本文關鍵詞： 肩胛盂 CT 測量 解剖　出處：《第三軍醫(yī)大學》2009年碩士論文　論文類型：學位論文

【摘要】：背景 多種致病因素可致肩胛盂關節(jié)面嚴重受損,需通過關節(jié)盂置換改善功能,緩解疼痛。自上世紀70年代以來,多種肱骨近端假體類型不斷涌現,而肩胛盂假體卻發(fā)展甚緩,因此,肩胛盂假體在全肩關節(jié)假體設計中具有很大挑戰(zhàn)。肩關節(jié)置換的最終目的是盡可能重建盂肱關節(jié)正常解剖結構并恢復其功能,因此,肩胛盂骨性解剖結構的精確測量不論對于肩胛盂假體設計還是肩關節(jié)置換術的成功實施都具有重要意義。 目的 通過MSCT后處理技術,對肩胛盂骨性解剖參數進行測量、驗證及分析,為肩胛盂假體設計提供解剖學數據,為假體置入手術提供必要的術前評估指標。 材料與方法 材料 10側成年人防腐肩胛骨標本(性別年齡不詳,左、右各5側),10側正常成年人肩胛骨新鮮標本(性別年齡不詳,左、右各5側)。用于測量方法的建立和驗證。 中國重慶地區(qū)征集成年志愿者100名,發(fā)育正常,雙肩健全,無肩關節(jié)疾病史和創(chuàng)傷史、經CT檢查雙肩關節(jié)無影像學異常。男性61名,女性39名,平均年齡38.9歲(19—60歲),左、右肩各100側。 方法 10側成年人防腐肩胛骨標本及10側正常成年人肩胛骨新鮮標本經MSCT掃描后,數據傳至LEONARDO工作站,經VRT,MPR等后處理技術完成相關參數的測量。防腐標本測量肩胛盂形態(tài)及假體固定點,新鮮標本測量肩胛盂扭轉角。以上標本及所測參數再通過解剖測量加以驗證。 100名志愿者采用MSCT及其后處理技術完成各項參數的測量。 測量參數： 肩胛盂形態(tài)參數：前后最大徑、前后曲率半徑、上下最大徑、上下曲率半徑。 假體固定點參數：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。 肩胛盂扭轉角：上扭轉角、中扭轉角、下扭轉角。 所得測量數據進行統(tǒng)計學分析： 20例標本測量的CT測量數據和解剖測量數據行配對樣本t檢驗。P值0.05為有統(tǒng)計學意義。 200側志愿者肩胛盂測量數據進行描述性統(tǒng)計,對不同性別、側別之間行獨立樣本t檢驗,P值0.05為有統(tǒng)計學意義。所測參數行相關性分析。 結果 1.肩胛骨標本MSCT測量的結果前后最大徑2.78cm±0.24cm(2.38cm～3.12cm)前后曲率半徑5.32cm±0.84cm(4.20cm～6.83cm)上下最大徑3.82cm±0.18cm(3.42cm～4.01cm)上下曲率半徑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)上扭轉角1.60°±3.60°(-3.00°～7.00°)中扭轉角0.10°+2.330(-4.000°～4.00°)下扭轉角-1.20°±2.35°(-5.00°～2.00°) 肩胛骨標本解剖測量的結果前后最大徑2.81cm±0.25cm(2.37cm～3.10cm)前后曲率半徑5.29cm±0.81cm(4.06cm～6.74cm)上下最大徑3.82cm±0.23cm(3.39cm～4.12cm)上下曲率半徑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)上扭轉角1.90°±3.90°(-2.00°～8.00°)中扭轉角0°±2.75°(-5.00°～4.00°)下扭轉角-1.30°±3.16°(-7.00°～3.00°) 2.200側志愿者肩關節(jié)測量結果前后最大徑2.51cm±0.30cm(1.71cm～3.15cm)前后曲率半徑5.59cm±1.13cm(3.06cm～8.92cm)上下最大徑3.46cm±0.31cm(2.69cm～4.15cm)上下曲率半徑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)上扭轉角1.5°±4.8°(-10°～14°)中扭轉角-0.3°±3.9°(-11°～8°)下扭轉角-1.9°±4.5°(-15°～9°) 3.20例標本中,所有CT測量參數和解剖測量參數之間無明顯統(tǒng)計學差異。 4.所測數據分男女行獨立樣本t檢驗,其中前后最大徑、上下最大徑、上下曲率半徑、前固定深度、后固定深度、中扭轉角和下扭轉角存在統(tǒng)計學差異(P0.05)。 5.所測數據分左右側行獨立樣本t檢驗,除前固定角外,其余各參數均不存在側別差異。 6.以下參數存在相關性：前后最大徑與上下最大徑,前后曲率半徑與上下曲率半徑,上下最大徑與上下曲率半徑,前固定角與前固定深度,后固定角與后固定深度,上、中、下各部分扭轉角存在相關性。 結論 1.采用MSCT及其后處理技術能夠對肩胛盂解剖參數進行測量,具有樣本獲取簡便,測量準確的優(yōu)點。 2.本實驗獲得了一組與肩胛盂假體設計相關的解剖學數據,這些數據對盂假體設計具有一定的參考價值。 3.肩胛盂的部分解剖參數存在性別差異,這種差異在盂的形態(tài)和扭轉角方面比較明顯。肩胛盂絕大部分解剖參數不存在側別的差異,當單側肩盂患病需行置換時,健側的解剖學數據具有參考價值。部分解剖參數存在相關性,這對肩胛盂假體的模型化設計具有參考價值。
[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嫻嬮噺鐨勭粨鏋滃墠鍚庢渶澶у緞2.78cm鹵0.24cm(2.38cm锝，

本文編號：1482919