基于CT三维重建的喙突形态学分型及其临床意义

郭兰前; 王定宣

doi:10.16098/j.issn.0529-1356.2023.01.012

PDF(2424 KB)

解剖学报 ›› 2023, Vol. 54 ›› Issue (1) : 82-86. DOI: 10.16098/j.issn.0529-1356.2023.01.012

解剖学

基于CT三维重建的喙突形态学分型及其临床意义

郭兰前¹ 王定宣^1*易刚² 李焱¹任杰英¹

作者信息 +

Morphological classification and clinical significance of the coracoid process based on CT three-dimensional reconstruction

GUO Lan-qian¹ WANG Ding-xuan^1* YI Gang² LI Yan¹ REN Jie-ying¹

Author information +

文章历史 +

摘要

目的通过对人体肩胛骨喙突的形态学进行分型，为临床治疗肩锁关节脱位提供解剖学依据。方法从四川省西南医科大学附属中医医院选取500例肩伤患者，并最终筛选出300例作为受试者，包含右肩159例，左肩141例，收集受试者的肩胛骨CT扫描图像以及三维重建结果。观察受试者喙突CT扫描图像的基本形态特征，并对相关参数进行测量，包括喙突尖端的最长水平距离以及其中点的厚度（cd, pp’），喙突肩胛骨上部到基底部的距离以及其中点厚度（mn, kk’），喙突尖端顶点到喙突基底部端点的距离（ab），喙突折返部的最长水平距离（ef），以及as的距离（点s是点a向mn做垂线的交点），hj的距离（点h、j分别是是喙突基底部与折返部重合的内外交点）和ik的距离（点i是点k向mn做垂线与喙突折返部的交点）。结果根据其喙突的基本形态特点将其分成5种类型，包括花生型占29.7%，短棒型占27.4%，瓜子型占12.6%，长棒型占17.0%，楔型占13.3%。通过数据比较发现，左侧的距离ef与距离hj均大于右侧，P<0.05。各型比较距离cd时差异均具有统计学意义，P <0.05；瓜子型在点p厚度pp’、距离ab、as对比中，和花生型、楔型、长棒型、短棒型差异均有统计学意义，P <0.05；在点k厚度kk’对比中，瓜子型与其他4种类型差异均有统计学意义，P <0.05；在距离ab对比中，短棒型对比其他4种类型差异均有统计学意义，P <0.05。结论通过对喙突的形态学分型，能为临床上重建喙锁韧带治疗肩锁关节脱位提供解剖学依据。

Abstract

Objective To provide anatomical basis for clinical treatment of acromioclavicular joint dislocation by studying the morphology of coracoid process of human scapula. Methods A total of 500 patients with shoulder injury were selected from the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University in Sichuan Province, and 300 patients were selected as subjects, including 159 cases of right shoulder and 141 cases of left shoulder. CT scan images and 3D reconstruction results of scapula of the subjects were collected. The basic morphological characteristics of coracoid process CT images of the subjects were observed, and the relevant parameters were measured, including the longest horizontal distance of the coracoid process tip and the thickness of the midpoint (cd, pp’), the distance from the upper part of the coracoid process scapula to the base and the thickness of the midpoint (mn, kk’). The distance from the apex of the coracoid process to the base of the coracoid process (ab ), the longest horizontal distance of the recursion part of the coracoid process (ef), the distance of as (point s was the intersection of point a perpendicular to mn, the distance of hj (point h and j were the intersection of the base of the coracoid process and the recursion part respectively), and ik (point i was the intersection of point k perpendicular to mn and the coracoid process retraction). Results According to the morphological characteristics of coracoid process, they were divided into five types, including peanut 29.7%; Short rod type accounted for 27.4%; Melon seed type accounted for 12.6%; Rod type accounted for 17.0%; Wedge type accounted for 13.3%. Through data comparison, it was found that the distance ef and distance hj on the left were larger than those on the right, P<0.05. All types had statistical difference in comparison distance cd, P<0.05. The melon seed type showed statistical differences with peanut type, wedge type, long stick type and short stick type in thickness pp’, distance ab and as of point p, P<0.05. In the comparison of point K thickness kk’, there was statistical difference between melon seed type and other four types, P<0.05. In the distance ab comparison, there was statistical difference between the short bar type and the other four types, P<0.05. Conclusion The study on the morphology of coracoid process can provide anatomical basis for clinical reconstruction of coracoid ligament to treat acromioclavicular joint dislocation.

导出引用

郭兰前王定宣易刚李焱任杰英. 基于CT三维重建的喙突形态学分型及其临床意义[J]. 解剖学报. 2023, 54(1): 82-86 https://doi.org/10.16098/j.issn.0529-1356.2023.01.012

GUO Lan-qian WANG Ding-xuan YI Gang LI Yan REN Jie-ying. Morphological classification and clinical significance of the coracoid process based on CT three-dimensional reconstruction[J]. Acta Anatomica Sinica. 2023, 54(1): 82-86 https://doi.org/10.16098/j.issn.0529-1356.2023.01.012

中图分类号： R323.4

参考文献

［1］North AS, Wilkinson T. Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach ［J］. Strategies Trauma Limb Reconstr, 2018, 13(2): 69-74.

［2］Banffy MB, Uquillas C, Neumann JA. Biomechanical evaluation of a single- versus double-tunnel coracoclavicular ligament re-construction with acromioclavicular stabilization for acromioclavicular joint injuries ［J］. Am J sports Med, 2018, 46(5): 1070-1076.

［3］Cisneros LN. Management of chronic unstable acromioclavicular joint injuries ［J］. J Orthop Traumatol, 2017, 18(4): 305-318.

［4］Rush LN, Lake N, Stiefel EC, et al. Comparison of short-term complications between 2 methods of coracoclavicular ligament reconstruction: a multicenter study ［J］. Orthop J Sports Med, 2016, 4(7): 2325967116658419.

［5］Martetschlger F, Horan MP, Warth RJ, et al. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments［J］. Ame J Sports Med, 2013, 41(12): 2896-2903.

［6］Sirin E, Aydin N. Acromioclavicular joint injuries: diagnosis, classification and ligamentoplasty procedures［J］. EFFORT Open Rev, 2018,3(7):426-433.

［7］Zhu NF, Rui BY, Zhang YL. Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations ［J］. J Orthop Sci, 2016, 21(6): 749-752.

［8］Sella GDV, Miyazaki AN, Nico MAC, et al. Study on the anatomic relationship between the clavicle and the coracoid process using computed tomography scans of the shoulder ［J］. J Shoulder Elbow Surg, 2017, 26(10): 1740-1747.

［9］Eisenstein ED, Lanzi JT, Waterman BR, et al. Medialized clavicular bone tunnel position predicts failure after anatomic coracoclavicular ligament reconstruction in young, active male patients ［J］. Am J Sports Med, 2016, 44(10): 2682-2689.

［10］Banffy MB, van Eck CF. Clinical outcomes of a single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction ［J］. J Shoulder Elbow Surg, 2018, 27(6S): S70-S75.

［11］van Bergen CJA, van Bemmel AF, Alta TDW. New insights in the treatment of acromioclavicular separation ［J］. World J Orthop, 2017, 8(12): 861-873.

［12］Skjaker SA, Enger M, Engebretsen L, et al. Young men in sports are at highout risk of acromioclavicular joint injuries: a prospective cohort study ［J］. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2039-2045.

［13］Rockwood CA, Williams G, Young C. Injuries to the Acromioclavicular Joint. In: Rockwood Jr CA, Green D, Bucholz R, eds. Fractures ［M］. Philiadelphia: Lippicott-Ravent, 1996: 1341-1414.

［14］Takase K, Yamamoto K. Arthroscopic procedures and therapeutic results of anatomical reconstruction of the coracoclavicular ligaments for acromioclavicular Joint dislocation ［J］. Orthop Traumatol Surg Res, 2016, 102(5): 583-587.

［15］Horst K, Garving C, Thometzki T, et al. Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: clinical results from the TightRope technique vs K-wire fixation ［J］. Orthop Traumatol Surg Res, 2017, 103(2): 171-176.

［16］Cetinkaya E, Arkan Y, Beng K, et al. Bosworth and modified Phemister techniques revisited A comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations ［J］. Acta Orthop Traumatol Turc, 2017, 51(6): 455-458.

［17］Stein T, Müller D, Blank M, et al. Stabilization of acute high-grade acromioclavicular joint separation: a prospective assessment of the clavicular hook plate versus the double double-button suture procedure ［J］. Am J Sports Med, 2018, 46(11): 2725-2734.

［18］Müller D, Reinig Y, Hoffmann R, et al. Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes ［J］. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12): 3832-3847.

［19］Gowd AK, Liu JN, Cabarcas BC, et al. Current concepts in the operative management of acromioclavicular dislocations: a systematic review and metaanalysis of operative techniques ［J］. Am J Sports Med, 2018, 46(12): 363546518795147.

［20］Chen XC, Li Y, Yu HR, et cl. Differences of bone mineral density and change with age among female adults of minorities in Guangxi ［J］. Acta Anatomica Sinica, 2018,49(5): 683-687. (in Chinese)

陈兴才, 李炎, 玉洪荣, 等. 广西少数民族成年女性骨密度的差异及年龄变化特点［J］. 解剖学报, 2018, 49(5): 683-687.

［21］Mori D, Yamashita F, Kizaki K, et al. Anatomic coracoclavicular ligament reconstruction for the treatment of acute acromioclavicular joint dislocation: minimum 10-year follow-up［J］. JB JS Open Access, 2017,2(3): e0007.

［22］Frank RM, Bernardoni ED, Cotter EJ. Anatomic acromioclavicular joint reconstruction with semitendinosus allograft: surgical technique ［J］. Arthros Tech, 2017, 6(5): 1721-1726.