喙锁韧带重建术中骨性通道建立的数字化研究

Safety location of bony tunnel in coraco-clavicular ligament reconstruction： a digital anatomical study

目的通过对锁骨及喙突相关解剖学特征进行数字化研究，探讨喙锁韧带重建术中骨道的安全位置。方法使用Mimiesl3．0软件对30例无肩锁关节及喙锁结构损伤的单侧肩部薄层螺旋CT扫描数据进行喙锁结构三维重建，男、女各15例；年龄20-71岁，平均49.3岁；左、右侧肩各15例。对喙突及锁骨进行解剖学测量，参照锥状韧带的解剖位置在模型上建立虚拟骨道，评估该骨道的安全性及相关参数。结果男性锁骨全长[（147．70±5．34）mm]、锥状韧带止点中心到锁骨远端的距离[（35．90±3．16）mm]、斜方韧带止点中心到锁骨远端的距离[（22．68±1．23）mm]均较女性[（133．09±6．61）、（30．48±0．54）、（18．69±1．65）mm]长，差异有统计学意义（P〈0．05）。但对于锥状韧带止点中心及斜方韧带止点中心到锁骨远端的距离与锁骨全长的比值、喙突内倾角，男性与女性之间比较差异均无统计学意义（P〉0．05）。从锁骨锥状结节尖端在锁骨上表面投影的后缘向喙突基底部前缘中点建立的骨道在喙突及锁骨上均位于正中。该骨道相对于躯干矢状面内倾35．23°±2．36°,相对于冠状面后倾5．91°±2．14°。结论为保证骨道安全，锁骨端的骨道中心应位于锥状结节尖端在锁骨上表面投影的后缘，喙突端的骨道中心应位于喙突基底部前缘中点。骨道内倾约35°后倾约6°。

Objective To determine the safety location of the bony tunnel in reconstruction of the eoracoelavicular ligaments on the basis of digital characterization of the anatomy of the clavicle and coracoid process. Methods Unilateral shoulder spiral CT scan was conducted in 30 patients without injury to the clavicle or coracoid process. They were 15 men and 15 women, aged from 20 to 71 years old （average, 49. 3 years）. Thirty 3D digital models of the clavicle and coracoid process were constructed using the CT scan data by Mimics13.0. Half of the models were of the left shoulder and half of the right. Anatomic measurements of the clavicle and eoracoid process were carried out on these models. Virtual transclavicular-transcoracoid bony tunnels were established according to the anatomy of the conoid ligament. Parameters of these bony tunnels were measured before the safety location was calculated. Results The mean clavicular length was 147.70±5. 34 mm in males and 133.09 ± 6. 61 mm in females; the distance between the lateral edge of the clavicle and the center of the conoid tuberosity （CCD） was 35. 90 ± 3. 16 mm in males and 30. 48 ± 0, 54 mm in females; the distance between the lateral edge of the clavicle and the center of the trapezoid tuberosity （CTD） was 22. 68 ± 1.23 nun in males and 18.69 ± 1.65 mm in females, with significant differences between genders （ P 〈 0. 05） . There were no significant differences between male and female regarding the ratio of the CCDto the clavicular length, the ratio of CTD to the clavicular length, or the mean internal rotational angle of the coracoid process （ P 〉 0. 05）. According the attachments of the conoid ligament on the clavicle and coraeoid, from the superior-posterior edge of the clavicle to the anterior midpoint of the eoracoid basement, the bony tunnels were established. These tunnels nearly bisected the cross section of the clavicle and coracoid basement, 35, 23° ± 2.36° medially inclined to the sagittal section and 5.91°±2. 14° posteriorly inclined to the coronal section of the body. Conclusions To ensure that the bony tunnel shouhl pass through the center of the clavicle and eoraeoid, it should be drilled from the superior-posterior edge of the clavicle and located at the elavicular attachment of the conoid ligament, tilting about 35° medially and 6° posteriorly to aim at the anterior midpoint of the coracoid basement.