CT三维重建数据下喙突与关节盂对应关系的解剖研究

发布时间：2018-07-28 12:52

【摘要】：目的:本研究通过CT三维重建数据和Mimcs软件重建技术研究喙突和关节盂解剖特点以及两者解剖形态之间的关系,为关节科医师提供喙突与关节盂结构的解剖数据,指导Bristow-Lartarjet喙突移位截骨术的临床应用。方法:调取自2015.1.1-2016.6.1之间的61(男35例,女26例),平均年龄48.7岁,例因病情需要行肩关节三维CT重建的患者影像学资料,获得61份影像学数据。将其DICM格式数据导入Mimcs软件,重建喙突三维模型。在计算机软件上分别测量所有患者喙突总长度、喙突尖以下1.5cm宽度与高度、喙突尖至喙突中点距离、喙突中点宽度与高度,肩胛盂最大前后径距离解剖学数据,收集测量数据,行统计学处理,并计算喙突尖以下1.5cm处宽高度与肩胛盂最大前后径比值,用于指导Bristow-Lartarjet手术的应用。结果:在61例喙突重建模型中,喙突及关节盂骨性结构:⑴喙突平均长度42.32±2.40mm;⑵喙突尖以下1.5cm平均宽度13.45±2.19mm;⑶喙突尖以下1.5cm平均高度9.27±1.84mm⑷喙突尖至喙突中点平均距离20.83±2.16mm;⑸喙突中点平均宽度15.48±1.69mm;⑹喙突尖中点平均高度11.60±1.97mm;⑺关节盂最大前后径距离26.58±1.92mm;⑻喙突尖以下1.5cm处的宽度、高度与肩胛盂最大前后径的比值分别为35%(25%—43%)和51%(39%—66%),这两组数据呈显著线性正相关,二者相关系数R2分别为0.982和0.972。喙突尖1.5cm横截面高度9.27±1.84mm,其中松质骨内径5.56±0.92mm,单侧皮质骨厚度1.85±0.13mm,单侧皮质骨厚度占横截面约20%,喙突尖以下1.5cm宽度平均13.45±2.19mm,其中松质骨内径8.61±1.74mm,单侧皮质骨厚度2.42±0.18mm,单侧皮质骨厚度占横截面约18%。结论:喙突宽度与厚度都和关节盂最大前后径存在显著线性正相关,随着关节盂前后径最大距离的增加,喙突尖宽度与高度也越大,对于较大骨质截缺损,取喙突骨块修复关节盂前向骨缺损时喙突骨块的固定方式应根据实际损伤情况选择合适的手术方式。
[Abstract]:Objective: to study the anatomical characteristics of coracoid and articular pelvis and the relationship between them by CT 3D reconstruction data and Mimcs software reconstruction technique, and to provide anatomical data of coracoid process and glenoid structure for arthrologists. To guide the clinical application of Bristow-Lartarjet coracoid process transposition osteotomy. Methods: 61 cases (35 males and 26 females), aged 48.7 years, were collected from 61 patients (35 males and 26 females) from January 1 to June 2016.The imaging data were obtained from 61 patients who needed 3D CT reconstruction of shoulder joint because of their condition. The DICM format data were imported into Mimcs software to reconstruct the coracoid process model. The total length of coracoid process, the width and height of 1.5cm below the tip of coracoid process, the distance between coracoid tip and middle point of coracoid process, the width and height of middle point of coracoid process, the maximum anteroposterior diameter of scapula glenoid were measured by computer software, and the measured data were collected. The ratio of width and height of 1.5cm to the maximum anteroposterior diameter of scapular glenoid was calculated to guide the application of Bristow-Lartarjet operation. Results: in 61 cases of coracoid process reconstruction model, The average width of 1.5cm below the coracoid process is 13.45 卤2.19mm.The average height of 1.5cm below the coracoid process is 9.27 卤1.84mm4 and the average distance from the coracoid process to the middle point of the coracoid process is 20.83 卤2.16mm.The average width of the middle point of the coracoid process is 15.48 卤1.69mm. The average height of the midpoint of the tip was 11.60 卤1.97mm, the width of 1.5cm below the coracoid process was 26.58 卤1.92mm, the distance between the maximum anterior and posterior diameters of the articular pelvis was 26.58 卤1.92mm. The ratio of height to maximum anteroposterior diameter of scapular pelvis was 35% (25-43%) and 51% (39-66%) respectively. The cross-sectional height of coracoid process 1.5cm was 9.27 卤1.84 mm, in which the inner diameter of cancellous bone was 5.56 卤0.92 mm, the thickness of unilateral cortical bone was 1.85 卤0.13 mm, and the thickness of unilateral cortical bone was about 20 mm. The average width of 1.5cm below coracoid tip was 13.45 卤2.19 mm, in which the diameter of cancellous bone was 8.61 卤1.74 mm, the thickness of unilateral cortical bone was 2.42 卤0.18 mm, and the thickness of unilateral cortical bone was 2.42 卤0.18 mm. The thickness of bone is about 18% of the cross section. Conclusion: there is a significant linear positive correlation between the width and thickness of the coracoid process and the maximum anteroposterior diameter of the articular pelvis. With the increase of the maximum distance between the anterior and posterior diameter of the articular pelvis, the width and height of the coracoid process tip are also larger. When coracoid bone was taken to repair the defect of anterior glenoid bone, the proper operation method should be selected according to the actual injury.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4;R816.8

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