锁骨瓣切除对锁骨力学性质影响的实验研究

目的评价锁骨半片骨瓣截取后的生物力学变化。方法选取经防腐固定的成人锁骨左右配对14根标本,测试完整锁骨的扭转刚度;然后随机配对分为两组一组在靠近锁骨内侧端切取长为8.5cm的半片骨瓣;另一组在靠近锁骨的内侧端切取长为4.5cm的半片骨瓣。测试切取骨瓣后锁骨的扭转刚度和强度。结果完整锁骨左右两侧的扭转刚度无显著性差异(P＞0.05),切取半片骨瓣后其扭转刚度显著下降(P＜0.01),锁骨在切取短骨瓣与切取长骨瓣后两者相比较其刚度、强度变化不大。骨瓣切取后抗扭转强度的破坏发生在骨瓣切取处外侧端。结论锁骨作为供骨修复骨缺损时,切取半片骨瓣在保证肩锁、胸锁关节完整前提下具有可行性。     

锁骨接骨板预弯塑形的生物力学研究

目的比较解剖型锁骨板与重建型锁骨板的生物力学特性,并探究预弯塑形及反复弯制对重建型锁骨板生物力学性能的影响,为临床治疗锁骨中段骨折提供生物力学依据。方法依据解剖型锁骨板的形状对重建型锁骨板分别进行1、2、3、5次弯制,通过静态压缩实验测试并比较各组试件的生物力学差异性。结果解剖型骨板固定刚度和强度显著优于重建型未弯制骨板。人工预弯1次后的重建型骨板与解剖型骨板间固定刚度和强度差异不明显。弯制对骨板力学性能有较大影响,且弯制1次后骨板固定刚度和强度明显提高。骨板仅弯制1次后再弯制会明显降低骨板的力学性能。结论与锁骨贴合度更高的解剖板和弯制1次的解剖型重建板与未塑形重建板相比,固定刚度和强度更佳。建议术者在使用重建型锁骨板进行骨折固定手术时,应根据患者锁骨解剖形态进行适当的预弯塑形,并尽量减少重复弯制次数,以维持骨板的刚度与强度。     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位的疗效分析

目的分析AO/ASOF锁骨钩钢板(Clavicular Hook Plate)对NeerII型锁骨远端骨折及TossyIII型肩锁关节脱位治疗中的疗效。方法 2005年7月～2009年5月,对16例急性锁骨远端骨折﹙NeerII型)和18例肩锁关节脱位(TossyIII型)行切开复位锁骨钩钢板内固定与喙锁韧带修补术。结果 34病例中28例得到随访,平均随访27个月。患者术后1周均能进行肩关节主动活动,术后6周均完全恢复日常生活和工作能力,无病例发生伤口感染、内固定松动断裂,无再骨折及肩锁关节半脱位。参照ConstantMurley功能评估标准,优22例,良6例。结论 AO/ASOF锁骨钩钢板治疗NeerII型锁骨远端骨折及TossyIII型肩锁关节脱位的一种较好的手术方法。     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位52例疗效分析

目的 探讨锁骨钩钢板在锁骨远端骨折及肩锁关节脱位中的治疗方法和疗效分析.方法 回顾性分析在我院采用锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位52例患者,术后随访6 ～18个月.结果 采用Lazzcano标准评价手术治疗效果,并结合影像学检查,优49例,良2例,差1例.优良率为98.1%.结论 锁骨钩钢板在锁骨远端骨折和肩锁关节脱位的治疗上,具有创伤小、操作简单,术后固定牢靠、肩锁关节功能影响小等特点,是目前锁骨远端骨折和肩锁关节脱位理想的治疗方法.     

应用修剪后的锁骨钩板内固定治疗单纯锁骨近端骨折

目的探讨应用剪去钩子的锁骨钩板内固定治疗单纯锁骨近端骨折的疗效。方法对2010年1月~2014年1月收治的53例不伴胸锁关节脱位的单纯锁骨近端骨折应用剪去钩子的锁骨钩钢板内固定手术治疗。结果所有病例平均随访14个月,所有病例均获得骨性愈合,无并发症。术后半年时可进行一般的轻体力劳动及体育锻炼。术后一年时Rockwood肩关节活动功能评分优为46例,良为4例,可3例。优良率为94.3%。结论修剪后的锁骨钩钢板内固定治疗单纯锁骨近端骨折,手术操作简单,能够牢固维持术中恢复的解剖形状,利于患肢早期的功能锻炼,取得良好效果。     

锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折

目的探讨治疗肩锁关节脱位和锁骨远端骨折的新方法。方法选择TossyⅢ型肩锁关节脱位16例锁骨远端骨折11例,采用切开复位锁骨钩钢板内固定术,随访6～15个月,按照Lazzcano标准评定。结果优24例,良3例,无其它合并症,肩锁关节无再脱位,骨折全部一期愈合。结论锁骨钩钢板是治疗肩锁关节脱位及锁骨远端骨折的有效方法。     

TightRope系统和锁骨钩钢板治疗Neer Ⅱb型锁骨远端骨折的疗效分析

目的对比TightRope系统和锁骨钩钢板治疗Neer Ⅱb型锁骨远端骨折的临床疗效。方法选取2012年6月至2016年6月期间Neer Ⅱb型锁骨远端骨折患者37例,其中TightRope带袢双钛板治疗组17例,锁骨钩钢板治疗组20例。回顾性分析两组患者基线资料、术后3、6、12个月Constant-Murley评分、骨折愈合和并发症情况。结果两组患者术前资料、术中出血量、手术时间、切口愈合情况均无统计学差异,但TightRope带袢双钛板治疗组手术切口更小(P0.01)。TightRope带袢双钛板治疗组术后3和6个月Constant-Murley评分明显高于锁骨钩钢板组,尤其在肩关节疼痛、日常生活和活动范围方面(P0.01)。术后12个月锁骨钩钢板治疗组与TightRope带袢双钛板治疗组Constant-Murley评分相当,但前者的疼痛评分仍低于后者(P=0.02)。所有患者均在术后6个月内达到骨性愈合,术后1年内未发现严重并发症,不需要翻修手术。结论双切口结合TightRope带袢双钛板治疗Neer Ⅱb型锁骨远端骨折安全、有效,与锁骨钩钢板治疗相比更利于早期症状改善和功能康复。     

颅锁骨发育不全伴生长激素减少一家系

颅锁骨发育不全伴生长激素减少一家系王艳林，伍汉文先证者（Ⅳ２）女，６岁，因生长发育迟缓６年就诊。８个月早产，出生重２．２５ｋｇ生后生长缓慢。身高不增，头发不长，生后一直未剪过头发，至今仍只有６～８ｃｍ。智力正常，出牙正常，至今前囟未闭，易感冒，每月２...     

右锁骨大块骨溶解症一例

患者男 ,15岁。主因间断性头痛 ,恶心 ,呕吐伴轻度胸痛 2个月于 1999年 5月 2 8日入院。体检 :右锁骨处塌陷 ,触之右锁骨中段缺如。头颅ＭＲＩ示枕骨斜坡及两侧岩骨骨尖呈Ｔ1低信号、Ｔ2高信号改变。颅底ＣＴ示斜坡及岩骨尖骨质结构消失 ,其内可见边缘略膨隆 ,呈清晰低密度区。胸部正侧位片示右锁骨及肩胛骨皮质变薄 ,髓腔内有透明区 ,未见骨膜反应及新骨形成 ,考虑为骨质溶解性病变 (图 1)。全身ＳＰＥＣＴ示右侧锁骨显影不明显。胸腔穿刺示血性乳糜胸水。取右锁骨病变处活检。病理检查 :(右锁骨 )灰红色不整形组织一堆 ,总体积 3ｃｍ× 3…     

胸锁乳突出锁骨头蒂半片锁骨瓣转位颈椎融合术的应用解剖

在４０例成人颈部标本上，观察了胸锁乳突肌锁骨头的形态，血供及其与锁骨的关系，锁骨头无损伤可分离长度为８．３ｃｍ，其主要血供为甲状腺上动脉胸锁乳突肌支，入肌点在该肌前缘后１．７ｃｍ，距锁肯上缘６．８ｃｍ，处，可设计以胸锁乳突肌锁骨头为蒂半片锁骨瓣移位颈椎前植骨融合的新术式。     

带外侧延伸部的锁定加压锁骨干前上方接骨板在锁骨近端骨折中的应用

目的探讨使用带外侧延伸部的锁定加压锁骨干前上方接骨板内固定治疗锁骨近端骨折,并评价其疗效。方法 2011年2月~2014年2月使用带外侧延伸部的锁定加压锁骨干前上方接骨板治疗锁骨近端骨折13例并评价其效果。锁骨近端骨折按Edinburg分型:1A1型1例,1A2型5例,1B1型5例,1B2型2例。结果 13例患者均获得随访,随访时间0.5~1.5年,平均11个月。13例患者骨折全部愈合,根据Rockwood评分,优8例,良2例,可3例。优良率为76.9﹪。结论带外侧延伸部的锁定加压锁骨干前上方接骨板内固定治疗锁骨近端骨折疗效良好,固定牢固,可以早期功能锻炼,术后并发症较少,肩关节功能恢复良好。     

Morphometric analysis of the clavicle in human foetuses

IntroductionA lot of work has been done till date to assess the age of the foetuses (in utero), by means of clinical examination, radiographically, ultrasonographically. But not much effort has been made to assess the age of a dead foetus or of foetal remains for forensic study or for medicolegal purposes. Morphometric studies have been done earlier on long bones of foetuses but it lacked information about human foetal clavicle. Manual measurements will give the most precise data than by radiography or by sonography. Recently the various invasive and non-invasive approaches aimed at correction of different foetal defects has lead to the emergence of a highly promising super speciality of foetal therapy which has now further enhanced the scope of study on foetal anatomy.Materials and methods30 human foetuses (14 weeks to 33 weeks) without congenital craniovertebral anomalies were divided into five groups on the basis of gestational age. Clavicles were dissected out in all the foetuses. Various parameters were considered which include weight, length, circumference, diameters at different levels. Student's ‘t’ test was used to analyse the results.Results and discussionThe human foetal clavicle was found to grow steadily in all its parameters. Weight and the interclavicular distance, also showed steady increase throughout intra-uterine growth.ConclusionAll the parameters, therefore, can be used to determine the age of live or dead foetuses which is of medicolegal importance.     

锁骨骨折单肩气囊外固定器的力学分析

目的针对传统外固定器存在的问题,发明一种新型的单肩气囊外固定器,分析评价该新型单肩气囊外固定器所产生的复位拉伸力。方法建立人体锁骨的三维有限元模型,对单肩气囊外固定器的加载状况及所产生的复位拉伸力进行全面系统分析,并与传统8字绷带外固定器的情况进行对比分析。同时,通过观察实验,对比分析单肩气囊外固定器和传统8字绷带外固定器的实际加载情况。结果单肩气囊外固定器所产生的复位拉伸力比传统外固定器更均匀而且较大,并可由患者自己调节。结论单肩气囊外固定器对人体肩部的作用力及加载方式更加利于锁骨骨折的拉伸复位和维持锁骨骨折复位位置,而且使得锁骨骨折患者更加舒适。     

微创内固定技术治疗锁骨骨折的基础研究

目的:根据锁骨形态特点,探讨微创内固定技术治疗锁骨骨折的手术入路。方法:成人锁骨标本60个,防腐成人尸体(8具)的肩关节标本16个。测量锁骨长度、锁骨最窄处直径、锥状结节处入钉点区域及该部位入钉在锁骨内的固定长度。结果:锁骨长度为(144.34±6.48)mm;最窄处直径为(9.40±1.92)mm。锁骨锥状结节至肩锁关节内侧进针范围为(32.86±5.18)mm;该范围内最近及最外穿刺点打入的克氏针均可通过锁骨前弧最凸点,穿行长度最短为(74.28±1.16)mm,最长为(98.86±2.16)mm。肩关节标本解剖显示,锁骨外侧端与肩胛冈形成向内侧开放的角度,锥状结节以远部分比相应的肩胛冈高(8.24±0.62)mm。左、右侧锁骨测量结果经t检验两侧无显著性差异(P>0.05)。结论:锁骨锥状结节处可作为微创手术入路及入钉点区域,该部位入钉可在锁骨内穿行足够的固定长度。     

The role of embryo movement in the development of the furcula

The pectoral girdle is a complex structure which varies in its morphology between species. A major component in birds is the furcula, which can be considered equivalent to a fusion of the paired clavicles found in many mammals, and the single interclavicle found in many reptiles. These elements are a remnant of the dermal skeleton and the only intramembranous bones in the trunk. Postnatally, the furcula plays important mechanical roles by stabilising the shoulder joint and acting as a mechanical spring during flight. In line with its mechanical role, previous studies indicate that, unlike many other intramembranous bones, furcula growth during development can be influenced by mechanical stimuli. This study investigated the response of individual aspects of furcula growth to both embryo immobilisation and hypermotility in the embryonic chicken. The impact of altered incubation temperature, which influences embryo motility, on crocodilian interclavicle development was also explored. We employed whole‐mount bone and cartilage staining and 3D imaging by microCT to quantify the impact of rigid paralysis, flaccid paralysis and hypermobility on furcula growth in the chicken, and 3D microCT imaging to quantify the impact of reduced temperature (32–28 °C) and motility on interclavicle growth in the crocodile. This revealed that the growth rates of the clavicular and interclavicular components of the furcula differ during normal development. Total furcula area was reduced by total unloading produced by flaccid paralysis, but not by rigid paralysis which maintains static loading of embryonic bones. This suggests that dynamic loading, which is required for postnatal bone adaptation, is not a requirement for prenatal furcula growth. Embryo hypermotility also had no impact on furcula area or arm length. Furcula 3D shape did, however, differ between groups; this was marked in the interclavicular component of the furcula, the hypocleideum. Hypocleideum length was reduced by both methods of immobilisation, and interclavicle area was reduced in crocodile embryos incubated at 28 °C, which are less motile than embryos incubated at 32 °C. These data suggest that the clavicular and interclavicle components of the avian furcula respond differently to alterations in embryo movement, with the interclavicle requiring both the static and dynamic components of movement‐related loading for normal growth, while static loading preserved most aspects of clavicle growth. Our data suggest that embryo movement, and the mechanical loading this produces, is important in shaping these structures during development to suit their postnatal mechanical roles.     

Clavicular facet of the coracoclavicular joint: Analysis in modern skeletons of the mapuche indigenous individuals

IntroductionThe coracoclavicular joint (CCJ) has been used as an anthropological marker for human migration, with a strong presence in Asian population. In South America, studies are scarce and incomplete. The aim was to determine the frequency of articular facet of CCJ in an osteological sample pertaining to Mapuche indigenous population in Chile.MethodsWe used 96 clavicles (48 left and 48 right), and the presence and characteristics of the articular facet on the conoid tubercle were determined by direct observation. Maximum transverse diameter (MTD) and maximum antero-posterior diameter (MAPD) were measured using a digital caliper. The frequency obtained was compared with other osteological studies on worldwide population.ResultsArticular facet was found in 22.9% of the cases. Twelve facets (12.5%) were present on the right side and 10 (10.4%) on the left, with 10 paired bilaterally and two paired unilaterally on the right side. Articular facets were very clear and prominent in 4 cases (4.2%), regularly prominent in 6 (6.3%), and poorly prominent in 14 (14.6%). The facets were usually oval, with an MTD and MAPD of 19.2 and 18.8 mm, respectively, without differences by side.DiscussionMapuche ethnic group showed the highest frequency of osteological material reported to date between native South American and global population. Their presence may not be related to a geographical migration, but to other causes such as genetic, environmental, or evolutionary adaptation factors. The study of CCJ as anthropological trait must be addressed through direct observation in osteological material, because radiological studies may underestimate its frequency.     

The anatomy of the clavicle

The clavicle has a complex osteologic structure that makes morphological analysis extremely difficult. A three‐dimensional study was conducted to examine the anatomical variations and characteristics of the bone. Sixty‐eight human cadaver clavicles were dissected, CAT‐scanned, and reconstructed. An automated parameterization and correspondence shape analysis system was developed. A new length, designated as centerline (CL) length, was defined and measured. This length represents the true length of the clavicle. The endpoint length was measured as the distance between two endpoints. The width and curvature were measured in the axial (AX) and frontal (FR) plane and defined along the CL. Next gender and side characteristics and variations were examined. The mean CL length was 159.0 ± 11.0 mm. The mean endpoint length was 149.4 ± 10.3 mm, which was statistically significantly shorter than the CL. The male clavicle was significantly longer (166.8 ± 7.3 mm vs. 151.0 ± 8.2 mm), wider (14.6 ± 1.5 mm vs. 12.7 ± 1.3 mm lateral FR plane, 25.9 ± 4.1 mm vs. 23.5 ± 3.0 mm lateral AX plane and 24.7 ± 2.8 mm vs. 22.8 ± 2.8 mm medial AX plane), and more curved (10.8 ± 2.8 mm vs. 8.6 ± 2.3 mm medial and 10.5 ± 3.3 mm vs. 9.1 ± 2.5 mm lateral) than the female one. Left clavicles were significant longer (159.8 ± 10.9 mm vs. 158.0 ± 11.2 mm) than right clavicles. A novel three‐dimensional system was developed, used and tested in order to explore the anatomical variations and characteristics of the human clavicle. This information, together with the automated system, can be applied to future clavicle populations and to the design of fixation plates for clavicle fractures. Clin. Anat. 27:712–723, 2014. © 2013 Wiley Periodicals, Inc.     

军人一般能力测验的信度及效度分析

目的编制《军人一般能力测验》问卷,并对其进行信效度研究。方法运用重测信度法和pearson相关法计算相关,研究重测信度以及效标关联效度;运用Kaiser标准化的正交旋转法研究结构效度。结果探索性因素分析结果表明,军人一般能力测验量表存在的5个独立维度(KMO=0.78,P0.01);量表的内部一致性系数为0.89,各维度的内部一致性系数介于0.82~0.91之间;问卷中各维度之间具有显著相关(r=0.19~0.67,P0.05),各维度与总分具有很高的相关性(r=0.47~0.78,P0.01),表明量表信度和效度良好。问卷总分与被试年龄无显著相关;问卷各维度与韦氏智力测验相应部分有显著相关(r=0.615~0.977,P0.01);问卷各维度得分与20门学习科目考试成绩有显著相关(r=0.436~0.983,P0.01),表明量表的效标关联效度较好。结论《军人一般能力测验》具有较高的信度和效度,具有一定的实用性。