目的 探讨基于CT三维重建的肩胛冈解剖形态学分型及其临床意义。 方法 选取在遵义医学院附属医院放射科对患侧肩胛骨进行CT平扫的319名患者（左肩179例，右肩140例），进而对患侧肩胛骨三维重建形态并分型。假设肩胛冈内侧端与肩胛骨内侧缘交点为A点，冈盂切迹与肩胛冈上缘的交点为B点，冈盂切迹为C点，肩峰内侧缘为D点，肩峰外侧缘为E点，AB的内1/3点为F ，AC的内1/3点为G，AB的外1/3点为H，AC的外1/3点为I，FG的中点为J，HI的中点为K，BC的中点为L。研究参数：AB、AC、AD、AE、BC、HI、FG的距离；B、H、F、L、K、J、E、I、G的厚度。 结果 CT重建下肩胛冈形态分为6型：大梭型、小梭型、木棒型、粗杆型、S型和细杆型。AE、BC、AC以及AD的长度大梭型、木棒型和粗杆型长于小梭型，S型和细杆型 (P<0.05)。AB的长度大梭型长于木棒型和细杆型 (P<0.05)。FG的高度大梭型高于小梭型 (P<0.05)。HI的高度大梭型高于其他所有类型 (P<0.05)。B、C、H、K、I、F、J以及G的厚度，大梭型以及粗杆型厚于细杆型以及小梭型 (P<0.05)。 结论 CT三维重建下肩胛冈分为6型：大梭型、小梭型、木棒型、粗杆型、S型和细杆型。不同的肩胛冈形态分型为临床医生选择内固定以及手术方式提供解剖学依据。
Abstract
Objective To explore morphological classification of scapular spine based on three-dimensional reconstruction of CT and its clinical significance. Methods Three hundred and nineteen patients (179 cases of left shoulder and 140 cases of right shoulder) from the department of Radiology in the affiliated Hospital of Zunyi Medical College were scanned by CT, and then the three-dimensional reconstruction and classification of the affected scapular spine were performed. It was assumed that the point of intersection between the medial end of the scapular spine and the medial margin of the scapula was point A. The intersection of the glenoid notch and the superior margin of the scapular spine was point B. The glenoid notch was point C. The medial edge of the acromion was point D. The lateral edge of the acromion was point E. The inner 1/3 point of AB was point F. The inner 1/3 point of AC was point G. The outer 1/3 point of AB was point H, the outer 1/3 point of AC was point I, the midpoint of FG was point J, the midpoint of HI was point K, the midpoint of BC was point L. Research parameters were the following: the distance between point A and point B, point A and point C, point A and point D, point A and point E, point B and point C, point H and point I, point F and point G, and the thickness of B, H, F, L, K, J, E, I, G. Results The shape of the inferior scapular spine reconstructed by CT can be divided into 6 types: large fusiform-type, small fusiform-type, wooden club-type, thick rod-type, S-type and slender rod-type. The length of AE, BC, AC and AD in large fusiform-type, wooden club-type and thick rod-type was longer than that of small fusiform-type, S-type and slender rod-type. The length of AB in large fusiform-type was longer than that of wooden club-type and slender rod-type (P<0.05). The height of FG in large fusiform-type was higher than that in small fusiform-type. The height of HI in large fusiform-type was higher than that of all other types (P<0.05). The thickness of B, C, H, K, I, F, J and Gin large fusiform-type and thick rod-type were thicker than those of slender rod -type and small fusiform-type (P<0.05). Conclusions The scapular spine can be divided into 6 types based on the CT three-dimensional reconstruction: large fusiform-type, small fusiform-type, wooden club-type, thick rod-type, S-type and slender rod-type. Different morphological types of scapular spine provide anatomical basis for clinicians to choose internal fixation and operation methods.
关键词
肩胛冈 /
解剖形态学 /
CT三维重建
Key words
Scapular spine /
Anatomic morphology /
CT three-dimensional reconstruction
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Pinsolle V, Tessier R, Casoli V, et al. The pedicled vascularised scapular bone flap for proximal humerus reconstruction and short humeral stump lengthening[J]. J Plast Reconstr Aesthet Surg, 2007, 60(9): 1019-1024. DOI: 10.1016/j.bjps.2007.03.028.
[2] Panje W, Cutting C. Trapezius osteomyocutaneous island flap for reconstruction of the anterior floor of the mouth and the mandible[J]. Head Neck Surg, 1980, 3(1):66-71. DOI:10.1001/archotol.1985.008000 50092015.
[3] Chen WL, Chen ZW, Yang ZH, et al. The trapezius osteomyocutaneous island flap for reconstructing hemimandibular and oral defects following the ablation of advanced oral malignant tumours[J]. J Craniomaxillofac Surg, 2009, 37(2): 91-95. DOI: 10.1016/j.jcms. 2008. 10.012.
[4] Vacher C, de Vasconcellos J-J Accioli. The anatomical basis of the osteo-musculo-cutaneous trapezius flap in mandibular reconstruction[J]. Surg Radiol Anat, 2005, 27(1): 1-7. DOI: 10.1007/s00276-004-0278-3.
[5] Burke CS, Roberts CS, Nyland JA, et al. Scapular thickness-implications for fracture fixation[J]. J Shoulder Elbow Surg, 2006, 15(5): 645-648. DOI: 10.1016/j.jse.2005.10.005.
[6] von Schroeder HP, Kuiper SD, Botte MJ. Osseous anatomy of the scapula[J]. Clin Orthop Relat Res, 2001, (383): 131-139. DOI: 10.1097/00003086-200102000-00015.
[7] DiStefano JG, Park AY, Nguyen TQ, et al. Optimal screw placement for base plate fixation in reverse total shoulder arthroplasty[J]. J Shoulder Elbow Surg, 2011, 20(3): 467-476. DOI: 10.1016/j.jse.2010.06.001.
[8] Zumstein MA, Pinedo M, Old J, et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review[J]. J Shoulder Elbow Surg, 2011, 20(1): 146-157. DOI 10.1016/j.jse.2010.08.001.
[9] Schrumpf M, Maak T, Sommer H, et al. The glenoid in total shoulder arthroplasty[J]. Curr Rev Musculoskelet Med, 2011, 4(4): 191-199. DOI: 10.1007/s12178-0119096-5.
[10]Crosby LA, Hamilton A, Twiss T. Scapula fractures after reverse total shoulder arthroplasty: classification and treatment[J]. Clin Orthop Relat Res, 2011, 469(9): 2544-2549. DOI: 10.1007/s11999-011-1881-3.
[11]Hattrup SJ. The influence of postoperative acromial and scapular spine fractures on the results of reverse shoulder arthroplasty[J]. Orthopedics, 2010, 33(5). DOI: 10.3928/01477447-20100329-04.
[12]Guery J, Favard L, Sirveaux F, et al. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years[J]. J Bone Joint Surg Am, 2006, 88(8): 1742-1747. DOI: 10.2106/jbjs.e.00851.
[13]Cheung E, Willis M, Walker M, et al. Complications in reverse total shoulder arthroplasty[J]. J Am Acad Orthop Surg, 2011, 19 (7): 439-449. DOI: 10.1145/1999995.2000018.
[14]Nicolay S, De Beuckeleer L, Stoffelen D, et al. Atraumatic bilateral scapular spine fracture several months after bilateral reverse total shoulder arthroplasty[J]. Skeletal Radiol, 2014, 43(5): 699-702. DOI: 10.1007/s00256-013-17754.
[15]Otto RJ, Virani NA, Levy JC, et al. Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification[J]. J Shoulder Elbow Surg, 2013, 22(11): 1514-1521. DOI: 1016/j.jse.2013.02.007.
[16]Ebraheim NA, Xu R, Haman SP, et al. Quantitative anatomy of the scapula[J]. Am J Orthop, 2000, 29(4): 287-292. DOI: 10.1002/bjs.1800135124.
[17]Mallon WJ, Brown HR, Vogler JB, et al. Radiographic and geometric anatomy of the scapula[J]. Clin Orthop Relat Res, 1992,(277): 142-154. DOI: 10.1097/00003086-199204000-00017.
[18]Wang HJ, Giambini H, Hou DB, et al. Classification and morphological parameters of the scapular spine: implications for surgery[J]. Medicine, 2015, 9(45): e1986. DOI: 10.1097/MD.0000000000001986.
[19]Tubbs RS, Wartmann CT, Louis RG, et al. Use of the scapular spine in lumbar fusion procedures: cadaveric feasibility study. Laboratory investigation[J]. J Neurosurg Spine, 2007, 7(5): 554-557. DOI: 10.3171/SPI-07/11/557.
[20]傅渊源, 王华军, 袁仕国, 等. 肩胛冈和肩峰角的骨性观测及临床意义[J]. 中国临床解剖学杂志, 2010, 28( 3): 268-271. DOI: CNKI:SUN:ZLJZ.0.2010-030014.
[21]As-Sultany M, Tambe A, Clark DI. Nonunion of a scapular spine fracture: case report and management with open reduction, internal fixation, and bone graft[J]. Int J Shoulder Surg, 2008, 2(3): 64-67. DOI: 10.4103/0973-6042.42202.
[22]Park AY, DiStefano JG, Nguyen TQ, et al. Congruency of scapula locking plates: implications for implant design. Am J Orthop (Belle Mead NJ), 2012, 41(4): E53-56. DOI: 10.1115/SBC2010-19117.
[23]Kuhn JE, Blasier RB, Carpenter JE. Fractures of the acromion process: a proposed classification system[J]. J Orthop Trauma, 1994, 8(1): 6-13. DOI: 10.1097/00005131-199402000-00002.
[24]Rohman E, Gronbeck K, Tompkins M, et al. Scapular spine dimensions and suitability as a glenoid bone graft donor site[J]. Am J Sports Med, 2019, 47(10): 2469-2477. DOI: 10.1177/036354 6519861965.
PDF(1760 KB)
京ICP备08002354号-3
