国人肱骨近端行肩关节置换与接骨板板固定的应用解剖研究

发布时间：2018-07-08 16:18

本文选题：肱骨 + 解剖研究　；参考：《南华大学》2007年硕士论文

【摘要】： 目的:研究国人肱骨近端解剖结构关系,探讨其在肩关节置换肱骨头假体植入和肱骨近端骨折复位接骨板内固定时的定位参考价值。方法:(1).肱骨标本直接测量法,对60具正常成人干燥肱骨标本进行解剖形态学测量:①肱骨头中轴与肱骨结节间沟所成角度的测定;②肱骨结节间沟与肱骨大、小结节联线所成角度的测定;③肱骨结节间沟与肱骨干纵轴所成角度的测定;确定肱骨头中轴与肱骨大结节下方的肱骨外侧平面交点位置,以此点为定位点,④测量定位点到肱骨大结节顶点的距离;⑤测量大结节顶点到肱骨头顶点的距离;⑥测量小结节顶点到肱骨头顶点的距离;⑦测量三角肌粗隆近端到肱骨头顶点的距离;⑧测量定位点到肱骨结节间沟外侧壁的距离;⑨大结节顶点到肱骨头中心的垂直距离;⑩大结节顶点到肱骨头下端的垂直距离。将测定数据进行统计学分析。 (2).用X线片测量上述①②③④⑤⑥⑦⑨⑩各项指标。将测定数据进行统计学分析,并将肱骨标本直接测量法与X线片测量法所得数据进行统计学分析。(3).用CT扫描肱骨近端研究肱骨头纵轴与结节间沟的关系结果:(1).肱骨标本直接测量法:①肱骨头中轴与肱骨结节间沟所成角度为58.1°±3.2°,左右及性别对比无统计学差异(P0.05)。②肱骨结节间沟与肱骨大、小结节联线所成角度65.8°±6.3°,左右及性别对比无统计学差异(P0.05)。③肱骨结节间沟与肱骨干纵轴所成角度为9.7°±1.8°,左右对比有统计学差异(P0.05)。性别对比无统计学差异(P0.05)。④定位点到肱骨大结节顶点的距离为28.3±3.8 m m,左右及性别对比无统计学差异(P0.05)。⑤大结节顶点到肱骨头顶点的距离为4.5±1.4mm,左右及性别对比无统计学差异(P0.05)。⑥小结节顶点到肱骨头顶点的距离为13.6±2.8mm,左右及性别对比无统计学差异(P0.05)。⑦三角肌粗隆近端到肱骨头顶点的距离为100.1±9.5mm,左右对比无统计学差异(P0.05)。性别对比有统计学差异(P0.05)。⑧定位点到肱骨结节间沟外侧壁的距离为7.5±1.9mm,左右及性别对比无统计学差异(P0.05)。⑨大结节顶点到肱骨头中心的垂直距离为17.9±3.3mm;左右及性别对比无统计学差异(P0.05)。⑩大结节顶点到肱骨头下端的垂直距离为32.4±5.3 mm;左右及性别对比无统计学差异(P0.05)。(2) .用X线片测量法:X①肱骨头中轴与肱骨结节间沟所成角度为58.7°±3.6°,左右及性别对比无统计学差异(P0.05)。X②肱骨结节间沟与肱骨大、小结节联线所成角度为65.3°±7.6°,左右及性别对比无统计学差异(P0.05)。X③肱骨结节间沟与肱骨干纵轴所成角度为8.5°±1.6°,左右对比有统计学差异(P0.05)。性别对比无统计学差异(P0.05)。X④定位点到肱骨大结节顶点的距离为26.8±3.5 m m,左右及性别对比无统计学差异(P0.05)。X⑤大结节顶点到肱骨头顶点的距离为4.6±1.5 mm,左右及性别对比无统计学差异(P0.05)。X⑥小结节顶点到肱骨头顶点的距离为12.7±2.6 mm,左右及性别对比无统计学差异(P0.05)。X⑦三角肌粗隆近端到肱骨头顶点的距离为100.9±8.9 mm,左右及性别对比无统计学差异(P0.05)。X⑨大结节顶点到肱骨头中心的垂直距离为18.2±3.2 mm,左右及性别对比无统计学差异(P0.05)。X⑩大结节顶点到肱骨头下端的垂直距离为31.8±5.2 mm,左右及性别对比无统计学差异(P0.05)。骨性标本直接测量法与X线片测量法所得各项数据进行对比统计学分析有无统计学差异(P0.05)。(3).用CT扫描肱骨近端研究肱骨头纵轴与结节间沟的关系:从肱骨上端开始横行扫描,每3mm一层,共15层,选择相应的8层进行分析:①肱骨近端得出肱骨头纵轴到肱骨结节间沟外侧壁的距离,平均数据分别是: 8.0mm, 7.9mm, 7.6mm,7.5mm, 7.4mm,7.7 mm 7.8mm,8.1mm。②肱骨头纵轴到肱骨结节间沟内侧壁的距离,平均数据分别18.2mm,18.0mm,16.9 mm,15.8mm,16.3 mm,17.5mm,17.7mm,18.1 mm。结论:肱骨近端解剖关系的研究,对于国人肩关节置换术正确掌握肱骨头假体高度及后倾角以及肱骨近端骨折接骨板内固定内置物的定位有参考价值。
[Abstract]:Objective: To study the relationship between the anatomical structure of the proximal humerus of the Chinese people and explore the reference value for the positioning of the humerus prosthesis with the replacement of the shoulder joint and the internal fixation of the proximal humerus fracture with the reduction of the plate.
Methods: (1) direct measurement of humeral specimens of humerus specimens, 60 normal adult humerus specimens were anatomic and morphologically measured: (1) measurement of the angle between the middle axis of the humerus and the humerus tubercle, and the measurement of the angle between the humerus tubercle and the large humerus and the small nodule, and the measurement of the angle of the humerus tubercle and the longitudinal axis of the humerus. Determine the location of the lateral plane of the lateral humerus below the humeral head and the large tubercle of the humerus, and measure the distance between the point of the location and the vertex of the humerus tubercle; (5) measure the distance from the vertex of the large tubercle to the vertex of the humerus; (6) measure the distance from the vertex of the small tubercle to the vertex of the humerus; and measure the proximal end of the deltoid to the humerus. The distance from the vertex to the lateral wall of the humerus tubercle; the vertical distance from the vertex of the large tubercle to the center of the humerus; the vertical distance from the vertex of the large tubercle to the lower end of the humeral head. The measured data were statistically analyzed.
(2) to measure the indexes of the above ((2) (4) (4) (6). Statistical analysis of the measured data and the statistical analysis of the data obtained by the direct measurement of the humerus specimen and the X-ray measurement. (3) the relationship between the longitudinal axis of the humerus and the internode sulcus with the proximal humerus was scanned with CT
Results: (1) the direct measurement of humeral specimens: (1) the angle between the middle axis of the humerus and the humerus tubercle is 58.1 + 3.2 degrees, and there is no statistical difference between the right and the right and the sex (P0.05). 2. The angle of the humerus tubercle is between the humerus and the humerus, the angle of the small nodule line is 65.8? 6.3 degrees, and there is no statistical difference between the right and the right and the sex (P0.05). The angle of the longitudinal axis of the humerus was 9.7 + 1.8 degrees (P0.05). There was no statistical difference between the left and the right (P0.05). (4) the distance between the location point and the vertex of the large tubercle of the humerus was 28.3 + 3.8 m m, and there was no statistical difference between the right and the sex (P0.05). 5. The distance between the vertex of the large tubercle to the vertex of the humerus was 4.5 + 1.4mm, and the difference was about 4.5 + 1.4mm There was no statistical difference in gender (P0.05). 6. The distance between the vertex of the small nodule to the vertex of the humeral head was 13.6 + 2.8mm, and there was no statistical difference between the right and the left and the right (P0.05). The distance between the proximal end of the tricus deltoid and the vertex of the humerus was 100.1 + 9.5mm, and there was no statistical difference between the right and left (P0.05). The gender contrast was statistically different (P0.05). The distance to the lateral wall of the humerus tubercle was 7.5 + 1.9mm, and there was no statistical difference between the left and the right and the sex (P0.05). The vertical distance from the apex to the center of the humerus was 17.9 + 3.3mm, and there was no statistical difference between the left and the right and the sex (P0.05). The vertical distance from the apex of the large tubercle to the lower end of the humerus was 32.4 + 5.3 mm; No statistical difference (P0.05) (2). (2) X-ray measurement: X (1) the angle between the middle axis of the humerus and the humerus tubercle was 58.7 + 3.6 degrees, and there was no statistical difference between the left and right and the sex (P0.05).X. The angle of the humerus tubercle and the humerus was large, the angle of the small nodule line was 65.3 + 7.6 degrees, and there was no statistical difference between the left and the right and the sex (P0.05). The angle between the humeral tubercle and the longitudinal axis of the humeral diaphysis was 8.5 + 1.6 degrees (P0.05). There was no statistical difference (P0.05) the distance between the location of.X (P0.05) and the apex of the large tubercle of the humerus was 26.8 + 3.5 m m, and there was no statistical difference between the left and right and the sex differences (P0.05) the vertex of the large nodule to the apex of the humeral head. The difference was 4.6 + 1.5 mm, and there was no statistical difference between the left and right and the sex (P0.05).X 6. The distance between the vertex of the small nodule to the vertex of the humerus was 12.7 + 2.6 mm, and there was no statistical difference between the left and right and the sexes (P0.05), the distance from the proximal end of the deltoid deltoid to the vertex of the humerus was 100.9 + 8.9 mm, and there was no statistical difference between the left and the right and the sex (P0.05). The vertical distance from the tubercle to the center of the humeral head was 18.2 + 3.2 mm, and there was no statistical difference between the left and right and the sex contrast (P0.05), the vertical distance from the apex of.X to the lower end of the humeral head was 31.8 + 5.2 mm, and there was no statistical difference between the left and right and the sex (P0.05). The direct measurement of bone specimens was compared with the data obtained by X-ray measurement. Statistical analysis (P0.05). (3) the relationship between the longitudinal axis of the humerus and the trench of the humerus was scanned with CT: the transverse scans of the humerus were scanned from the upper end of the humerus, 15 layers per 3mm layer, and the corresponding 8 layers were selected: (1) the distance of the proximal humerus longitudinal axis to the lateral sulcus of the humerus tubercle and the average data were obtained. 8.0mm, 7.9MM, 7.6mm, 7.5mm, 7.4mm, 7.7 mm 7.8mm, 8.1mm. (2) the distance between the longitudinal axis of the humerus and the medial wall of the humerus tubercle. The average data were 18.2mm, 18.0mm, 16.9 mm, 15.8mm, 16.3, 18.1
Conclusion: the study of the proximal humerus anatomical relationship is of reference value for the correct mastery of the height and the obliquity of the humeral head prosthesis and the fixation of the internal fixator of the proximal humerus fracture of the humerus.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R687.1;R322

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