CAJ | 학술논문

背景：经喙锁骨道的喙锁韧带重建是一种治疗肩锁关节脱位的有效方法，锁骨钻孔位置直接决定骨道的质量及治疗的成败。目的：观察锁骨不同钻孔位置对喙锁韧带重建过程中骨道位置的影响。方法：使用Mimics 13.0软件对60个肩部的CT影像资料进行重建得到喙锁结构模型。根据目前2种主流喙锁韧带重建方案的钻孔位置及一种作者提出的理想的钻孔位置在模型上虚拟手术建立骨道，并进行相关的测量以评估其安全性。方案1：钻孔位置距锁骨远端30 mm，位于锁骨表面前后缘的正中；方案2：钻孔位置距锁骨远端40 mm，位于锁骨表面前后缘的正中；方案3：与锥状结节尖端和喙突基底部的中点在同一直线上，在锁骨上表面的后缘。结果与结论：重建方案1的喙突骨道在男性模型中过于偏内侧。重建方案1和2的骨道均不在锁骨正中。重建方案3的喙突及锁骨骨道均位于正中。以距离锁骨远端一个固定数值来确定钻孔位置的方法在男女性的模型中得到的骨道差异很大。锁骨端的钻孔位置应与锥状结节尖端和喙突基底部的中点在同一直线上，并且应靠锁骨上表面的后缘，才能保证喙突及锁骨骨道的居中。
배경：경훼쇄골도적훼쇄인대중건시일충치료견쇄관절탈위적유효방법，쇄골찬공위치직접결정골도적질량급치료적성패。목적：관찰쇄골불동찬공위치대훼쇄인대중건과정중골도위치적영향。방법：사용Mimics 13.0연건대60개견부적CT영상자료진행중건득도훼쇄결구모형。근거목전2충주류훼쇄인대중건방안적찬공위치급일충작자제출적이상적찬공위치재모형상허의수술건립골도，병진행상관적측량이평고기안전성。방안1：찬공위치거쇄골원단30 mm，위우쇄골표면전후연적정중；방안2：찬공위치거쇄골원단40 mm，위우쇄골표면전후연적정중；방안3：여추상결절첨단화훼돌기저부적중점재동일직선상，재쇄골상표면적후연。결과여결론：중건방안1적훼돌골도재남성모형중과우편내측。중건방안1화2적골도균불재쇄골정중。중건방안3적훼돌급쇄골골도균위우정중。이거리쇄골원단일개고정수치래학정찬공위치적방법재남녀성적모형중득도적골도차이흔대。쇄골단적찬공위치응여추상결절첨단화훼돌기저부적중점재동일직선상，병차응고쇄골상표면적후연，재능보증훼돌급쇄골골도적거중。
BACKGROUND:Coracoclavicular ligament reconstruction with transclavicular-transcoracoid driling is an effective surgical technique to treat acromioclavicular dislocation. A good driling in the clavicle leads to a perfect bony tunnel and a good surgery. OBJECTIVE: To observe the effects of different driling positions of the clavicle on the location of bony tunnels in coracoclavicular ligament reconstruction. METHODS:Sixty three-dimensional digital models of the clavicle and coracoid process were constructed by Mimics13.0. Virtual transclavicular-transcoracoid bony tunnels were established according to different surgical planes with different driling positions in the clavicle. Parameters of these bony tunnels were measured, and the safety was evaluated. Option 1: The driling was made 30 mm distal to the clavicle, located in the center of the front and rear edges of the clavicle surface. Option 2: The driling was made 40 mm distal to the clavicle, located in the center of the front and rear edges of the clavicle surface. Option 3: The driling was made at the straight line of tapered nodule tip and the midpoint of the base of the coracoid process, located at the rear edge of the clavicle upper surface. RESULTS AND CONCLUSION: Bony tunnels in option 1 were extremely on the inside of the coracoid. Bony tunnels in options 1 and 2 were not in the center of clavicle. Bony tunnels in option 3 were in the center of both clavicle and coracoid. The method of locating the driling position with a certain distance to the distal clavicle leads to different results in man’s and woman’s models. To ensure that the bony tunnel can pass through the center of clavicle and coracoid, it is suggested to dril at the straight line of tapered nodule tip and the midpoint of the base of the coracoid process and nearby the rear edge of the clavicle upper surface.