双侧第6肋(共16肋)，每肋制成肋椎关节及后扭转角段、侧段、前段、前扭转角段等四段标本，每段长120mm。于每段中点用钢锯横形锯断，制造骨折模型。肋椎关节及后扭转角标本只单用自行设计的普通型和锁定型肋椎关节解剖钢板固定，并相互比较。其余区段用四种不同内固定，2具标本用相应普通型解剖钢板固定，2具用相应锁定型解剖钢板固定，2具用1mm克氏针(两枚)固定作为对照，2具用重建钢板固定作为对照。对上述每段标本均行非破坏性三点弯曲试验和扭转试验。另选取各区解剖钢板各两块，其中一组进行破坏性弯曲试验，另一组进行破坏性扭转试验。结果：各解剖钢板最大抗弯曲力分别为，肋椎关节及后扭转角钢板185.41±3.81N，前区钢板217.40±3.55N，侧区钢板200.69±4.14N，前扭转角钢板206.25±3.81N。最大抗扭转能力分别为，肋椎关节及后扭转角钢板4.12±0.92Nm，前区钢板3.47±0.11Nm，侧区钢板3.76±0.47Nm，前扭转角钢板3.65±0.02Nm。解剖钢板抗弯曲能力和抗扭转能力优于克氏针，差于重建钢板(P＜0.05)。普通解剖钢板和锁定解剖钢板抗扭转和抗弯曲能力无统计学差异。结论：(1)普通解剖钢板和锁定解剖钢板抗扭转与抗弯曲性能优于克氏针，能够作为肋骨骨折的固定材料。 (2)普通解剖钢板和锁定解剖钢板在生物力学性能上无显著差异，而锁定解剖钢板只需穿过单侧皮质，提高了手术安全性。
[Abstract]:The anatomic and imaging measurements of the ribs in the first chapter
Objective: Based on the division of thoracic surgery, sixth ribs were selected for anatomical and imaging measurement, and the results of two methods were compared, so as to provide technical parameters for the development of ribs anatomical steel plate.
Methods: 6 cases of adult thoracic wet specimens (male 3, female 3), to observe the gross morphology, intercostal muscles and nerves. Intercostal vessels to the rib and rib groove angle line of vanishing points is equivalent to the surface projection of the lateral paravertebral and anterior axillary line as the dividing line, will be divided into the anterior thoracic area (AA), lateral area (LA) and posterior (PA). Select multiple fractures sixth ribs as the research object, by imaging and anatomy of two measuring methods of various samples of bilateral sixth rib rib with the length, width, thickness and angle; transverse rib nodules formed in the coronal plane level, angles, tubercle of rib length and the angle of tubercle of rib rib; the rib rib length is the arc, the arc length, the width of rib thickness, the midpoint, the thickness of cortical bone, rib groove width; torsion angle before and after.
Results: the whole thorax is a complex three-dimensional structure, the blood vessels in rib intercostal groove, costal sulcus disappeared in the anterior axillary line at the sixth rib rib. The arc length in the side area maximum 167.28 + 1.98mm, 133.14 + 3.61 after the maximum radian degree, rib width of the maximum lateral area to 14.57 + 0.62mm thickness before the maximum area was 6.86 + 0.30mm, the maximum lateral area of cortical thickness to 4.54 + 0.16mm, posterior costal groove width of 6.23 + 0.26mm, no ribbed groove area before, torsion after 24.14 + 0.49 degrees higher than before torsion angle, P < 0.05. costotransverse joint length was 14.48 + 0.200mm, 11.60 + 0.35 mm width and the thickness is 14.86 + 0.24 mm, length of tubercle of rib was 15.02 + 0.32mm; transverse and coronal angle of tubercle of rib 143.09 + 1.86 degrees, the horizontal angle of 144.21 plus or minus 1.56 degrees, and the horizontal rib rib nodules measuring angle of 166.07 + 1.88 ~.CT and the anatomy of two kinds of methods of measuring results no significant statistical difference.
Conclusion: (1) on the basis of the existing rib surgical zoning research, we have made anatomical and imaging studies on the sixth rib sections, providing experimental evidence for the design and development of all sections of anatomical steel plates, and laying the foundation for the research of other ribs.
(2) there is no statistical difference between the two methods of anatomy and imaging. In clinical practice, the three-dimensional reconstruction of CT can be used for accurate measurement of the rib to meet the needs of operation.
The development and biomechanical determination of the second chapter of the ribs anatomic plate
Objective: Based on the results of anatomical and imaging studies, we designed and produced anatomical plates of sixth costal regions, and evaluated the biomechanical properties of steel plates, providing theoretical basis for further clinical application.
Methods: the ordinary stainless steel, the results according to the anatomy and image design, processing into sixth rib District normal anatomical plate and locking anatomical plate. 8 adult cadavers (5 male, 3 female) of thoracic wet specimens of bilateral sixth ribs (16 ribs), each rib made of costovertebral joints and torsion after segment that side, front, front torsion angle section four section specimens, the length of each 120mm. in each point with a hacksaw was sawed, making fracture model. Costovertebral joints and torsion after only a single specimen with the ordinary self design and locking costovertebral joint anatomical plate fixation, and mutual comparison. Other sections fixed with four different, 2 specimens with the corresponding common anatomical plate fixation, 2 with corresponding locking anatomical plate fixation, 2 1mm Kirschner wire (two) fixed as control, 2 with reconstruction plate fixation as the control group. The specimens were performed for each non destruction three point bending The test and torsion test were carried out. Another two pieces of each area were selected, one of which was a destructive bending test, and the other was a destructive torsion test.
Results: the maximum bending strength of anatomic plate respectively, costovertebral joints and torsion angle steel plate 185.41 + 3.81N, 217.40 + 3.55N front plate, side plate area of 200.69 + 4.14N, 206.25 + 3.81N. plate before the torsion angle of maximum torsion resisting ability respectively, costovertebral joints and torsion angle steel plate 4.12 + 0.92Nm. The area before the plate was 3.47 + 0.11Nm, 3.76 + 0.47Nm side plate, front plate torsion angle of 3.65 + 0.02Nm. anatomic plate bending and torsion resistance ability than Kirschner wire, for reconstruction plate (P < 0.05). Normal anatomical plate and locking anatomical plate torsion and bending resistance with no significant difference.
Conclusion: (1) the anti torsional and flexural performance of the common anatomical plate and the locking anatomical plate is superior to the Kirschner's needle and can be used as a fixed material for the fracture of the ribs.
(2) there is no significant difference in biomechanical properties between anatomical plates and locking anatomical plates. Locking anatomical plates only need to pass through the unilateral cortex, which improves the safety of operation.

【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R687.1;R322

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