肩胛盂骨性解剖结构的测量和分析

发布时间：2018-02-01 21:31

  本文关键词： 肩胛盂 CT 测量 解剖　出处：《第三军医大学》2009年硕士论文　论文类型：学位论文

【摘要】：背景 多种致病因素可致肩胛盂关节面严重受损,需通过关节盂置换改善功能,缓解疼痛。自上世纪70年代以来,多种肱骨近端假体类型不断涌现,而肩胛盂假体却发展甚缓,因此,肩胛盂假体在全肩关节假体设计中具有很大挑战。肩关节置换的最终目的是尽可能重建盂肱关节正常解剖结构并恢复其功能,因此,肩胛盂骨性解剖结构的精确测量不论对于肩胛盂假体设计还是肩关节置换术的成功实施都具有重要意义。 目的 通过MSCT后处理技术,对肩胛盂骨性解剖参数进行测量、验证及分析,为肩胛盂假体设计提供解剖学数据,为假体置入手术提供必要的术前评估指标。 材料与方法 材料 10侧成年人防腐肩胛骨标本(性别年龄不详,左、右各5侧),10侧正常成年人肩胛骨新鲜标本(性别年龄不详,左、右各5侧)。用于测量方法的建立和验证。 中国重庆地区征集成年志愿者100名,发育正常,双肩健全,无肩关节疾病史和创伤史、经CT检查双肩关节无影像学异常。男性61名,女性39名,平均年龄38.9岁(19—60岁),左、右肩各100侧。 方法 10侧成年人防腐肩胛骨标本及10侧正常成年人肩胛骨新鲜标本经MSCT扫描后,数据传至LEONARDO工作站,经VRT,MPR等后处理技术完成相关参数的测量。防腐标本测量肩胛盂形态及假体固定点,新鲜标本测量肩胛盂扭转角。以上标本及所测参数再通过解剖测量加以验证。 100名志愿者采用MSCT及其后处理技术完成各项参数的测量。 测量参数： 肩胛盂形态参数：前后最大径、前后曲率半径、上下最大径、上下曲率半径。 假体固定点参数：上固定角、下固定角、前固定角、后固定角、上固定深度、下固定深度、前固定深度、后固定深度。 肩胛盂扭转角：上扭转角、中扭转角、下扭转角。 所得测量数据进行统计学分析： 20例标本测量的CT测量数据和解剖测量数据行配对样本t检验。P值0.05为有统计学意义。 200侧志愿者肩胛盂测量数据进行描述性统计,对不同性别、侧别之间行独立样本t检验,P值0.05为有统计学意义。所测参数行相关性分析。 结果 1.肩胛骨标本MSCT测量的结果前后最大径2.78cm±0.24cm(2.38cm～3.12cm)前后曲率半径5.32cm±0.84cm(4.20cm～6.83cm)上下最大径3.82cm±0.18cm(3.42cm～4.01cm)上下曲率半径4.28cm±0.74cm(3.12cm～5.69cm)上固定角142.30°±6.58°(132.00°～150.00°)下固定角124.30°±3.95°(119.00°～132.00°)前固定角63.20°±4.42°(56.00°～68.00°)后固定角45.20°±5.65°(39.00°～58.00°)上固定深度2.81cm±0.43cm(2.13cm～3.38cm)下固定深度4.99cm±1.34cm(2.61cm～6.32cm)前固定深度3.95cm±0.52cm(3.35cm～4.96cm)后固定深度1.96cm±0.24cm(1.70cm～2.36cm)上扭转角1.60°±3.60°(-3.00°～7.00°)中扭转角0.10°+2.330(-4.000°～4.00°)下扭转角-1.20°±2.35°(-5.00°～2.00°) 肩胛骨标本解剖测量的结果前后最大径2.81cm±0.25cm(2.37cm～3.10cm)前后曲率半径5.29cm±0.81cm(4.06cm～6.74cm)上下最大径3.82cm±0.23cm(3.39cm～4.12cm)上下曲率半径4.32cm±0.59cm(3.47cm～5.43cm)上固定角142.70°±7.56°(128.00°～152.00°)下固定角123.90°±5.57°(114.00°～133.00°)前固定角62.80°±4.10°(56.00°～68.00。)后固定角45.00°±6.43°(36.00°～58.00°)上固定深度2.85cm±0.44cm(2.04cm～3.45cm)下固定深度4.93cm±1.54cm(2.15cm～6.46cm)前固定深度3.94cm±0.47cm(3.37cm～4.73cm)后固定深度1.97cm±0.29cm(1.64cm～2.59cm)上扭转角1.90°±3.90°(-2.00°～8.00°)中扭转角0°±2.75°(-5.00°～4.00°)下扭转角-1.30°±3.16°(-7.00°～3.00°) 2.200侧志愿者肩关节测量结果前后最大径2.51cm±0.30cm(1.71cm～3.15cm)前后曲率半径5.59cm±1.13cm(3.06cm～8.92cm)上下最大径3.46cm±0.31cm(2.69cm～4.15cm)上下曲率半径3.99cm±0.54cm(2.58cm～5.82cm)上固定角139.20±11.0°(110°～168°)下固定角122.70±7.5°(95°～156°)前固定角63.9°±5.4°(46°～79°)后固定角55.90±16.7°(32°～89°)上固定深度2.59cm±0.53cm(1.29cm～3.50cm)下固定深度4.71cm±1.62cm(1.80cm～9.20cm)前固定深度3.46cm±0.56cm(1.73cm～5.28cm)后固定深度2.10cm±0.55cm(1.15cm～3.71cm)上扭转角1.5°±4.8°(-10°～14°)中扭转角-0.3°±3.9°(-11°～8°)下扭转角-1.9°±4.5°(-15°～9°) 3.20例标本中,所有CT测量参数和解剖测量参数之间无明显统计学差异。 4.所测数据分男女行独立样本t检验,其中前后最大径、上下最大径、上下曲率半径、前固定深度、后固定深度、中扭转角和下扭转角存在统计学差异(P0.05)。 5.所测数据分左右侧行独立样本t检验,除前固定角外,其余各参数均不存在侧别差异。 6.以下参数存在相关性：前后最大径与上下最大径,前后曲率半径与上下曲率半径,上下最大径与上下曲率半径,前固定角与前固定深度,后固定角与后固定深度,上、中、下各部分扭转角存在相关性。 结论 1.采用MSCT及其后处理技术能够对肩胛盂解剖参数进行测量,具有样本获取简便,测量准确的优点。 2.本实验获得了一组与肩胛盂假体设计相关的解剖学数据,这些数据对盂假体设计具有一定的参考价值。 3.肩胛盂的部分解剖参数存在性别差异,这种差异在盂的形态和扭转角方面比较明显。肩胛盂绝大部分解剖参数不存在侧别的差异,当单侧肩盂患病需行置换时,健侧的解剖学数据具有参考价值。部分解剖参数存在相关性,这对肩胛盂假体的模型化设计具有参考价值。
[Abstract]:background
Several factors can cause the glenoid articular surface was severely damaged by the glenoid replacement to improve function, relieve the pain. Since the last century since 70s, a variety of proximal humeral prosthesis have emerged, but the glenoid prosthesis development is very slow, therefore, the glenoid prosthesis in total shoulder turn is a big challenge to design the final holiday. The purpose of shoulder arthroplasty is possible to reconstruct the normal glenohumeral anatomy and restore its function, therefore, the accurate measurement of glenoid bony structure regardless of the glenoid prosthesis design or shoulder arthroplasty for successful implementation are of great significance.
objective
Through the post-processing technology of MSCT, the anatomical parameters of the glenoid bone were measured, verified and analyzed, providing anatomical data for the design of the scapular cavity prosthesis, providing the necessary preoperative evaluation index for prosthetic implantation.
Materials and methods
Material Science
There were 10 adult specimens for preservation of scapula (gender, age, left side and right side, 5 sides). Fresh specimens of scapula in 10 normal adults (gender, age, unknown, left and right sides, 5 sides) were used.
Chongqing area Chinese for adult volunteers 100, normal development, shoulders sound, without shoulder joint disease and trauma, by CT examination of shoulder normal imageology. 61 males and 39 females, the average age of 38.9 years (19 - 60), left and right shoulder of the 100 side.
Method
The 10 side adult anticorrosion scapula specimens and 10 normal adult scapula fresh specimens by MSCT scanning, the data were transmitted to LEONARDO workstation, the VRT, MPR and other postprocessing techniques to complete the measurement of relevant parameters. Specimens measuring the scapula glenoid morphology and prosthesis fixation, fresh specimens of measuring the scapula glenoid version angle. The above samples and measured parameters measured by dissection verified.
100 volunteers used MSCT and their post-processing techniques to measure the parameters.
Measurement parameters:
The morphological parameters of the scapula glenoid: the maximum diameter, the radius of the front and back curvature, the maximum diameter of the upper and lower, the radius of the upper and lower curvature.
Fixed point parameters of prosthesis: upper fixed angle, lower fixed angle, anterior fixed angle, posterior fixed angle, upper fixation depth, lower fixed depth, anterior fixation depth, and posterior fixation depth.
The twist angle of the scapula glenoid: the twisting angle, the middle twist angle and the downward twist angle.
The measured data were statistically analyzed.
The CT measurement data and the dissection data of 20 specimens were statistically significant for the paired sample t test of the.P value of 0.05.
The 200 sides of volunteers were descriptive statistics for the measurement of scapular cavity data. The independent samples t test was performed among different sexes. The P value of 0.05 was statistically significant.
Result
1.鑲╄儧楠ㄦ爣鏈琈SCT娴嬮噺鐨勭粨鏋滃墠鍚庢渶澶у緞2.78cm卤0.24cm(2.38cm锝，

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