中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (42): 6759-6763.doi: 10.3969/j.issn.2095-4344.2015.42.007

• 肌肉肌腱韧带组织构建 tissue construction of the muscle, tendon and ligament • 上一篇    下一篇

喙锁韧带重建中锁骨钻孔位置的数字解剖学

陈 羽，宋 烜，陆 骅，张天浩，姚 兵   

  1. 上海交通大学医学院附属新华医院崇明分院骨科，上海市 202150
  • 出版日期:2015-10-08 发布日期:2015-10-08
  • 作者简介:陈羽，男，1981年生，上海市人，2007年复旦大学医学院毕业，主治医师，从事创伤骨科及计算机辅助骨科方面研究
  • 基金资助:

    上海市高等职业教育重点专业建设(085工程)(FY(14)700-A5-1-17，FY(15)700-A6-1-10)

Digital anatomical analysis of drilling position of the clavicle in coracoclavicular ligament reconstruction

Chen Yu, Song Xuan, Lu Hua, Zhang Tian-hao, Yao Bing   

  1. Department of Orthopedics, Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China
  • Online:2015-10-08 Published:2015-10-08
  • About author:Chen Yu, Attending physician, Department of Orthopedics, Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China
  • Supported by:

    the Key Specialty Construction of Shanghai Higher Vocational Education, No. FY(14)700-A5-1-17, FY(15)700-A6-1-10

PDF

277

被引次数

6

摘要：

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。

关键词: 组织构建, 组织工程, 数字解剖学, 锁骨, 喙突, 喙锁韧带重建, 骨道, 肩锁关节脱位

Abstract:

BACKGROUND: Coracoclavicular ligament reconstruction with transclavicular-transcoracoid drilling is an effective surgical technique to treat acromioclavicular dislocation. A good drilling in the clavicle leads to a perfect bony tunnel and a good surgery.
OBJECTIVE: To observe the effects of different drilling 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 drilling positions in the clavicle. Parameters of these bony tunnels were measured, and the safety was evaluated. Option 1: The drilling 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 drilling 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 drilling 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 drilling 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 drill 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. 

Key words: Clavicle, Ligaments, Anatomy, Shoulder Dislocation