目的 研究肩峰与肱骨头相对位置的放射解剖学特征，探讨其在髓内钉治疗肱骨近端骨折方面的临床意义。 方法 选取105例标准肩关节正位图像，以盂上结节为A点，盂下结节为B点，肱骨解剖颈外上方顶点为C点，肱骨解剖颈前下方为D点，肩峰最外侧缘为E点，以肱骨干轴线与肱骨头皮质交会处为F点，肱骨近端大结节部最外侧缘为H点，分别经E点、H点作一条平行于肱骨干轴线的直线，经F点作一条垂直于肱骨干轴线的直型，两交点为G点、I点；分别测量AB、CD、EF、EG、FG、GI、HI、EI、肱骨颈干角（∠α）、EF与FG的夹角（∠β），计算肩峰投影指数（Acromial Projection Index, API，API=FG/FI×100%）。观察肩峰形态及其在矢状面与肱骨干轴线的相对位置关系。用双变量Spearman相关分析各解剖参数的相关性，以独立样本T检验分析解剖参数的性别差异，采用单因素ANOVA检验分析解剖参数在不同肩峰形态上的差异。 结果 年龄与HI负相关；AB与CD、GI及HI正相关；CD与AB、EG、GI及HI正相关；∠β与EG、GI正相关，与EF、FG及API负相关；API与EF、FG正相关、与EG、GI、HI及∠β负相关。男性的AB、CD、GI及HI比女性的长，男性的∠β比女性的大，男性的API比女性小。差异有统计学意义（P≤0.05）。观察发现I型肩峰基本不越过肱骨干轴线，而II、III型肩峰普遍越过肱骨干轴线，在3组不同肩峰分型的之间，各解剖参数均无显著差异（P>0.05）。 结论 置钉的难易程度与API密切相关，肱骨头越大，肩峰投影指数越小，对肱骨髓内钉置钉的影响越小。男性的肱骨头大小较女性大，可能在髓内钉置钉的过程中，肩峰的阻挡更小。II、III型肩峰较I型肩峰对置钉遮挡影响更大。
关键词：
肩峰; ; ; 肱骨近端; ; ; 放射解剖学; ; ; 髓内钉; ; ; 肩峰投影指数
Objective To explore the radiologic anatomical characteristics of the relative position between acromion and humerus head, as well as the clinical application in the treatment of proximal humerus fractures with intramedullary nailing. Methods A total of 105 standard shoulder joint images under X-ray were selected. The supraglenoid tubercles was defined as point A, the subglenoid tubercles as point B, the apex of the superior lateral aspect of anatomical neck of humerus as point C, the anteroinferior aspect of anatomical neck of humerus as point D, and the outermost edge of the acromion as point E, the intersection of the axis of the humerus shaft and the cortex of the humerus head as point F, and the outermost edge of the greater tuberosity of humerus as point H. The line was drawn parallel to the axis of the humerus shaft through point E and point H respectively. The line perpendicular to the axis of the humerus shaft was drawn through point F. The two points of intersection were point G and I. Lines AB, CD, EF, EG, FG, GI, HI, EI were measured respectively. The humeral neck shaft angle (∠α) and the angle between line EF and line FG (∠β) were measured respectively. And the acromial projection index (API, FG/FI×100%) was calculated. The morphology of acromion and its relative position with the axis of the humerus shaft in the sagittal plane were observed. The correlation among the above measurements were analyzed by Spearman correlation. The gender difference was analyzed by t-test. The difference in anatomical parameters among three types of the morphology of acromion was analyzed by ANOVA test. Results The age was negatively related with HI, AB was positively related with CD, GI and HI, CD was positively related with AB, EG, GI and HI, ∠β was positively related with EG, GI, and negatively related with EF, FG and API, API was positively related with EF, FG and negatively related with EG, GI, HI and ∠β. The AB, CD, GI and HI of the male were longer than those of the female, the ∠β of the male was larger than that of the female, and the API of the male was smaller than that of the female, with statistical difference (P≤0.05). Except for the type I, acromion generally crossed the axis of the humerus shaft in type II and III. There was no significant difference in anatomical parameters among the three types of acromion (P>0.05). Conclusions The difficulty of intramedullary nailing placement in the humerus is closely related to the API. The larger the humerus head, the smaller the acromion projection index, and the easier it is to insert the nail. The male have a larger humeral head size than female, so it may be easier to insert intramedullary nail in male. Compared to the type I acromion, it may be more difficult in inserting the nail for the type II and III.
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