基于CT三维重建的肩胛上角形态学分型及临床意义

赵虹瑾, 郭晓光, 覃波, 汪国友, 扶世杰, 张磊

中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (5) : 508-511.

中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (5) : 508-511. DOI: 10.13418/j.issn.1001-165x.2019.05.006
断层影像解剖

基于CT三维重建的肩胛上角形态学分型及临床意义

  • 赵虹瑾1, 郭晓光2, 3, 覃波2, 3, 汪国友2, 3, 扶世杰2, 3, 张磊2, 3
作者信息 +

The morphological classification and clinical significance of the angulus superior scapulae based on CT three-dimensional reconstruction

  • ZHAO Hong-jin1, GUO Xiao-guang2, 3, QIN Bo2, 3, WANG Guo-you2, 3, FU Shi-jie2, 3, ZHANG Lei2, 3
Author information +
文章历史 +

摘要

目的 探讨基于CT重建的肩胛上角形态学分型及临床意义。  方法 根据志愿者肩胛骨CT重建形态进行分型。设肩胛上角为A点,肩胛切迹最低点为B点,肩胛冈与肩胛骨内侧缘之交点为C点,A点在CE连线上的垂点为D点,冈盂切迹为E点,肩胛下角最低点为F点。研究参数:A点厚度;AB、AC、AD距离;∠A(AB连线与AC连线的夹角);∠ACF在矢状面的度数;∠ACF在冠状面的度数。  结果 CT重建下肩胛上角分为3型:山丘型48%,冠状面∠A(93.76±7.69)°;山峰型47%,冠状面∠A(86.69±6.23)°;烟囱型5%,冠状面∠A(85.33±7.10)°。其中,山丘型及烟囱型A点均较山峰型薄(P<0.05);在AB、AC、AD、∠A、∠ACF(冠状面)中,山丘型与山峰型对比有统计学差异(P<0.05);在AD、∠A中,山丘型与烟囱型对比有统计学差异(P<0.05)。  结论 CT重建下肩胛上角分为3型:山丘型、山峰型、烟囱型;不同的肩胛上角分型可能对颈肩痛及肩胛提肌综合症有着潜在的影响。

Abstract

Objective To explore the morphological classification and the clinical significance of the angulus superior scapulae based on CT three-dimensional reconstruction. Methods The CT three-dimensional reconstruction of scapular was classified according to the morphological characteristics. Reference points: A, the angulus superior scapulae; B, the lowest point of the scapular notch; C, the intersection between the scapula and the inner margin of the scapula; D, the vertical point of the point A on the line CE; E, the spinoglenoid notch; F, the lowest point of the subscapular angle. Parameters studied: the thickness of point A; the distance of AB, AC and AD; the angle of ∠A (the angle between the straight line AB and the straight line AC); the angle of ∠ACF in sagittal plane; the angle of ∠ACF in coronal plane. Results Under the CT three-dimensional reconstruction, the superior scapulae was classified into three types: Hilly type 48%, ∠A =(93.76±7.69)°; Mountain peak type 47%, ∠A=(86.69±6.23)°; and Chimney type 5%, ∠A =(85.33±7.10)°. Among them,the thickness of point A of Hill type and Chimney type was thinner than Mountain peak type (P<0.05). For the distance of AB, AC, AD and the angle of ∠A, ∠ACF (Coronal plane), there were statistical differences between Hill type and Mountain peak type (P<0.05). For the distance of AD and the angle of ∠A, there were statistical differences between Hill type and Chimney type (P<0.05). Conclusion Under the CT three-dimensional reconstruction, the superior scapulae is classified into three types: Hilly type, Mountain peak type and Chimney type. Different types of superior scapulae may have a potential effect in neck pain and the levator muscle syndrome.

关键词

肩胛上角 /  CT三维重建 /  颈肩痛 /  肩胛提肌综合症

Key words

Angulus superior scapulae /  CT three-dimensional reconstruction /  Neck pain /  Levator muscle syndrome

引用本文

导出引用
赵虹瑾, 郭晓光, 覃波, 汪国友, 扶世杰, 张磊. 基于CT三维重建的肩胛上角形态学分型及临床意义[J]. 中国临床解剖学杂志. 2019, 37(5): 508-511 https://doi.org/10.13418/j.issn.1001-165x.2019.05.006
ZHAO Hong-jin, GUO Xiao-guang, QIN Bo, WANG Guo-you, FU Shi-jie, ZHANG Lei. The morphological classification and clinical significance of the angulus superior scapulae based on CT three-dimensional reconstruction[J]. Chinese Journal of Clinical Anatomy. 2019, 37(5): 508-511 https://doi.org/10.13418/j.issn.1001-165x.2019.05.006
中图分类号: R323.42   

参考文献

[1]  黄崇友, 赵丽云, 曾耿, 等. 肩胛上神经体表定位研究及临床意义[J]. 中国临床研究, 2016, 29(06): 771-773.
[2]  杨希重, 王德春, 沈若武, 等. 肩胛骨上角区的解剖及临床意义[J]. 中国临床解剖学杂志, 2007, 25(4): 361-363.
[3]  Neuhaus V, Bot AG, Guitton TG, et al. Scapula fractures: interobserver reliability of classification and treatment[J]. J Orthop Trauma, 2014, 28(3): 124-129.
[4] Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures[J]. Rozhl Chir. 2018, 97(2): 67-76.
[5]  Bartoniček J, Tuček M, Naňka O. Scapular fractures[J]. Rozhl Chir. 2015, 94(10): 393-404.
[6]  Audigé L, Kellam JF, Lambert S, et al. The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement[J]. J Shoulder Elbow Surg, 2014, 23(2): 189-196.
[7] Buttagat V, Taepa N, Suwannived N, et al. Effects of scapular stabilization exercise on pain related parameters in patients with scapulocostal syndrome: A randomized controlled trial[J]. J Bodyw Mov Ther, 2016, 20(1): 115-122.
[8] McCarthy C , Harmon D. A technical report on ultrasound-guided scapulocostal syndrome injection[J]. Ir J Med Sci, 2016, 185(3): 669-672.
[9]  Erro R, Bhatia KP, Catania S, et al. When the levator scapulae becomes a "rotator capitis": implications for cervical dystonia[J]. Parkinsonism Relat Disord, 2013, 19(7): 705-706.
[10] Metin Ökmen B, Ökmen K, Altan L. Comparison of the Efficiency of Ultrasound-Guided Injections of the Rhomboid Major and Trapezius Muscles in Myofascial Pain Syndrome: A Prospective Randomized Controlled Double-blind Study[J]. J Ultrasound Med. 2018, 37(5): 1151-1157.
[11] Islam SU, Choudhry MN, Akbar S, et al. Outcome of Scapulothoracic Arthroscopy for Painful Snapping Scapula[J]. Open Orthop J, 2017, 11: 785-793.
[12] 陈显辉, 张毅, 黄星球, 等. 肩关节镜辅助肩关节粘连松解近期疗效[J]. 南方医科大学学报, 2010, 30(2): 411-412.
[13] 袁锋, 蔡俊丰, 马敏, 等. 关节镜下360º松解治疗原发性冻结肩[J]. 中华肩肘外科电子杂志, 2016, 4(2): 76-81.                 (下转第516页)
(上接第511页)
[14] 何栩, 罗小兵, 李少柏, 等. 冲击波联合肩关节功能训练治疗冈上肌肌腱炎的临床研究[J]. 中华肩肘外科电子杂志, 2017, 5(1): 9-14.
[15]Williams GR, Shakil M, Klimkiewicz J. Anatomy of the scapulothoracic articulation[J]. Clin Orthop Relat Res, 1999, 359: 237-246.
[16] Jeong HJ, Cynn HS, Yi CH, et al. Stretching position can affect levator scapular muscle activity, length, and cervical range of motion in people with a shortened levator scapulae[J]. Phys Ther Sport, 2017, 26: 13-19.
[17] Bae WS, Lee HO, Shin JW. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome[J]. J Phys Ther Sci, 2016, 28(5): 1636-1639.
[18]Au J, Webb AL, Buirski G, et al. Anatomic variations of levator scapulae in a normal cohort: an MRI study[J]. Surg Radiol Anat, 2017, 39(3): 337-343.
[19]Castelein B, Cagnie B, Parlevliet T, et al. Optimal Normalization Tests for Muscle Activation of the Levator Scapulae, Pectoralis Minor, and Rhomboid Major: An Electromyography Study Using Maximum Voluntary Isometric Contractions[J]. Arch Phys Med Rehabil, 2015, 96(10): 1820-1827.
[20]Wang ML, Miller AJ, Ballard BL, et al. Management of Snapping Scapula Syndrome[J]. Orthopedics, 2016, 39(4): e783-e786.
[21]Chotai PN, Loukas M, Tubbs RS. Unusual origin of the levator scapulae muscle from mastoid process[J]. Surg Radiol Anat, 2015, 37(10): 1277-1281.
[22]Ha SM, Kwon OY, Yi CH, et al. Effects of passive correction of scapular position on pain, proprioception, and range of motion in neck-pain patients with bilateral scapular downward-rotation syndrome[J]. Man Ther, 2011, 16(6): 585-589.
[23]Lynch SS, Thigpen CA, Mihalik JP, et al. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers[J]. Br J Sports Med, 2010, 44(5): 376-381.
[24]Lee JH, Cynn HS, Choi WJ, et al. Reliability of levator scapulae index in subjects with and without scapular downward rotation syndrome[J]. Phys Ther Sport, 2016, 19: 1-6.
[25]Diener, Ina. The effect of Levator scapula tightness on the cervical spine: Proposal of another lenght test[J]. J Man Manip Ther, 1998, 6(2), 78-86.
[26]Osias W, Matcuk GR, Skalski MR, et al. Scapulothoracic pathology: review of anatomy, pathophysiology, imaging findings, and an approach to management[J]. Skeletal Radiol, 2018, 47(2): 161-171.
[27]Tahal DS, Katthagen JC, Marchetti DC, et al. A Cadaveric Model Evaluating the Influence of Bony Anatomy and the Effectiveness of Partial Scapulectomy on Decompression of the Scapulothoracic Space in Snapping Scapula Syndrome[J]. Am J Sports Med, 2017, 45(6): 1276-1282.
[28]Spiegl UJ, Petri M, Smith SW, et al. Association between scapula bony morphology and snapping scapula syndrome[J]. J Shoulder Elbow Surg, 2015, 24(8): 1289-1295.
[29]Lazar MA, Kwon YW, Rokito AS. Snapping scapula syndrome[J]. J Bone Joint Surg Am, 2009, 91(9): 2251-2262.
[30]Lehtinen JT, Tingart MJ, Apreleva M, et al. Quantitative morphology of the scapula: normal variation of the superomedial scapular angle, and superior and inferior pole thickness[J]. Orthopedics, 2005, 28(5): 481-486.
[31]Aggarwal A, Wahee P, Harjeet, et al. Variable osseous anatomy of costal surface of scapula and its implications in relation to snapping scapula syndrome[J]. Surg Radiol Anat, 2011, 33(2): 135-140.

基金

泸州市院士工作站在建项目(20180101)

Accesses

Citation

Detail

段落导航
相关文章

/