前置与上置重建钢板治疗锁骨骨折的应用解剖学

摘要

Objective:To provide anatomic indexes for clavicular fractures about placing plate in different sites by establishing three-dimensional visualization models of clavicle and measurting the related anatomical data.Methods:Adult normal clavicle specimens were selected using continuous CT scanning by the thickness of 0.625 mm and a row spacing of 0,and saving all images by Dicom format.Mimics software was used to read all images and reconstruct 3-D models,and measure the anatomic indexes about 2 angles and 4 diameters of clavicle 3-D models.Results:There was significant difference among anteroposterior diameter and vertical diameter at lateral side and the junction of middle 1/3 and lateral 1/3.There was no significant difference among anteroposterior diameter and vertical diameter at the junction of middle 1/3 and medial 1/3 and medial side.Conclusion:It is more appropriate to place the plate on the front side of clavicle when fractures occurred in the medial half by the anatomy.The clavicle anatomic indexes measured by three-dimensional reconstruction can provide references for choosing exactly the sites of placing the plate,accurate nailing and the personalized surgery designing of internal fixation of clavicular fractures.%目的:建立锁骨数字化三维可视模型,测量相关解剖数据,为前置与上置重建钢板治疗锁骨骨折提供解剖学依据.方法:正常成人锁骨标本,进行层厚0.625mm,间距为0的CT连续扫描,所得图片以Dicom格式刻盘保存,导入Mimics软件进行三维重建,并利用Mimics软件的三维测量功能测量锁骨内外凸出角度,外侧端、中外1/3交界处、中内1/3交界处和内侧端的前后径和上下径.结果:重建的锁骨三维模型能从多角度、多层面进行观察与测量,锁骨外侧端、中外1/3交界处的前后径和上下径比较有差异,中内1/3交界处和内侧端的前后径和上下径比较无差异.结论:从解剖形态来看锁骨内侧半骨折钢板适于前置,外侧半骨折钢板前置和上置均可.本研究结果对临床选择置板部位、术中准确进行穿钉以及锁骨骨折的个性化手术设计等有一定的参考价值.