髋臼卵圆窝在实现术前预期髋臼杯外展角中的参考价值

  目的 探讨髋臼卵圆窝的解剖及影像学特点,评价其在实现术前预期髋臼杯外展角中的作用。方法 在16具正常成人骨盆标本上标记髋臼卵圆窝 中轴线,观察卵圆窝中轴线走行特点及其与卵圆窝顶和髋臼骨性边缘交点在标准骨盆正位X线片上的对应关系。通过模板测量观察预期外展角度的髋臼杯中轴线 与髋臼卵圆窝顶点之间的对应关系。于骨盆标本两侧髋臼施行生物髋臼杯植入术,一侧采用卵圆窝参照法,对侧采用髋臼定位器法,在标准骨盆正位X线片上比 较两侧手术前后髋臼杯外展角偏差的差异。结果 卵圆窝中轴与卵圆窝顶和髋臼骨性边缘的交点是较为恒定的解剖标志,在标准骨盆正位X线上分别对应髋臼顶部 关节面软骨下骨的内缘和外缘。髋臼卵圆窝顶点与40°±5°外展角度的髋臼杯中轴线密切相关。卵圆窝参照组手术前后髋臼杯外展角偏差为0.19° ±3.14°（-6°~5°）,髋臼定位器组为2.75°±2.89°（-2°~8°）,两组差异有统计学意义（t=－2.453,Ρ=0.027）。结论 对于患者髋臼解剖相对正常的 初次全髋关节置换,依据术前模板测量获得的预期髋臼杯位置与卵圆窝顶点的关系,可较精确地获得预期髋臼杯外展位置。     

正常髌骨解剖形态学的CT研究

 目的 探讨正常髌骨的解剖形态学特点及其对髌骨置换手术操作与髌骨假体设计的指导作用。方法 募集膝关节结构正常的健康成年国人60名,男32名,女28名;年龄18～54岁,平均33.7岁。随机选择左侧或右侧行膝关节伸直位CT扫描,扫描范围从胫骨近端二分之一至股骨远端二分之一。扫描图像应用mimics软件进行三维重建处理,重建后分别生成髌骨的矢状面和横断面图像。按性别分组分别测量及计算髌骨的高度、宽度、厚度,髌骨嵴的位置,高宽比及模拟髌骨置换手术中髌骨切骨后的剩余骨量厚度。结果 男性髌骨的高度、宽度、厚度及模拟髌骨切骨后的剩余骨量厚度分别为(31.95±2.77) mm、(45.02±2.70) mm、(22.38±1.63) mm、(13.18±1.62) mm,女性分别为(28.72±2.17) mm、(39.57±2.57) mm、(19.88±1.36) mm、(11.20±1.20) mm,男性与女性之间的差异均有统计学意义。男性髌骨的宽高比为1.42±0.11、髌骨嵴位于髌骨上42.9%偏内侧位置,女性髌骨的宽高比为1.38±0.10、髌骨嵴位于髌骨上42.6%偏内侧位置,男性与女性之间的差异无统计学意义。结论 中国人的髌骨相对小、扁且薄,选择及设计髌骨假体时应考虑人种差异。女性的髌骨较男性尺寸更小,在髌骨置换时尤其应该注意保留一定的髌骨厚度。     

髋臼前柱螺钉固定解剖学研究及导向器的设计

目的为经髋臼前柱螺钉固定提供解剖学依据。方法对22只成人尸体骨盆标本,共44侧髋臼进行解剖学研究,观测髋臼前柱横断面形状,测量髋臼前柱螺钉固定在髂骨翼外侧面的进针点、进针方向、钉道直径、进针点至闭孔沟的距离。结果髋臼前柱横断面呈近似直角三角形,钉道直径10.5±0.8mm;螺钉进针点位于髂骨翼后外侧面坐骨大切迹和髂前上棘连线上方9.2±2.4mm,距坐骨大切迹38.5±3.8mm;螺钉进针方向于水平面与中心线夹角为40.7±3.8°,矢状面向尾端成角54.2±5.5°。钉道长度84.1±6.2mm。并设计出髋臼前柱螺钉固定导向器。结论髋臼前柱可接受1枚直径6.5mm、长70mm的螺钉,螺钉进针点位于髂骨翼后外侧面坐骨大切迹和髂前上棘连线上方10mm,距坐骨大切迹40mm。螺钉进针方向于水平面与中心线夹角40°,矢状面向尾端成角55°。髋臼前柱螺钉固定导向器将提高前柱螺钉固定的安全性。     

经喙突和肩峰行肩关节外固定术的应用解剖

目的通过对喙突和肩峰的解剖学观测探讨经喙突和肩峰行肩关节外固定术的可行性和可靠性,为临床治疗肩关节疾病提供一种新的手术方法.方法利用18具经动脉灌注红色乳胶的成人上肢标本,对喙突和肩峰的宽度、厚度、长度、轴线的倾斜角度及进钉深度等做了解剖学观测.结果喙突宽(17.65±1.82)mm,厚(13.11±2.11)mm,长(45.43±4.52)mm,外倾角(30.2±8.545)°,下倾角(22.9±4.229)°.肩峰宽(24.71±3.75)mm,厚外侧(8.67±1.34)mm,内侧(11.81±1.33)mm,长(48.21±4.68)mm,外倾角(10.81±4.336)°,上倾角(16.316±6.395)°.结论肩关节外固定术效果可靠,喙突和肩峰可以接受直径5mm的螺钉,其形态学资料有助于合理选择外固定器、准确确定进钉点的位置和方向、保证肩关节外固定术的成功.     

腰骶椎前路螺旋融合笼设计的解剖学依据

目的测量国人L3～S1终板凹陷深度(d)、椎间盘中央厚度(m)及椎体矢状径(S),找出兼顾机械稳定与生物融合效果的AFC直径和长度.方法用39具成人干燥腰骶椎骨L3～S1标本共156块,测量椎体中央高度(M)、椎体前后缘骺环处高度(A,P)及椎体上矢状径(S),并参考郭世绂椎间盘前后骺环处厚度值(a,p),通过统计学处理及几何运算,求得2d(±s)、S(±s)、m.结果L3、L4、L5的2d分别为3.95±0.75mm、4.02±0.82mm、4.01±0.55mm;L3、L4、L5、S1的S分别为29.72±1.71mm、30.18±2.15mm、30.58±1.94mm、30.69±1.88mm;L3/4、L4/5、L5/S1的m近似值为12～16mm、13～16mm、12～17mm,故AFC长度范围为15～26mm,AFC外直径范围分别是21～25mm、22～25mm、21～26mm.结论经前路椎体间正中前后向放置1枚AFC时,其所用AFC外径≈1/2(a+p)+12～16(mm);AFC长度≈S-6-S×滑脱百分比.     

螺旋CT三维重建在小儿髋臼发育不良中的作用

目的探讨螺旋CT三维表面遮盖重建(SSD)在小儿髋臼发育不良中的应用价值。方法采用美国Picker2000S螺旋CT扫描装置对39例单侧先天性髋脱位患儿行骨盆三维重建。全部患儿均为女性,平均年龄4.3岁(3.5～8岁)。其中先天性髋关节半脱位17例,全脱位22例。分别测量:(1)健侧、患侧髋臼的深度和表面积;(2)健侧、患侧髋臼底最低点(O点)分别至髋臼前柱外缘前端(A点)、髋臼顶中点(B点)、髋臼后柱外缘后端(C点)的距离。结果先天性半脱位患儿健侧髋臼深度为(23.89±1.56)mm,患侧为(21.25±1.25)mm,双侧比较差异有显著性意义(P<0.05)。全脱位患儿健侧髋臼深度为(24.67±1.43)mm,患侧为(20.76±1.12)mm,双侧比较差异有显著性意义(P<0.05)。半脱位患儿健侧髋臼表面积为(27.78±1.65)mm2,患侧为(24.25±2.72)mm2,双侧比较差异有显著性意义(P<0.05)。全脱位患儿健侧髋臼表面积为(28.26±2.25)mm2,患侧为(24.54±2.51)mm2,双侧比较差异有显著性意义(P<0.05)。全脱位患儿OA,OB,OC距离健侧分别为(46.92±4.07)mm、(55.65±4.34)mm和(64.36±5.21)mm,患侧为(40.73±4.28)mm、(44.28±6.43)mm和(48.09±4.85)mm,双侧比较差异有显著性意义。半脱位患儿OA,OB,OC距离健侧分别为(47.68±3.98)mm、(54.25±3.34)mm和(12.96±4.65)mm,患     

髋臼前壁厚度的解剖学测量及其意义

目的 研究正常成人髋臼前壁臼前壁的解剖厚度,为髋臼前/壁骨折术中预防内固定进入关节提供依据.方法 解剖男女各8具成人新鲜冷冻尸体骨盆标本,对髋臼前柱壁采用"3-6"分割法,于交点处垂直于髋臼前壁逐个钻孔,分别测量不同分割点髋臼前壁厚度以及髋臼前柱壁宽度、髋臼直径及深度.结果 根据"3-6"分割法,髋臼前壁内1/3各分割点厚度波于:男(24.09±2.69)～(15.38±2.58)mm,女(22.99±2.16)～(14.77±1.82)mm;前壁外1/3各分割点厚度动于:男(20.44±2.28)～(10.50±1.08)mm,女(19.84±2.16)～(10.39±0.99)mm.结论 根据"3-6"分割法便于估计髋臼前壁不同进针点的厚度,对于髋臼前壁骨折重建术中避免内固定物进入关节有重要的指导意义.     

踝关节X线片分析与临床应用

目的测量正常成人踝关节X线片的有关数据,提高踝关节损伤诊断的准确率,以利于早期治疗、提高疗效。方法40例正常踝关节X线片,测量踝关节间隙内侧宽度、上方胫距关节间隙宽度、距骨外侧与外踝胫侧骨重叠影宽度、侧位片距骨与胫骨之间的宽度、下胫腓联合的宽度、胫骨外侧与腓骨胫侧构成重叠的宽度共六组数据。结果踝穴内侧宽度平均(3.8±0.5)mm,正位距胫关节宽度为(3.0±0.5)mm,距骨外侧与外踝的重叠影为(4.1±2.2)mm,侧位片中距骨与胫骨的间隙为(2.8±0.5)mm,下胫腓联合宽为(3.2±0.7)mm,胫骨外侧与腓骨胫侧重叠影宽平均为(7.7±1.9)mm。结论综合分析各组正常值,结合其它骨折改变,超过正常值范围是距骨脱位移位下胫腓联合分离的依据。多组数据改变可提高早期诊断准确率。     

肝细胞生长因子对大鼠移植小肠粘膜结构的保护作用

目的　探讨肝细胞生长因子 (HGF)对大鼠移植小肠粘膜结构的保护作用。方法　近交系Wistar (RT1k)大鼠行异位全小肠移植后第 2天开始给予肠外营养至第 10天 ,对照组 (n =10 )行常规TPN支持 ,HGF组 (n =10 )行常规TPN支持的同时加用人胎肝细胞生长因子 15 0 μg/ (kg·d) ,观察移植肠粘膜结构的形态学参数如绒毛高度、绒毛宽度、隐窝深度、粘膜厚度及绒毛表面积的变化 ,以及移植肠上皮细胞超微结构变化及移植肠粘膜蛋白质和DNA含量的改变。结果　移植前两组肠粘膜形态学参数差异无显著性意义 ,行移植及TPN后对照组各参数较移植前明显减小 (P<0 .0 5 ) ;而HGF组各参数与移植前比较变化不明显 (P>0 .0 5 ) ,但明显高于对照组 ,分别是绒毛高度为 ( 2 98.79± 2 2 .3 1) μmvs ( 176.45± 14 .62 ) μm ,P=0 .0 0 1;绒毛宽度为 ( 10 7.46± 12 .3 4) μmvs ( 74.2 0± 16.85 ) μm ,P =0 .0 0 4;隐窝深度为 ( 10 4.5 6± 11.17) μmvs ( 74.45± 8.3 4)μm ,P =0 .0 0 0 5 ;粘膜厚度为 ( 4 0 9.5 3± 3 5 .83 ) μmvs( 2 5 9.3 8± 2 4.65 ) μm ,P =0 .0 0 3 ;绒毛表面积为 ( 0 .10 1± 0 .0 11)mm2 vs ( 0 .0 41± 0 .0 0 5 )mm2 ,P =0 .0 0 1。HGF组蛋白质含量明显高于对照组 (P =0 .0 12 )而与基准值接近     

下颌骨及颧弓测量相关分析在美容医学中的应用

目的原位测量成人下颌角间距及颧弓深度、长度,并进行相关分析,以期在活体上通过测量下颌角间距来推算下颌骨和颧弓深度、长度各项指标,为临床美容矫治术及复合体的制作提供相关资料。方法经甲醛溶液固定成人男、女性尸体各50具,用游标卡尺直接测量下颌骨、颧弓各项指标。结果男性下颌体厚度(12.60±1.26)mm,下颌体高度(33.60±3.35)mm,下颌体长度(77.60±7.80)mm,下颌支宽(34.80±3.50)mm,下颌支高度(67.20±6.70)mm,颧弓深度(9.54±1.19)mm,颧弓长度(40.60±4.97)mm,下颌角厚度(12.20±0.67)mm(P=0.001)。性女下颌体厚度(10.70±0.98)mm,下颌体高度(29.40±2.64)mm,下颌体长度(74.00±7.07)mm,下颌支宽(31.10±3.04)mm,下颌支高(64.00±5.53)mm,颧弓深度(8.67±1.09)mm,颧弓长度(36.50±4.59)mm,下颌角厚度(13.80±1.28)mm等(P=0.001)。结论采用下颌角间宽推算颧弓深度、长度及下颌骨各项指标,对进行美容、复合体制作具有一定的参考意义。     

Transethmoidal approach to the optic canal: surgical and radiological microanatomy

BACKGROUND: The purpose of the study is to describe anatomic topographic landmarks for transethmoidal approach to optic canal for optic nerve decompression. The study focuses on microsurgical/radiologic anatomies and their relationships in the region of the optic canal and orbit. METHODS: Human optic canal and related anatomic structures were studied in orbits of 6 formalin preserved adult human cadavers. In addition, anatomic measurements were made with digital vernier caliper on the orbits of 25 adult human skulls. The relation between ethmoidal and sinus was assessed with computed tomography (CT) scan in 25 living human heads needing cranial CT scan for any reason. RESULTS: The suture on the conjunction of frontal, maxilla, and lacrimal bones with a location in medial side of the orbit was accepted as a landmark. When the measurements were taken from this landmark, the distances to supraorbital margin were: right(R): 16.76 +/- 2.62 mm, left (L): 17.10 +/- 1.97 mm, and to infraorbital margin were R: 20.18 +/- 3.24 mm, L: 18.94 +/- 2.19 mm. The distances to the anterior ethmoidal foramen were R: 19.66 +/- 3.96 mm, L: 19.11 +/- 2.84 mm, and to the posterior ethmoidal foramen were R: 32.01 +/- 2.90 mm, L: 32.62 +/- 3.33 mm. Mean distance between the anterior and posterior ethmoidal foramen were R: 12.55 +/- 3.4 mm, L: 13.51 +/- 4.2 mm. The posterior ethmoidal foramen and optic ring were separated only by the mean distances of R: 5.34 +/- 2.81 mm, L: 4.9 +/- 3.35 mm. The distance from the suture to the distal (orbital) opening of the optic canal was R: 37.35 +/- 2.73 mm, L: 37.52 +/- 3.47 mm and to proximal (intracranial) opening of the canal were R: 49.52 +/- 2.62 mm, L: 50.94 +/- 3.35 mm. The average widths of proximal (intracranial) canal measured were R: 7.43 +/- 1.95 mm, L: 7.38 +/- 2.01 mm and those of distal canal (orbital) were R: 5.12 +/- 1.1 mm, L: 4.95 +/- 1.32 mm. The mean lengths of the optic canal were R: 11.19 +/- 2.68 mm, L: 12.42 +/- 3.38 mm. In radiologic examinations, the mean numbers of anterior group ethmoidal cells were R: 7, L: 6 and those of posterior group ethmoidal cells were R: 4, L: 3. The results of CT demonstrated 7 (14%) Onodi or sphenoethmoidal cells in 50 orbits of living humans. CONCLUSION: The examination of radiologic anatomy in addition to microanatomy can significantly contribute to preoperative and postoperative evaluation of the patients.     

Neglected congenital dislocation of the hip: Role of computed tomography and computer-aided design for total hip arthroplasty

Computed tomography (CT) provides important three-dimensional anatomic details in congenital dislocation of the hip that are useful for total hip arthroplasty (THR) and are not obtainable with conventional radiographic evaluation. In this study, 84 patients (119 hips) with congenital dislocation of the hip were evaluated with CT before surgery. Specifically, both the acetabulum and the femur were analyzed to make the best selection of the prosthesis. The average anteversion of the acetabulum was 23°, with an opening of 30.9 mm and a depth of 14.7 mm. The bone stock of the true acetabulum was calculated and the average available diameter for the acetabular implant was 44.9 mm. The CT topogram revealed the true leg-length discrepancy (average, 0.5–1.9 cm), and the amount of a shortening osteotomy when necessary was determined. Finally, to determine the stem with optimum fit and fill, a three-dimensional reconstruction of the femoral canal using CT data and computer-aided design (CAD) was matched with a three-dimensional geometry of several stem designs and sizes obtained from a CAD system.     

Linear and angular measurements of computer-generated models: are they accurate, valid, and reliable?

INTRODUCTION: Traditional advanced imaging modalities such as CT and MRI are limited in their ability to perform accurate linear distance and angular measurements regardless of anatomical orientation. The construction of 3D models has been used to perform anthropometric analyses as well as in the reconstruction of rapid prototypes. We hypothesized that such measurements would be precise to within 2 mm or 2 degrees of measurements performed with a coordinate measurement machine (CMM). We also hypothesized that there would be a high degree of interobserver reliability with these measurements. MATERIALS AND METHODS: Multiple aluminum screws were implanted in various positions in three foam pelvises which were subsequently scanned by CT and rendered as 3D models using a commercially available software package (Mimics). Linear and angular measurements were performed using a CMM machine, the software package, and a dial caliper or goniometer. The deviation of the measurements from the CMM data was compared using ANOVA. The interobserver reliability of both the manual and computer-generated measurements was calculated. RESULTS: The mean difference between the CMM distances and those measured manually and with the software was 2.12 +/- 1.20 mm and 1.57 +/- 1.05 mm, respectively. The mean difference between the CMM angular measurements and the angular measurements performed manually and with the software was 4.07 +/- 4.70 degrees and 1.62 +/- 1.32 degrees, respectively. In all cases, the manual measurements were significantly less accurate (p < 0.0001) and there was a high degree of interobserver reliability. CONCLUSIONS: Computer-generated measurements taken from three-dimensionally reconstructed models are more accurate than manual measurements and are within 2 mm and 2 degrees of measurements performed with a CMM. These measurements have high interobserver reliability.     

Stereotactic imaging quality assurance using an anthropomorphic phantom.

OBJECTIVE: A custom-designed anthropomorphic head phantom, containing computed tomography (CT) and magnetic resonance (MR) viewable targets, was used in the assessment of stereotactic localization accuracy. MATERIALS AND METHODS: The Brown-Roberts-Wells (BRW) or Leksell stereotactic ring was rigidly fixed to the phantom. CT and MR images were then obtained according to radiosurgery protocols with the corresponding localizer frame attached. Plastic spheres and rods appeared at various locations within the phantom, when filled with aqueous solution, and their images served as targets to compute stereotactic target coordinates using software compatible with each frame. Coordinates derived using CT and MR were compared with mechanical measurements obtained using the BRW or Leksell stereotactic arc systems. RESULTS: For the BRW stereotactic system, the average vector distance to agreement of image-derived coordinates with the mechanical measurements was 1.41 +/- 0.90 mm (CT) and 1.37 +/- 0.38 mm (MR). Similar results were obtained using the Leksell system: 0.78 +/- 0.33 mm (CT) and 1.45 +/- 0.86 mm (MR). The vector distance to agreement between CT and MR was 1.42 +/- 0.55 mm for the BRW and 1.31 +/- 0.60 mm for the Leksell systems. CONCLUSIONS: The data support the use of our anthropomorphic phantom, and present a methodology for assessing radiosurgery target localization and imaging accuracy.     

Geometric accuracy of a newly developed cone-beam device for maxillofacial imaging.

OBJECTIVE: The aim of this study was to determine the geometric accuracy of scans obtained with a newly developed cone-beam computed tomography (CBCT) device in comparison with a multidetector row computed tomography (MDCT) scanner. STUDY DESIGN: Cone-beam scans were obtained with the preretail version of a newly developed compact size device with a scan volume of 15 x 15 x 15 cm. Conventional CT scans for comparison were performed with a 6-detector row CT scanner. To determine distance accuracy, 100 measurements were performed on radiopaque markers on a dry human skull. To determine volume accuracy, 25 measurements were carried out on a geometric phantom. Commercially available software was used for three-dimensional visualization and measurements on imaging data. RESULTS: Mean absolute measurement error (AME) for linear distances was 0.26 mm (+/-0.18 mm) for the CBCT device and 0.18 mm (+/-0.17 mm) for the MDCT device (P = .196 in paired t test). The average absolute percentage error (APE) was 0.98% (+/-0.73%) and 1.26% (+/-1.50%), respectively (P = .485 in paired t test). Linear regression analysis showed a positive correlation between AME and distance length (R = 0.628; P = .004) for CBCT-based measurements. Average AME in volume measurements was 1.78 mL (+/-0.99 mL) for the CBCT device and 1.23 mL (+/-0.93 mL) for the MDCT device. The average APE was 6.01% (+/-1.49%) and 4.42% (+/-1.99%), respectively. CONCLUSIONS: The results indicate that the evaluated cone-beam device provides satisfactory information about linear distances and volumes. Multidetector row computed tomography scans proved slightly more accurate in both measurement categories. The difference may be considered as not relevant for the majority of clinical applications.     

Morphological study of abdominal aortic aneurysm: optimal stent-graft size for Japanese patients.

PURPOSE: We report on the optimal stent-graft (SG) size for Japanese patients with abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: Ninety three Japanese patients undergoing elective AAA repair were selected for this study. The parameters measured were the proximal neck (PN) diameter (D1), the diameter of the right and left common iliac arteries (D2 and D3, respectively), the diameter of the right and left external iliac arteries (D4 and D5, respectively), the distance between the lowest renal artery and the common iliac arterial bifurcation (L1), and the distance between the right and left common iliac arterial bifurcations and the internal iliac arterial bifurcation (L2 and L3, respectively). RESULTS: The following results were obtained: D1: 20.7+/-3.9 mm (14 to 28 mm); D2: 14.0+/-3.0 mm (9.5 to 20 mm); D3: 13.8+/-3.1 mm (9 to 19.5 mm); D4: 7.5+/-1.0 mm (6 to 10 mm); D5: 7.4+/-0.9 mm (6 to 10 mm); L1: 107.7+/-13.4 mm (80 to 130 mm); L2: 40.0+/-10.1 mm (20 to 61 mm); L3: 39.7+/-9.6 mm (20 to 60 mm). CONCLUSION: The results indicate the necessity of exercising adequate care when selecting a device for Japanese patients.     

Anatomic and spiral computed tomographic study of the genial tubercles for genioglossus advancement.

OBJECTIVE: To measure and compare Chinese mandibular genial tubercles measured anatomically and with computed tomography (CT). STUDY DESIGN AND SETTING: Spiral CT scans were taken of 40 adult human skulls; the superior genial spines were measured using anatomic and CT methods. RESULTS: The height and width of the superior genial spines, mandible thickness, and distance from the menton to the inferior and superior margins of the superior genial spines were 5.82 +/- 0.71, 6.98 +/- 1.35, 11.95 +/- 1.59, 11.08 +/- 2.05, and 16.91 +/- 2.30 mm from anatomic measurements and 6.17 +/- 0.71, 7.01 +/- 1.13, 12.19 +/- 1.64, 10.41 +/- 1.55, and 15.73 +/- 2.12 mm using spiral CT, respectively. The anatomic and CT measurements were correlated. CONCLUSION: Spiral CT of the genial tubercles can help locate the osteotomy in genioglossus advancement. SIGNIFICANCE: This study acquired reference data on Chinese genial tubercles demonstrating that CT measurements of the genial tubercles reflect their anatomy, which should allow accurately locate the osteotomy.     

Crowe IV 型髋关节发育不良全髋关节置换术前计算机辅助设计

 目的 探索采用计算机辅助技术, 对接受全髋关节置换(total hip arthroplasty, THA)的 Crowe IV型髋关节发育不良患者进行术前评估, 确定髋臼大小、骨缺损程度, 并在此基础上辅助手术设 计、假体选择及骨缺损修复。 方法2011 年3 月至10 月, 共10 例(13 髋)Crowe IV型高位脱位髋关节发 育不良患者接受THA 治疗。患者均为女性;年龄32~74 岁, 平均42 岁。所有患者术前行髋关节三维CT 扫描, 然后将扫描数据输入SuperImage 软件重建骨盆及髋臼。重建后在不同角度精确评估真臼位置, 测 量真臼大小及前后柱厚度, 评估骨缺损程度;将髋臼试模、骨缺损修复材料(钽金属垫块)按1颐1 大小扫 描输入计算机系统, 进行术前模拟安放, 确定髋臼假体大小、安放位置;髋臼假体安放后评估遗留的骨缺 损, 确定骨缺损修复材料, 进行骨缺损修复模拟测试。 结果 9 例(12 髋)术中实际安放髋臼假体型号与 术前计算机辅助设计一致, 1 例(1髋)假体型号较术前设计大一号。所有患者髋臼安放位置与术前计划 一致, 均安放于真臼。髋臼骨缺损修复按术前设计:4 髋因髋臼顶部骨缺损明显(臼顶部骨性覆盖 < 70%), 采用钽金属垫块修复骨缺损, 以增强髋臼的稳定性;7 髋采用Harris 法自体股骨头植骨修复骨缺 损;2 髋髋臼杯植入后臼顶覆盖可, 术中未植骨。 结论 对Crowe IV型髋关节发育不良者行计算机辅助 下THA术前设计, 有助于术前精确评估真臼发育情况、大小及髋臼骨缺损, 提高手术治疗精确性。     

CT-based preoperative analysis of scapula morphology and glenohumeral joint geometry.

OBJECTIVE: To investigate the geometry of the glenohumeral joint using three-dimensional (3D) models; define landmarks, planes, angles and regions of interest; and analyze the exact morphology of the scapula. MATERIALS AND METHODS: We reconstructed 3D scapula models based on computed tomography (CT) data sets of 12 healthy controls. Three-dimensional models were reconstructed using the 3D Slicer2 (Surgical Planning Lab, Boston, MA), which provides interactive measurement. The 3D model and measuring tools can be freely shifted and rotated in all planes. RESULTS: The average length of the scapulas was 209.58 +/- 26.72 mm (left) and 223.68 +/- 47.74 mm (right); width was 124.03 +/- 13.28 mm (left) and 141.44 +/- 27.78 mm (right); and volume was 121.38 +/- 12.02 ml (left) and 130.24 +/- 20.86 ml (right). The glenoid dimensions were 34.34 +/- 5.62 mm (left) and 36.44 +/- 7.36 mm (right) (anteroposterior); and 49.16 +/- 7.68 mm (left), 51.46 +/- 10.07 mm (right) (superoinferior). For all average values, scapulas from male controls were significantly larger than those from females, and right sides were larger than left sides (p < 0.05). The glenoid version was nearly the same for male/female and left/right (left = 9.02 +/- 3.89 degrees retroversion; right = 8.26 +/- 3.72 degrees retroversion) (p > or = 0.05). CONCLUSION: The 3D measurement of scapula morphology compared with geometry of the glenohumeral joint leads to a more precise planning of shoulder surgery. As new shoulder prostheses are intended to reconstruct the normal anatomy as closely as possible, such exact 3D measurements may be used for optimization.     

Correlation of cephalic anthropometric parameters and microsurgical anatomy of the optic nerves: a cadaveric morphometric study

BACKGROUND: This study was designed to elucidate the possible correlation of cranial anthropometric measurements with the chiasm to limbus sphenoidale distance to facilitate preoperative estimation of this distance and to choose a better surgical approach. METHODS: Thirty-three fresh adult cadaver heads (22 males and 11 females) were evaluated for cranial anthropometric measurements. The precraniotomy anthropometric measurements included (A) inion to nasion distance and (B) the longest intermeatal meridian. Subsequently, with a standard craniotomy, the following intervals were measured: (C) optic chiasm to falciform ligament, (D) anterior aspect of optic chiasm to limbus sphenoidale, and (E) limbus sphenoidale to inner nasion. A combined ratio parameter, labeled as (F), was calculated from the following equation: F = B/E x 10. RESULTS: The mean values and standard errors of the mean of parameters A to F were 195.8 +/- 14.53 mm, 374.7 +/- 25.29 mm, 10.47 +/- 1.89 mm, 9.93 +/- 2.01 mm, 38.46 +/- 3.17 mm, and 9.81 +/- 1.11, respectively. The parameter D had significant correlation to the parameters B, C, E, and F. The most significant correlation was seen between parameters D and F (p < 0.001). According to linear regression assessment between parameters D and F, the following regression equation was obtained: D = 4.24 + 0.58F. CONCLUSIONS: Optic nerve topography and dimensions show inter-personal variations that may be anticipated to some extent with cranial anthropometric data. Calculating of F ratio gives us an acceptable estimation of the actual distance of chiasm to limbus sphenoidale, which in turn can help the surgeon to select the approach to tumors of intrasellar region. However, the role of meticulous imaging studies cannot be overemphasized to confirm the anticipated estimations.