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、外侧盂缘角最小角度分别出现在4、3点钟方向,术中不同位置可用于锚钉固定的骨量也不同;不同位置的最小锚钉置入角度不同.在进行Bankart修复术时,肩胛盂不同位置的盂缘角、解剖结构、锚钉最小置入角度对手术有一定指导意义.
目的 研究肩胛盂緣的正常解剖結構,測量肩胛盂緣的內、外盂緣角,併測量Bankart損傷脩複的有效錨釘插入角度及方嚮.方法 採用12具不成對的肩胛骨尸體模型(左側6具,右側6具),無外傷及骨摺.320排CT掃描,Mimics軟件重建後,穫得6箇斷麵的斷層影像,右側肩胛盂用順時針標記,左側肩胛盂用逆時針標記,在8箇重要位點(2、3、4、5、6、7、8、9點鐘方嚮)測量內盂緣角α和外盂緣角β,精確到1°,併觀察每箇方嚮的形態學特點.以常用的12 mm長的錨釘為例,測量8箇重要位點的錨釘最小置入角度γ.配對t檢驗檢測長軸兩側對應位置的盂緣角有無差彆,兩組獨立樣本t檢驗檢測左右側相同位置角度的差彆.方差分析法檢測左右側、盂緣不同位置的角度的差彆.結果 最小內盂緣角齣現在4點鐘位置(右側50°±6°,左側52°±9°),與6點鐘位置比較差異有統計學意義(t=10.466,p=0.000),與5點鐘位置比較差異有統計學意義(t=3.754,P=0.003),與3點鐘位置之間比較差異無統計學意義(t=0.926,P =0.374).最小外盂緣角齣現在3點鐘位置(右側50°±6°,左側53°±10°),與6點鐘位置比較差異有統計學意義(t=9.862,P=0.000),與5點鐘位置比較差異有統計學意義(t=3.634,P=0.003),與4點鐘位置比較差異無統計學意義(t=0.697,P=0.501).肩胛盂形態不對稱,在3點鐘方嚮盂緣到頸部幾乎為一條直線,9點鐘方嚮則存在凹陷.同樣的情況也齣現在其他位點.錨釘最小置入角度3、4、5、6點鐘方嚮分彆為右側25°±4°、54°±6°、83°±4°、119°±2°;左側23°±4°、57°±4°、89°±7°、119°±4°.各箇位置的內盂緣角、外盂緣角、錨釘最小置入角度等,在左右側對比時差異無統計學意義(內盂緣角t=0.283 ～ 1.785,P＞0.05;外盂緣角t=0.369 ～ 2.067,P＞0.05;錨釘最小置入角度t=0.145 ～ 0.492,P＞0.05).結論 肩胛盂不同位置的解剖結構不同,內、外側盂緣角最小角度分彆齣現在4、3點鐘方嚮,術中不同位置可用于錨釘固定的骨量也不同;不同位置的最小錨釘置入角度不同.在進行Bankart脩複術時,肩胛盂不同位置的盂緣角、解剖結構、錨釘最小置入角度對手術有一定指導意義.
목적 연구견갑우연적정상해부결구,측량견갑우연적내、외우연각,병측량Bankart손상수복적유효묘정삽입각도급방향.방법 채용12구불성대적견갑골시체모형(좌측6구,우측6구),무외상급골절.320배CT소묘,Mimics연건중건후,획득6개단면적단층영상,우측견갑우용순시침표기,좌측견갑우용역시침표기,재8개중요위점(2、3、4、5、6、7、8、9점종방향)측량내우연각α화외우연각β,정학도1°,병관찰매개방향적형태학특점.이상용적12 mm장적묘정위례,측량8개중요위점적묘정최소치입각도γ.배대t검험검측장축량측대응위치적우연각유무차별,량조독립양본t검험검측좌우측상동위치각도적차별.방차분석법검측좌우측、우연불동위치적각도적차별.결과 최소내우연각출현재4점종위치(우측50°±6°,좌측52°±9°),여6점종위치비교차이유통계학의의(t=10.466,p=0.000),여5점종위치비교차이유통계학의의(t=3.754,P=0.003),여3점종위치지간비교차이무통계학의의(t=0.926,P =0.374).최소외우연각출현재3점종위치(우측50°±6°,좌측53°±10°),여6점종위치비교차이유통계학의의(t=9.862,P=0.000),여5점종위치비교차이유통계학의의(t=3.634,P=0.003),여4점종위치비교차이무통계학의의(t=0.697,P=0.501).견갑우형태불대칭,재3점종방향우연도경부궤호위일조직선,9점종방향칙존재요함.동양적정황야출현재기타위점.묘정최소치입각도3、4、5、6점종방향분별위우측25°±4°、54°±6°、83°±4°、119°±2°;좌측23°±4°、57°±4°、89°±7°、119°±4°.각개위치적내우연각、외우연각、묘정최소치입각도등,재좌우측대비시차이무통계학의의(내우연각t=0.283 ～ 1.785,P＞0.05;외우연각t=0.369 ～ 2.067,P＞0.05;묘정최소치입각도t=0.145 ～ 0.492,P＞0.05).결론 견갑우불동위치적해부결구불동,내、외측우연각최소각도분별출현재4、3점종방향,술중불동위치가용우묘정고정적골량야불동;불동위치적최소묘정치입각도불동.재진행Bankart수복술시,견갑우불동위치적우연각、해부결구、묘정최소치입각도대수술유일정지도의의.
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),no significant difference exist between 4-o'clock position and 3-o'elock posion (t =0.697,P =0.501).Asymmetric morphology of the glenoid was noted with an almost straight line extending medially from the rim at the 3-o'clock position,whereas a concave morthology was noted at the 9-o'clock position.Similary at the 4-and 5-o'clock position,the scapular bony surface did not curve toward the base as markedlv as it did at the corresponding posterior 8-and 7-o'clock position.Angle γ from the 3-o'clock to the 9-o'clock were 25° ±4°,54° ±6°,83° ±4°,119° ±2° at right side,23° ±4°,57° ±4°,89° ±7°,119° ±4° at left side.No significant difference of any angle at the same position was noted between left and right (α:t =0.283-1.785,P ＞ 0.05 ; β:t =0.369-2.067,P ＞ 0.05 ; γ:t =0.145-0.492,P ＞0.05).Conclusions The available bone mass for the anchor insertion is found to vary depending on the position of the glenoid rim.The smallest inner and outer glenoid rim angle are at the 4-and 3-o'clock position.The minimum insertion angles of anchor differ at different position.Both rim angle and glenoid morthology for each position must be considered when selecting the ideal anchor insertion angle for Bankart repair.Meanwhile,minimum insertion angle of anchor should also be considered before anchor insertion.
