经喙突肩胛骨关节盂螺钉内固定的最优化计算机辅助测量

Optimal computer aided measure for screw internal fixation in the cavitas glenoidalis through human coracoid process of scapula

目的探讨最优化计算机辅助解剖测量技术,为经喙突肩胛骨关节盂螺钉内固定提供解剖学基础。方法取肩胛骨CT数据30份,进行精确的三维重建得到肩胛骨数字模型。首先为使用单螺钉的内固定方法设计最优化目标函数,并在约束条件下自动计算其最佳位置;然后结合主元分析,搜索和确定使用双螺钉内固定方法的进钉位置;最后用统计方法分析测量结果,并设计新的解剖测量参考体系。结果使用单螺钉时,进针点P到肩峰前外侧最突起点X的距离为(39.15±2.28)mm、到喙突前内点Y为(28.66±2.68)mm、到上角点Z为(61.13±6.57)mm;PX、PY之间的夹角为(81.27±7.15)°,PX、PZ之间的夹角为(133.27±6.84)°;对于进钉方向,螺钉与PX的夹角为(104.08±4.41)°,与PY的夹角为(101.29±3.51)°,与PZ之间的夹角为(76.23±5.03)°。使用双螺钉时,进针点E与原单螺钉的进针点之间的距离为(5.12±1.37)mm,进针点F与原单螺钉的进针点之间的距离为(3.88±0.94)mm;两进针点的连线与长轴方向之间的夹角为(27.41±3.51)°。结论最优化计算机辅助解剖测量是一种非常有效的新测量技术,克服了传统手工实物解剖测量的很多缺点,并且方便设计新的解剖测量参考体系和临床手术方案。

Objective To investigate a special optimization technique for computer aided measure, and provide anatomical basis for screw internal fixation in the cavitas glenoidalis through the coracoid process of scapula. Methods Thirty accurate scapula models were reconstructed from CT data sets. First, special optimization objective function was designed for single screw internal fixation configuration, and the optimal placement of screw was found automatically under constraints. Then, the placements of double screws internal fixation configuration were searched taking advantage of principal component analysis. Finally, statistical measure data were provided according to new anatomical reference landmarks for clinical use. Results For single screw internal fixation configuration, the distance from the optimal screw entry point P to the acromion process point X was （39. 15 ± 2.28） mm, to the coracoid process point Y was （28.66± 2.68） mm, to the angulus superior point Z was （61.13±6.57） mm; The angle was （81.27 ±7.15）° between PX and PY, and （133.27±6.84）° between PX and PZ. The mean inclination of the lag screw was （104.08 ±4.41） ° for the angle with line PX, （ 101.29 ±3.51 ）° with line PY, and （76.23 ± 5.03 ）° with line PZ. For double screws configuration, the distance from the original single screw entry point P to the screw entry point E was （5. 12 ± 1.37 ）mm, to the screw entry point F was （3.88 ±0.94）mm. The angle between the long axis of coracoid process and line EF was （27.41 ± 3.51 ）°. Conclusion The automatic optimization technique for computer aided measure is very efficient and has many advantages over the conventional manual dissection methods, and is convenient to design new anatomical reference landmark system for clinical use.