肩关节Bankart损伤修复锚钉置入位置及方向的影像学研究  

An anatomic study of glenoid regarding anchor insertion posion and direction

作　　者：王胜群[1] 王佳音[2] 谷长跃[1] 左建林[1] 

机构地区：[1]吉林大学中日联谊医院骨科,长春130033 [2]吉林省松原市前郭县医院骨科

出　　处：《中华外科杂志》2015年第2期90-94,共5页Chinese Journal of Surgery

摘　　要：目的 研究肩胛盂缘的正常解剖结构,测量肩胛盂缘的内、外盂缘角,并测量Bankart损伤修复的有效锚钉插入角度及方向.方法 采用12具不成对的肩胛骨尸体模型（左侧6具,右侧6具）,无外伤及骨折.320排CT扫描,Mimics软件重建后,获得6个断面的断层影像,右侧肩胛盂用顺时针标记,左侧肩胛盂用逆时针标记,在8个重要位点（2、3、4、5、6、7、8、9点钟方向）测量内盂缘角α和外盂缘角β,精确到1°,并观察每个方向的形态学特点.以常用的12 mm长的锚钉为例,测量8个重要位点的锚钉最小置入角度γ.配对t检验检测长轴两侧对应位置的盂缘角有无差别,两组独立样本t检验检测左右侧相同位置角度的差别.方差分析法检测左右侧、盂缘不同位置的角度的差别.结果 最小内盂缘角出现在4点钟位置（右侧50°±6°,左侧52°±9°）,与6点钟位置比较差异有统计学意义（t=10.466,p=0.000）,与5点钟位置比较差异有统计学意义（t=3.754,P=0.003）,与3点钟位置之间比较差异无统计学意义（t=0.926,P =0.374）.最小外盂缘角出现在3点钟位置（右侧50°±6°,左侧53°±10°）,与6点钟位置比较差异有统计学意义（t=9.862,P=0.000）,与5点钟位置比较差异有统计学意义（t=3.634,P=0.003）,与4点钟位置比较差异无统计学意义（t=0.697,P=0.501）.肩胛盂形态不对称,在3点钟方向盂缘到颈部几乎为一条直线,9点钟方向则存在凹陷.同样的情况也出现在其他位点.锚钉最小置入角度3、4、5、6点钟方向分别为右侧25°±4°、54°±6°、83°±4°、119°±2°;左侧23°±4°、57°±4°、89°±7°、119°±4°.各个位置的内盂缘角、外盂缘角、锚钉最小置入角度等,在左右侧对比时差异无统计学意义（内盂缘角t=0.283 ～ 1.785,P＞0.05;外盂缘角t=0.369 ～ 2.067,P＞0.05;锚钉最小置入角度t=0.145 ～ 0.492,P＞0.05）.结论 肩胛盂不同位置的解剖结构不同,内、外侧盂�Objective To investigate normal bony anatomy of the glenoid rim,to measure inner glenoid rim angle and outer glenoid rim angle,and the angles for successful anchor insertion for arthroscopic labral repairs.Methods Twelve unpaired isolated human glenoids （6 right,6 left） without any evidence of trauma were for studying.The glenoid specimens were scanned using 320-slice CT （Aquilion ONE）,then reconstruction glenoid to a three dimensional model using materialise′s interactive medical image control system （Mimics） and to obtain cross-sectional images in 6 different planes,mark the right glenoid rim with clockwise tag,the left with counterclockwise tag.Inner glenoid rim angle marked as angle α and outer glenoid rim angle marked as angle β were measured from the cross-sectional images of the glenoids at 8 positions：2-,3-,4-,5-,6-,7-,8-and 9-o′clock positions.Glenoid morphology was noted for each position.Using 12 mm as radius,measured the minimum insertion angle of anchor,marked as angle γ.Normal distribution of the data was confirmed with Kolmogorov-Smirnov test.Paired t-test was performed to detect differences in the angles between two locations.Two independent samples t-test was performed to detect differences in the angles between same location of left and right.Analysis of variance （ANOVA） was performed to detect differences in the angles between right and left,and different locations of the glenoid rim.Results The smallest α was at the 4-o′ clock position （right 50° ± 6°,left 52° ± 9°）,significant difference were seen when compared with the 6-o′clock position （t =10.466,P =0.000） or the 5-o′clock position（t =3.754,P =0.003）,no significant difference exist between 4-o′clock position and 3-o′clock posion （t =0.926,P =0.374）.The smallest β was at the 3-o′clock position（right 50° ± 6°,left 53° ±10°）,significant difference were seen when compared with the 6-o′clock position（t =9.862,P =0.000） or the 5-o′clock position（t =3.634,P =0.003）

关 键 词：肩 关节镜 缝合锚 

分 类 号：R687.3[医药卫生—骨科学]