胸壁重建肋骨骨折内固定有关的肋骨几何形态学研究

Geometry of Human Ribs Pertinent to Chest-wall Reconstruction and Internal Rib Fixation

目的采用X线计算机断层摄影术（CT）测量成年人第3～9肋的几何形态，为肋骨内表面解剖型接骨板提供设计参数。方法选择2012年5～7月在河北省人民医院行胸部CT扫描的患者20例，男10例、女10例，汉族，身高167～180（173±8）cm，年龄16～58（37±18）岁，排除外伤及其他导致肋骨外形及密度异常的疾病。胸部CT扫描后，重建骨性胸廓三维图像，对肋骨几何形态进行分析与测量。结果将肋骨按如下方法分为3个区：肋头～37．5％点（1区），25．0％点～75．0％点（2区），50．0％点～100．0％点（3区）。肋骨长轴整体弯曲度最大值均出现在1区，其中第3肋最大[（20．24±2．86）／m）]，第8肋2区最小[（6．14±0．96）／m]，第7～9肋中2区弯曲度小于其他两区，第3～6肋弯曲度最小值出现在3区。肋骨沿其长轴都有扭转，数值是30°～50°肋骨的铺展角先下降后逐渐上升。髓腔面积变化范围是从肋骨后部的27．59mm2。到前部的55．91mm2。结论多层螺旋CT三维重建肋骨像能准确显示并测量肋骨的形态特征，为临床肋骨内固定器械的设计提供实用的影像学测量方法。

Objective To provide geometric morphometric parameters for anatomical plate design by measuring the geometry of the 3rd to 9th ribs of adults using X-ray computed tomography （CT）. Methods Twenty patients receiv- ing chest CT scan in Hebei Province General Hospital from May to July of 2012 were recruited in this study. There were 10 Han males and 10 Han females with their height of 167-180 （ 173 ± 8 ） cm and age of 16-58 （37 ±18 ）years. None of the patients had thoracic trauma history or other disease which might influence the shape or density of ribs. After general chest CT scan, three-dimensional images of thoracic bones were constructed. The geometric shape of the ribs was analyzed and measured. Results The ribs were divided into 3 sections as followed, from rib head to -37.5% of rib （section I ）, 25%- 75% （section 2）, and 50%-100% （section 3 ）. The maximum curvature of general curved ribs on long axis occurred in section 1 of the ribs. The third rib had the largest curvature （20.24＋2.86/m）. Section 2 of the 8th rib had the smallest cur- vature （6.14 ＋ 0.96/m）. The curvature of section 2 of 7th to 9th ribs was smaller than that of other 2 sections. The smallest curvature appeared in section 3 of 3rd to 6th ribs. Each rib had a retroversion angle along its longitudinal axis, and its nu- merical value was 30-50 degrees. The rib unrolled angle decreased firstly and then increased gradually. The cross-sectional area of marrow cavity ranged from 27.59 mm2 at the rear to 55.91 mm2 in the front. Conclusion Multi-slice spiral CT three-dimensional reconstruction of ribs can accurately measure the morphological characteristics of ribs, and provide a practical method for designing imernal rib fixation plates.