中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (12): 1920-1924.doi: 10.12307/2024.009

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

定量CT测定锁骨远端骨密度分区指导肩锁关节脱位重建的价值

许  健1，毕文智1，冀云聪1，康运康1，马培旗1，王家亮1，张宗夕1，干阜生1，于海洋1，2，郭  标1，2   

  1. 1安徽医科大学附属阜阳人民医院(阜阳市人民医院)，安徽省阜阳市   236000；2安徽省脊柱畸形临床医学研究中心，安徽省阜阳市   236000
  • 收稿日期:2022-12-21 接受日期:2023-02-20 出版日期:2024-04-28 发布日期:2023-08-23
  • 通讯作者: 郭标，主任医师，教授，硕士生导师，安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科，安徽省阜阳市 236000；安徽省脊柱畸形临床医学研究中心，安徽省阜阳市 236000 于海洋，主任医师，教授，博士生导师，安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科，安徽省阜阳市 236000；安徽省脊柱畸形临床医学研究中心，安徽省阜阳市 236000
  • 作者简介:许健，男，安徽省阜阳市人，汉族，2018年安徽医科大学毕业，硕士，主治医师，主要从事骨科运动损伤与关节镜研究。 毕文智，男，安徽省蚌埠市人，汉族，蚌埠医学院在读硕士，医师，主要从事骨科运动损伤与关节镜研究。
  • 基金资助:
    2021年度阜阳市卫生健康委科研课题青年项目基金(十四五安徽省重点临床专科项目FY2021-030)，项目负责人：许健；2022年度蚌埠医学院自然科学重点项目(2022byzd172)，项目负责人：许健

Quantitative CT measurement of bone mass density in different regions of the distal clavicle in reconstruction of acromioclavicular joint dislocation

Xu Jian1, Bi Wenzhi1, Ji Yuncong1, Kang Yunkang1, Ma Peiqi1, Wang Jialiang1, Zhang Zongxi1, Gan Fusheng1, Yu Haiyang1, 2,  Guo Biao1, 2   

  1. 1Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang People’s Hospital), Fuyang 236000, Anhui Province, China; 2Anhui Provincial Spinal Deformity Clinical Research Center, Fuyang 236000, Anhui Province, China
  • Received:2022-12-21 Accepted:2023-02-20 Online:2024-04-28 Published:2023-08-23
  • Contact: Guo Biao, Chief physician, Professor, Master’s supervisor, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang People’s Hospital), Fuyang 236000, Anhui Province, China; Anhui Provincial Spinal Deformity Clinical Research Center, Fuyang 236000, Anhui Province, China Yu Haiyang, Chief physician, Professor, Doctoral supervisor, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang People’s Hospital), Fuyang 236000, Anhui Province, China; Anhui Provincial Spinal Deformity Clinical Research Center, Fuyang 236000, Anhui Province, China
  • About author:Xu Jian, Master, Attending physician, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang People’s Hospital), Fuyang 236000, Anhui Province, China Bi Wenzhi, Master candidate, Physician, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang People’s Hospital), Fuyang 236000, Anhui Province, China
  • Supported by:
    Fuyang Health Commission Research Project Youth Project Fund (14th Five-Year Plan Anhui Province Key Clinical Specialties Project) in 2021, No. FY2021-030 (to XJ); Key Project of Natural Science of Bengbu Medical College in 2022, No. 2022byzd172 (to XJ)

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摘要：


文题释义：

肩锁关节脱位：肩锁关节是由锁骨远端和肩峰内缘组成的微动关节，一般由直接暴力、间接暴力导致脱位，临床上Rockwood Ⅲ型以上的肩锁关节脱位伴有喙锁韧带、肩锁韧带完全断裂，常需手术治疗。
骨密度：指单位体积的骨矿物质含量，是反映骨骼强度的重要指标，单位是g/cm2，定量 CT是其目前最准确的测量方法。


背景：肩锁关节脱位喙锁韧带重建在锁骨侧骨隧道的最佳位置尚未达成共识，且术后会发生锁骨侧骨隧道扩大、骨溶解、锁骨骨折、内固定失效等并发症。骨密度在内植物固定强度及稳定性上起重要作用，锁骨远端骨密度的区域差异在肩锁关节脱位修复重建中不应被忽视，目前临床上尚无人体有关锁骨远端骨密度的定量研究。

目的：通过定量CT测量锁骨远端不同区域骨密度的大小，为外科医生修复重建喙锁韧带提供参考。
方法：对2022年10-12月在安徽医科大学附属阜阳人民医院(阜阳市人民医院)行定量CT检查的101例患者1 616份亚分区进行锁骨远端骨密度测量。对于每个定量CT样本，首先由内侧向外侧划分锁骨远端为以下4个区域，即锥状结节区(A区)、结节间区(B区)、斜方嵴区(C区)以及锁骨远端区(D区)，再将每个区域分为前半部分和后半部分确定8个亚分区，在亚分区中设置半自动感兴趣区(ROI A1、A2、B1、B2、C1、C2、D1、D2)，将每个定量CT扫描图像传输至QCT pro分析工作站，对锁骨远端感兴趣区松质骨骨密度进行测量，测量时注意避开锁骨骨皮质。

结果与结论：①不同侧肩部骨密度比较，差异无显著性意义(P > 0.05)；②锁骨远端A1、A2、B1、B2、C1、C2、D1、D2亚分区骨密度分析，差异有显著性意义(P < 0.05)，可以认为锁骨远端不同区域骨密度有差别，经过两两比较，除A1与 A2，D1与D2，A2与 B1之间的骨密度差异无显著性意义(P > 0.05)，其余亚分区骨密度两两比较差异均有显著性意义(P < 0.05)；③锥状韧带解剖止点A2区骨密度高于B区，差异有显著性意义(P < 0.05)；A1区骨密度高于A2区，但差异无显著性意义(P > 0.05)；斜方韧带解剖止点C1区骨密度高于C2区、D1区及D2区，B区骨密度高于C区及D区，差异有显著性意义(P < 0.05)；④结果表明，锁骨远端不同区域骨密度存在差异，肩锁关节脱位修复重建时锁骨远端骨密度的区域差异不容忽视，除考虑生物力学因素外，还应考虑将内植物或骨隧道置于骨密度较高的区域，以提高内植物固定强度及稳定性，减少骨隧道扩大、骨溶解、骨折及内植物失效等并发症发生的风险。

https://orcid.org/0000-0002-9323-1128(许健) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 肩锁关节脱位, 修复, 重建, 锁骨, 骨密度, 定量CT, 区域, 骨隧道, 喙锁韧带

Abstract: BACKGROUND: There is no consensus on the optimal bone tunnel position in the lateral clavicle, which guides coracoclavicular ligament reconstruction. Postoperative complications such as enlargement of the lateral clavicle bone tunnel, bone osteolysis, clavicle fracture, and failure of internal fixation are likely to occur. Bone mass density plays an important role in the strength and stability of endophytic fixation. Regional differences in the bone mass density of the distal clavicle should not be overlooked in the repair and reconstruction of acromioclavicular dislocation. Currently, there are no quantitative clinical studies in humans regarding the bone mass density of the distal clavicle.
OBJECTIVE: To measure the magnitude of bone mass density in different regions of the distal clavicle by quantitative CT to provide a reference for surgeons to repair and reconstruct the coracoclavicular ligament.
METHODS: 101 patients undergoing quantitative CT checking in Fuyang People’s Hospital Affiliated to Anhui Medical University from October to December 2022 were enrolled, from which 1 616 samples of subdivisional bone mass density of the distal clavicle were measured. For each of the quantitative CT samples, firstly, the distal clavicle was divided medially to laterally into the following four regions: conical nodal region (region A), inter-nodal region (region B), oblique crest region (region C) and distal clavicular region (region D). Secondly, each region was divided into the first half and the second half to determine eight subdivisions, then setting semiautomatic region of interest (ROI) in each subdivision: (ROI A1, A2, B1, B2, C1, C2, D1, and D2). Thirdly, each quantitative CT scan was transferred to the quantitative CT pro analysis workstation, and cancellous bone mass density was measured in the distal clavicle ROI. Finally, the clavicular cortex was avoided when measuring. 
RESULTS AND CONCLUSION: (1) There was no statistically significant difference in bone mineral density on the different sides of the shoulder (P > 0.05). (2) The analysis of bone mineral density in eight sub-areas of the distal clavicle A1, A2, B1, B2, C1, C2, D1, and D2 showed statistically significant differences (P < 0.05). It could be considered that there were differences in bone mineral density in different areas of the distal clavicle. After pairwise comparison, there was no statistically significant difference in bone mineral density between A1 and A2, D1 and D2, A2 and B1 (P > 0.05), and there was a statistically significant difference in bone mineral density between the other sub-areas (P < 0.05). (3) The bone mineral density in the region A2 of the anatomical insertion of the conical ligament was significantly higher than that in the inter-nodular area (region B) (P < 0.05). The bone mineral density in the region A1 was higher than that in the region A2, but the difference was not statistically significant (P > 0.05). The bone mineral density in the region C1 of the anatomical insertion of the trapezium ligament was higher than that in regions C2, D1 and D2, and the bone mineral density in the inter-nodular area (region B) was significantly higher than that in regions C and D (P < 0.05). (4) These results have suggested that there are differences in bone mass density in different regions of the distal clavicle; regional differences in bone mass density in the distal clavicle during repair and reconstruction of acromioclavicular dislocation cannot be ignored. Consideration should be given not only to biomechanical factors but also to the placement of implants or bone tunnels in regions of higher bone mass density, which could improve the strength and stability of implant fixation and reduce the risk of complications such as bone tunnel enlargement, osteolysis, fracture and implant failure.

Key words: acromioclavicular joint dislocation, repair, reconstruction, clavicle, bone mass density, quantitative CT, region, bone tunnel, coracoclavicular ligament

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