中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (20): 3247-3252.doi: 10.12307/2023.449

• 骨组织构建 bone tissue construction • 上一篇    下一篇

肩胛骨孔洞的分类与形态学观测及其临床意义

陈美雄1，郑  凯2，郑南生1，周  理1，徐明奎1，袁仕国1   

  1. 1海南省中医院骨伤中心，海南省海口市  570203；2右江民族医学院基础医学院，广西壮族自治区百色市  533000
  • 收稿日期:2022-05-20 接受日期:2022-07-27 出版日期:2023-07-18 发布日期:2022-11-19
  • 通讯作者: 袁仕国，博士，主治医师，海南省中医院骨伤中心，海南省海口市 570203
  • 作者简介:陈美雄，男，1964年生，海南省万宁市人，汉族，主任医师，主要从事骨伤科疾病临床与基础研究。 郑凯，女，1986年生，吉林省长春市人，汉族，护师，主要从事临床与基础数据分析研究。
  • 基金资助:
    海南省临床医学中心建设项目资助(琼卫医函[2021]276号)，项目负责人：陈美雄

Classification and morphological parameters of scapular foraminal defects and its clinical significance

Chen Meixiong1, Zheng Kai2, Zheng Nansheng1, Zhou Li1, Xu Mingkui1, Yuan Shiguo1   

  1. 1Orthopaedic Center, Hainan Traditional Chinese Medicine Hospital, Haikou 570203, Hainan Province, China; 2School of Basic Medical Sciences, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
  • Received:2022-05-20 Accepted:2022-07-27 Online:2023-07-18 Published:2022-11-19
  • Contact: Yuan Shiguo, MD, Attending physician, Orthopaedic Center, Hainan Traditional Chinese Medicine Hospital, Haikou 570203, Hainan Province, China
  • About author:Chen Meixiong, Chief physician, Orthopaedic Center, Hainan Traditional Chinese Medicine Hospital, Haikou 570203, Hainan Province, China Zheng Kai, Senior nurse, School of Basic Medical Sciences, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
  • Supported by:
    a grant from Hainan Province Clinical Medical Center, No. [2021]276 (to CMX)

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摘要：


文题释义：

肩胛骨孔洞：是指分布于肩胛骨上穿透双层骨皮质的非盲端的孔、洞、隧道、营养血管孔等，包括韧带骨化后形成的孔洞。肩胛骨孔洞可能影响涉及肩胛骨的疾病诊断和侵入性操作的临床决策。
天宗穴：是位于肩胛下窝区的手太阳小肠经穴位，肩胛冈中点与肩胛骨下角连线上1/3与下2/3交点凹陷中，此区域是肩胛骨孔洞可能出现的部位，也是针刀、针刺等操作的常见部位。

背景：肩胛骨孔洞可影响临床上对肩胛骨及其周围解剖结构疾病诊断和治疗的临床决策。然而，肩胛骨孔洞缺乏分型，国人的肩胛骨孔洞分布及其形态计量研究等仍缺乏。
目的：研究中国人群干燥肩胛骨孔洞的分类、分布和形态计量学，探讨其临床意义。
方法：定义了一个新的肩胛骨孔洞分类系统，包括3个类别和A-F等6个亚型。Ⅰ类对应于肩胛骨的神经和血管孔，Ⅱ类对应于肩胛骨的非神经血管孔洞，Ⅲ类为Ⅰ类和Ⅱ类的混合型。Ⅰ类包括2种类型：A型为肩胛上孔，B型为营养血管孔；Ⅱ类分C-E亚型；Ⅲ类仅包括F型(即为A-E的混合型)。同时分析统计了336个非配对干燥国人肩胛骨的分类、分布和形态计量学数据。
结果与结论：①观察者间的信度优秀。在336个肩胛骨中，共观察到92个肩胛骨上分布118个肩胛骨孔洞，肩胛骨孔洞发生率为27.38%，其中Ⅰ、Ⅱ、Ⅲ类分别占2.81%，16.96%和7.61%，A-F型肩胛骨孔洞占比分别为7.61%，19.57%，9.78%，10.87%，40.22%和11.96%，E型最多；②A-F型肩胛骨孔洞总直径分别为(8.09±1.29)，(1.98±0.80)，(6.60±3.10)，(11.19±6.67)，(16.80±11.04)和(17.43±13.88) mm，F型总直径最大；A-F型肩胛骨孔洞总面积分别为(37.62±19.48)，(2.13±2.23)，(32.52±24.85)，(77.56±124.32)，(150.69±181.34)和(109.98±193.50) mm2，E型总面积最大；③结果表明，肩胛骨孔洞的变异是常见的，需要临床医生注意，以避免因肩胛骨孔洞的出现而对诊断产生干扰，同时治疗时需要加以关注，避免侵入性操作时引起并发症。
https://orcid.org/0000-0002-0013-9059(陈美雄)；https://orcid.org/0000-0002-0319-1303(郑凯)；

https://orcid.org/0000-0003-3781-6786(袁仕国)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 肩胛骨孔洞, 肩胛骨解剖, 形态学, 肩胛骨变异, 分类

Abstract: BACKGROUND: Scapular foraminal defects can affect the clinical diagnoses and treatments of diseases around the scapula. However, the classification of scapular foraminal defects is lacking, and less is reported on the distribution and morphological parameters of scapular foraminal defects in Chinese people.
OBJECTIVE: To investigate the classification, distribution, and morphometric parameters of scapular foraminal defects in dry scapulae in a Chinese population.
METHODS: A novel classification system with three categories and six subtypes of scapular foraminal defects was defined. Category I corresponds to the foramina of the scapular body for nerves and blood vessels, Category II corresponds to the variation in non-neurovascular holes or defects, and Category III is a mixture of Category I and Category II. Category I comprises two subtypes: Type A, suprascapular foramina; Type B, nutrient foramina. The scapula is divided into three partitions that correspond to Types C to E in Category II. Category III includes only Type F, a mixture of Type A to Type E. The distribution, classifications and morphometric data for 336 unpaired dry scapulae from Chinese adults were analyzed.
RESULTS AND CONCLUSION: The interobserver reliability was excellent. Of 336 scapulae, 92 scapulae had 118 scapular foraminal defects. The incidence rate of scapular foraminal defects was 27.38%, of which Category I to III accounted for 2.81%, 16.96%, and 7.61%, respectively. The proportion of Types A-F was 7.61%, 19.57%, 9.78%, 10.87%, 40.22%, and 11.96%, respectively. The proportion of Type E was the most. The total diameters of Types A-F were (8.09±1.29), (1.98±0.80), (6.60±3.10), (11.19±6.67), (16.80±11.04), and  (17.43±13.88) mm, respectively. The total diameter of Type F was the largest. The total areas of Types A-F were (37.62±19.48), (2.13±2.23), (32.52±24.85), (77.56±124.32), (150.69±181.34), and (109.98±193.50) mm2, respectively. The total area of Type E was the largest. To conclude, variations in scapular foraminal defects are common, which require the attention of clinicians to avoid interfering with the diagnosis due to the appearance of scapular foraminal defects. Attention should also be paid to the treatment at the same time to avoid complications caused by invasive operation. 

Key words: scapular foraminal defect, anatomy of the scapulae, morphology, variation in the scapula, classification

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