發(fā)布時(shí)間：2018-07-28 12:52

【摘要】：目的:本研究通過(guò)CT三維重建數(shù)據(jù)和Mimcs軟件重建技術(shù)研究喙突和關(guān)節(jié)盂解剖特點(diǎn)以及兩者解剖形態(tài)之間的關(guān)系,為關(guān)節(jié)科醫(yī)師提供喙突與關(guān)節(jié)盂結(jié)構(gòu)的解剖數(shù)據(jù),指導(dǎo)Bristow-Lartarjet喙突移位截骨術(shù)的臨床應(yīng)用。方法:調(diào)取自2015.1.1-2016.6.1之間的61(男35例,女26例),平均年齡48.7歲,例因病情需要行肩關(guān)節(jié)三維CT重建的患者影像學(xué)資料,獲得61份影像學(xué)數(shù)據(jù)。將其DICM格式數(shù)據(jù)導(dǎo)入Mimcs軟件,重建喙突三維模型。在計(jì)算機(jī)軟件上分別測(cè)量所有患者喙突總長(zhǎng)度、喙突尖以下1.5cm寬度與高度、喙突尖至喙突中點(diǎn)距離、喙突中點(diǎn)寬度與高度,肩胛盂最大前后徑距離解剖學(xué)數(shù)據(jù),收集測(cè)量數(shù)據(jù),行統(tǒng)計(jì)學(xué)處理,并計(jì)算喙突尖以下1.5cm處寬高度與肩胛盂最大前后徑比值,用于指導(dǎo)Bristow-Lartarjet手術(shù)的應(yīng)用。結(jié)果:在61例喙突重建模型中,喙突及關(guān)節(jié)盂骨性結(jié)構(gòu):⑴喙突平均長(zhǎng)度42.32±2.40mm;⑵喙突尖以下1.5cm平均寬度13.45±2.19mm;⑶喙突尖以下1.5cm平均高度9.27±1.84mm⑷喙突尖至喙突中點(diǎn)平均距離20.83±2.16mm;⑸喙突中點(diǎn)平均寬度15.48±1.69mm;⑹喙突尖中點(diǎn)平均高度11.60±1.97mm;⑺關(guān)節(jié)盂最大前后徑距離26.58±1.92mm;⑻喙突尖以下1.5cm處的寬度、高度與肩胛盂最大前后徑的比值分別為35%(25%—43%)和51%(39%—66%),這兩組數(shù)據(jù)呈顯著線性正相關(guān),二者相關(guān)系數(shù)R2分別為0.982和0.972。喙突尖1.5cm橫截面高度9.27±1.84mm,其中松質(zhì)骨內(nèi)徑5.56±0.92mm,單側(cè)皮質(zhì)骨厚度1.85±0.13mm,單側(cè)皮質(zhì)骨厚度占橫截面約20%,喙突尖以下1.5cm寬度平均13.45±2.19mm,其中松質(zhì)骨內(nèi)徑8.61±1.74mm,單側(cè)皮質(zhì)骨厚度2.42±0.18mm,單側(cè)皮質(zhì)骨厚度占橫截面約18%。結(jié)論:喙突寬度與厚度都和關(guān)節(jié)盂最大前后徑存在顯著線性正相關(guān),隨著關(guān)節(jié)盂前后徑最大距離的增加,喙突尖寬度與高度也越大,對(duì)于較大骨質(zhì)截缺損,取喙突骨塊修復(fù)關(guān)節(jié)盂前向骨缺損時(shí)喙突骨塊的固定方式應(yīng)根據(jù)實(shí)際損傷情況選擇合適的手術(shù)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 鹵2.19mm.The average height of 1.5cm below the coracoid process is 9.27 鹵1.84mm4 and the average distance from the coracoid process to the middle point of the coracoid process is 20.83 鹵2.16mm.The average width of the middle point of the coracoid process is 15.48 鹵1.69mm. The average height of the midpoint of the tip was 11.60 鹵1.97mm, the width of 1.5cm below the coracoid process was 26.58 鹵1.92mm, the distance between the maximum anterior and posterior diameters of the articular pelvis was 26.58 鹵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 鹵1.84 mm, in which the inner diameter of cancellous bone was 5.56 鹵0.92 mm, the thickness of unilateral cortical bone was 1.85 鹵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 鹵2.19 mm, in which the diameter of cancellous bone was 8.61 鹵1.74 mm, the thickness of unilateral cortical bone was 2.42 鹵0.18 mm, and the thickness of unilateral cortical bone was 2.42 鹵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.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.4;R816.8

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