本文關(guān)鍵詞：肋骨的解剖學(xué)、影像學(xué)測(cè)量及肋骨解剖鋼板的研制和生物力學(xué)測(cè)定　出處：《中南大學(xué)》2007年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肋骨 骨折 解剖學(xué) 影像學(xué) 肋骨 骨折 內(nèi)固定 鎖定鋼板 解剖鋼板

【摘要】： 第一章肋骨的解剖學(xué)與影像學(xué)測(cè)量 目的：在對(duì)胸廓外科學(xué)分區(qū)基礎(chǔ)上，挑選第6肋進(jìn)行解剖學(xué)與影像學(xué)測(cè)量，對(duì)兩種方法測(cè)量結(jié)果進(jìn)行比較，為研制肋骨解剖型鋼板提供技術(shù)參數(shù)。 方法：選取6具成人胸廓濕標(biāo)本(男3、女3)，觀察標(biāo)本大體形態(tài)、肋間肌及肋間血管神經(jīng)走行。以各肋骨肋角連線和肋溝消失點(diǎn)連線即體表投影相當(dāng)于脊柱旁線偏外側(cè)和腋前線為分界，將胸廓分為前區(qū)(AA)、側(cè)區(qū)(LA)和后區(qū)(PA)。挑選骨折多發(fā)的第6肋作為研究對(duì)象，用影像學(xué)和解剖學(xué)兩種方法測(cè)量各標(biāo)本雙側(cè)第6肋肋橫突結(jié)合部的長(zhǎng)度、寬度、厚度；橫突和肋結(jié)節(jié)在冠狀面所成角度，水平面所成角度，肋結(jié)節(jié)長(zhǎng)度，肋結(jié)節(jié)與肋骨所成角度；各區(qū)肋骨的弧度，各區(qū)肋骨的長(zhǎng)度即弧長(zhǎng)，各區(qū)肋骨中點(diǎn)寬度、厚度、骨皮質(zhì)的厚度、肋溝寬度；前后扭轉(zhuǎn)角度。 結(jié)果：整個(gè)胸廓是一個(gè)復(fù)雜的三維立體結(jié)構(gòu)，肋間血管走行于肋溝，肋溝消失于腋前線處。第6肋肋骨弧長(zhǎng)以側(cè)區(qū)最大167.28±1.98mm，弧度以后區(qū)最大133.14±3.61°，肋骨寬度以側(cè)區(qū)最大14.57±0.62mm，厚度以前區(qū)最大6.86±0.30mm，皮質(zhì)厚度以側(cè)區(qū)最大4.54±0.16mm，后區(qū)肋溝最寬6.23±0.26mm，前區(qū)無(wú)肋溝，，后扭轉(zhuǎn)角24.14±0.49°大于前扭轉(zhuǎn)角，P＜0.05。肋橫突結(jié)合部長(zhǎng)度為14.48±0.200mm，寬度為11.60±0.35 mm，厚度為14.86±0.24 mm，肋結(jié)節(jié)長(zhǎng)度為15.02±0.32mm；橫突與肋結(jié)節(jié)冠狀面成角143.09±1.86°，水平面成角144.21±1.56°，肋結(jié)節(jié)與肋骨水平面成角166.07±1.88°。CT和解剖學(xué)兩種測(cè)量方法測(cè)量的結(jié)果無(wú)顯著統(tǒng)計(jì)學(xué)差異。 結(jié)論：(1)本研究在已有的肋骨外科學(xué)分區(qū)研究基礎(chǔ)之上，選擇性對(duì)第6肋各區(qū)段進(jìn)行了解剖學(xué)與影像學(xué)研究，為設(shè)計(jì)并研制各區(qū)段解剖學(xué)鋼板提供實(shí)驗(yàn)依據(jù)，也為其他肋骨的研究打下基礎(chǔ)。 (2)解剖學(xué)和影像學(xué)兩種測(cè)量方法無(wú)統(tǒng)計(jì)學(xué)差異，臨床上術(shù)前可用CT三維重建對(duì)肋骨進(jìn)行較準(zhǔn)確的測(cè)量，以滿足手術(shù)的需要。 第二章肋骨解剖鋼板的研制和生物力學(xué)測(cè)定 目的：根據(jù)解剖學(xué)與影像學(xué)研究結(jié)果，設(shè)計(jì)并生產(chǎn)第6肋各區(qū)解剖鋼板，并對(duì)鋼板生物力學(xué)特性進(jìn)行評(píng)價(jià)，為進(jìn)一步臨床應(yīng)用提供理論依據(jù)。 方法：選用普通不銹鋼，按照解剖學(xué)和影像學(xué)測(cè)量結(jié)果，設(shè)計(jì)加工成第6肋各區(qū)普通解剖鋼板和鎖定解剖鋼板。取8具成人(5男，3女)胸廓濕標(biāo)本的雙側(cè)第6肋(共16肋)，每肋制成肋椎關(guān)節(jié)及后扭轉(zhuǎn)角段、側(cè)段、前段、前扭轉(zhuǎn)角段等四段標(biāo)本，每段長(zhǎng)120mm。于每段中點(diǎn)用鋼鋸橫形鋸斷，制造骨折模型。肋椎關(guān)節(jié)及后扭轉(zhuǎn)角標(biāo)本只單用自行設(shè)計(jì)的普通型和鎖定型肋椎關(guān)節(jié)解剖鋼板固定，并相互比較。其余區(qū)段用四種不同內(nèi)固定，2具標(biāo)本用相應(yīng)普通型解剖鋼板固定，2具用相應(yīng)鎖定型解剖鋼板固定，2具用1mm克氏針(兩枚)固定作為對(duì)照，2具用重建鋼板固定作為對(duì)照。對(duì)上述每段標(biāo)本均行非破壞性三點(diǎn)彎曲試驗(yàn)和扭轉(zhuǎn)試驗(yàn)。另選取各區(qū)解剖鋼板各兩塊，其中一組進(jìn)行破壞性彎曲試驗(yàn)，另一組進(jìn)行破壞性扭轉(zhuǎn)試驗(yàn)。 結(jié)果：各解剖鋼板最大抗彎曲力分別為，肋椎關(guān)節(jié)及后扭轉(zhuǎn)角鋼板185.41±3.81N，前區(qū)鋼板217.40±3.55N，側(cè)區(qū)鋼板200.69±4.14N，前扭轉(zhuǎn)角鋼板206.25±3.81N。最大抗扭轉(zhuǎn)能力分別為，肋椎關(guān)節(jié)及后扭轉(zhuǎn)角鋼板4.12±0.92Nm，前區(qū)鋼板3.47±0.11Nm，側(cè)區(qū)鋼板3.76±0.47Nm，前扭轉(zhuǎn)角鋼板3.65±0.02Nm。解剖鋼板抗彎曲能力和抗扭轉(zhuǎn)能力優(yōu)于克氏針，差于重建鋼板(P＜0.05)。普通解剖鋼板和鎖定解剖鋼板抗扭轉(zhuǎn)和抗彎曲能力無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)論：(1)普通解剖鋼板和鎖定解剖鋼板抗扭轉(zhuǎn)與抗彎曲性能優(yōu)于克氏針，能夠作為肋骨骨折的固定材料。 (2)普通解剖鋼板和鎖定解剖鋼板在生物力學(xué)性能上無(wú)顯著差異，而鎖定解剖鋼板只需穿過(guò)單側(cè)皮質(zhì)，提高了手術(shù)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.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2007
【分類號(hào)】：R687.1;R322

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