健康成人肱骨远端的CT解剖形态学特征

目的探讨健康成人肱骨远端的CT解剖形态学特征及性别差异,为肱骨远端植入物的设计提供参考。方法从医院图像存档与传输系统中选取121例正常肘关节CT图像,于AW4.5工作站中进行重建和测量。通过屈戌轴和肱骨干确定冠状面和水平面,与屈戌轴垂直的面确定为矢状面。于冠状面上测量肱轴角;取四个不同的矢状面测量肱骨小头高度、外侧滑车缘高度、滑车沟高度、内侧滑车缘高度;于水平面上测量肱骨小头宽度、肱骨小头前距、外侧滑车缘前宽、外侧滑车缘后宽、滑车宽度、内侧滑车缘前宽、内侧滑车缘后宽、滑车沟前后距、外侧滑车缘前距、外侧滑车缘后距、内侧滑车缘前距、内侧滑车缘后距、肱骨远端宽度。分析测量参数的性别差异、数据间的相关性及肱轴角与90°的差异。结果男性肱骨小头高度为(21.5±1.3)mm、肱骨小头宽度为(17.5±1.1)mm、肱骨小头前距为(10.8±0.9)mm、滑车宽度为(25.1±2.2)mm、滑车沟高度为(17.3±1.5)mm、滑车沟前后距为(17.5±1.4)mm、外侧滑车缘前宽为(7.7±1.2)mm、外侧滑车缘后宽为(12.5±1.6)mm、内侧滑车缘前宽为(12.4±1.6)mm、内侧滑车缘后宽为(9.8±2.0)mm、外侧滑车缘前距为(10.0±0.8)mm、外侧滑车缘后距为(16.3±1.4)mm、内侧滑车缘前距为(12.9±1.4)mm、内侧滑车缘后距为(13.2±1.4)mm、外侧滑车缘高度为(20.6±1.3)mm、内侧滑车缘高度为(25.0±2.4)mm、肱骨远端宽度为(42.6±2.5)mm,女性分别为(18.7±1.1)mm、(15.3±1.1)mm、(9.5±0.6)mm、(21.7±1.5)mm、(15.4±1.7)mm、(15.6±1.5)mm、(6.8±1.3)mm、(10.7±1.4)mm、(10.6±1.4)mm、(8.5±1.4)mm、(8.9±0.8)mm、(14.5±1.1)mm、(11.4±1.1)mm、(11.5±1.0)mm、(18.1±1.4)mm、(21.6±1.4)mm、(37.0±1.8)mm,男性均大于女性,差异有统计学意义(P<0.05)。肱轴角(男87.4°±3.5°,女87.8°±3.3°)、肱骨小头宽度与肱骨小头高度比(男0.8±0.1,女0.8±0.1)、滑车宽度与肱骨小头宽度比(男1.4±0.2,女1.4±0.1)、内外侧滑车缘高度比(男1.2±0.1,女1.2±0.1)、内侧滑车缘前宽与滑车宽度比(男0.5±0.1,女0.5±0.1)、内侧滑车缘后宽与滑车宽度比(男0.4±0.1,女0.4±0.1)、外侧滑车缘前宽与滑车宽度比(男0.3±0.0,女0.3±0.1)、外侧滑车缘后宽与滑车宽度比(男0.5±0.1,女0.5±0.1)的性别差异无统计学意义(P>0.05)。各项参数除肱轴角外均与肱骨远端宽度呈正相关,随肱骨远端宽度的增大而增大(r值0.335~0.928,P<0.05)。肱轴角(87.6°±3.4°)与90°的差异有统计学意义(t=-7.287,P<0.05)。结论男性肱骨远端尺寸略大于女性,但形状无差异。关节宽度可以作为一个衡量肱骨远端大小的指标,肱骨骨干更偏向于桡侧。

CT anatomical features of the distal humerus in healthy adults

Objective To study the anatomical features of the distal humerus in Chinese healthy adults.Methods A total of 121 cases of normal elbow joint CT images were selected from the picture archiving and communication system(PACS),and reconstructed and measured on the AW4.5 workstation.Coronal plane and horizontal plane were determined by flexion-extension(FE)axis and humeral shaft,while the sagittal plane was perpendicular to the FE axis.The angle between the axis of humerus medullary cavity and the FE axis of elbow(H-FE angle)was measured on the coronal plane.The capitellar height(CH),lateral trochlear height(LTH),trochlear height(TH)and medial trochlear height(MTH)were measured on four different sagittal planes.The capitellar width(CW),capitellar depth(CD),anterior lateral trochlear width(ALTW),posterior lateral trochlear width(PLTW),trochlear width(TW),anterior medial trochlear width(AMTW),posterior medial trochlear width(PMTW),trochlear depth(TD),anterior lateral trochlear depth(ALTD),posterior lateral trochlear depth(PLTD),anterior medial trochlear depth(AMTD),posterior medial trochlear depth(PMTD),and distal humeral width(W)were measured on the horizontal plane.The gender differences in measured parameters,correlations between data,and differences in H-FE angle from 90°were analyzed.Results In male,CH was 21.5±1.3 mm,CW 17.5±1.1 mm,CD 10.8±0.9 mm,TW 25.1±2.2 mm,TH 17.3±1.5 mm,TD 17.5±1.4 mm,ALTW 7.7±1.2 mm,PLTW 12.5±1.6 mm,AMTW 12.4±1.6 mm,PMTW 9.8±2.0 mm,ALTD 10.0±0.8 mm,PLTD 16.3±1.4 mm,AMTD 12.9±1.4 mm,PMTD 13.2±1.4 mm,LTH 20.6±1.3 mm,MTH 25.0±2.4 mm,W 42.6±2.5 mm.The above parameters in female was 18.7±1.1 mm,15.3±1.1 mm,9.5±0.6 mm,21.7±1.5 mm,15.4±1.7 mm,15.6±1.5 mm,6.8±1.3 mm,10.7±1.4 mm,10.6±1.4 mm,8.5±1.4 mm,8.9±0.8 mm,14.5±1.1 mm,11.4±1.1 mm,11.5±1.0 mm,18.1±1.4 mm,21.6±1.4 mm and 37.0±1.8 mm,respectively.All the above anatomical parameters in men were larger than those in women with statistically significant difference(P<0.05).However,the H-FE angle(male:87.4°±3.5°,female 87.8°±3.3°),CW/CH(male:0.8±0.1,female:0.8±0.1),TW/CW(male:1.4±0.2,female:1.4±0.1),MTH/LTH(male:1.2±0.1,female:1.2±0.1),AMTW/TW(male:0.5±0.1,female:0.5±0.1),PMTW/TW(male:0.4±0.1,female:0.4±0.1),ALTW/TW(male:0.3±0.0,female:0.3±0.1),PLTW/TW(male:0.5±0.1,female:0.5±0.1)were not statistically different between male and female groups(P>0.05).All measurements except for the H-FE angle had a positive correlation with the articular width(0.335≤r≤0.928,P<0.05).The difference between the angle of the H-FE axis(87.6°±3.4°)and 90°was statistically significant(t=-7.287,P<0.05).Conclusion The size of the distal humerus in male is larger than that in female without difference in shape.Distal humerus width can be used as an indicator to measure the size of the distal humerus.The humeral shaft is more biased toward the radial side.