正常成人锁骨形态的CT影像学研究

目的 观察测量锁骨CT影像学形态,为锁骨骨折锁定接骨板的治疗及改进提供解剖学参考。方法 回顾性研究2014年3—12月南京鼓楼医院排除锁骨骨折及其他可影响锁骨形态疾病的32例行肺部或颈部CT扫描患者的影像学资料,其中男16例,女16例;年龄20~75岁,平均年龄41.4岁。通过CT扫描及3D重建,分别测量32例64侧投影位锁骨的长度,近端、中段和远端宽度,锁骨近端和远端的曲率半径,锁骨水平面、冠状面的两端最大宽度及中间最小宽度等,采用成组t检验,分别比较不同侧别及性别间测量数据的差异。结果 男性锁骨的平均长度为(153.9±7.5)mm、女性锁骨的平均长度为(135.4±7.6)mm。男女的锁骨近端曲率半径均明显较远端曲率半径大,垂直投影的锁骨中段最小宽度男性为(11.7±1.9)mm,女性为(9.3±1.0)mm。左右侧各观察测数据差异均无统计学意义(P值均>0.05);男女性别间比较,除中远段曲率半径、中近段角度、中远段角度、冠状面近端最大宽度、上缘曲度差异均无统计学意义(P值均>0.05),其他指标差异均有统计学意义(P值均<0.05)。结论 锁骨的形态存在较大的性别差异,表现为女性锁骨的总长度及各部分长度较短、水平面和冠状面近端最大宽度较小,有必要根据性别差异改进器械;此外,测量结果还可为锁定接骨板术前预弯提供依据。

Morphological study of the adult clavicle based on CT

Objective To improve the clinical applicability of locking plates which designed for clavicle fracture fixation by measuring the morphological parameters of the clavicle with CT.Methods For the morphological study, the research chose 32 CT datums of Chinese patients (16 males and 16 females) who had the disease needed spiral CT scaning of cervicothoracic region in Nanjing Drum Tower Clinical Medical School of Southeast University. Their ages ranged from 20 to 75 years old, and the average age was 41.4. The length of the clavicle, lateral epiphysis diameter, mean diaphysis diameter and medial epiphysis diameter of the horizontal and coronal plane, lateral width, lateral radius of curvature, medial width and medial radius of curvature, the mean medial and lateral angles, the coronal plane width were measured. Both sides of the clavicle were measured, so there were 64 sides to be used. Then the difference between the left and right, the diversity among the males and females were both compared.Results There were significant differences between males and females in the parameters, except lateral radius of curvature, the lateral angles, and lateral epiphysis diameter of coronal plane. Average length was (153.9±7.5) mm for males and(135.4±7.6) mm for females. The medial radius of curvature was obviously larger than the lateral radius of curvature both for males and females. The minimum of the coronal plane width was (11.7±1.9)mm for males and (9.3±1.0)mm for females. All measurements were not statistically significant (all P values>0.05) compared left by right sides. There were significant differences (all P values<0.05) between males and females except lateral radius of curvature, medial width and medial radius of curvature, the lateral angles, lateral epiphysis diameter of coronal plane and the coronal plane width.Conclusions The clavicle morphology varies significantly by genders in Chinese population, particularly in length, diameter, the lateral angles. It is optimal that the plates should be ameliorated by gender and should allow individualized pre-shaping to enhance its therapeutic efficacy.