喙锁韧带重建的解剖放射学研究

Anatomical and radiological study of coracoclavicular ligament reconstruction

目的测量不同透视体位下喙锁韧带骨道走行的放射学参数,为临床喙锁韧带重建提供解剖学依据。方法取22具防腐处理的成人肩关节标本,解剖测量喙锁韧带两部分(斜方韧带,锥状韧带)的走行方向、止点宽度及透视体位下成角。结果斜方韧带锁骨侧足印宽度(26.2±1.2)mm,喙突侧(22.7±1.6)mm。锥状韧带锁骨侧足印宽度(24.6±1.4)mm,喙突侧(19.2±1.6)mm。影像学测量韧带的插入角度:肩胛骨正位与锥状韧带与锁骨长轴成角(81±4)°,斜方韧带成角(67±7)°。侧位成角:斜方韧带(83±3)°,锥状韧带(70±6)°。与外科标志的毗邻关系:斜方韧带与锥状韧带足印区长轴中心点在锁骨间距(21.9±4.8)mm,在喙突侧间距(15.7±1.6)mm。结论锥状韧带及斜方韧带止点足印宽度较为恒定,斜方韧带插入角度有变异度较大,锥状韧带较为恒定。两韧带在锁骨及喙突上间距较小。在进行肩锁关节解剖重建时,可参照其解剖学特点。

Background Occurring in almost all age groups,acromioclavicular joint dislocation is a common type of injury in orthopedics with 15-45 years old as the age range with the highest incidence.The core pathological change of acromioclavicular joint dislocation is a rupture ofcoracoclavicular ligament,which in turn causes the instability of acromioclavicular joint and the displacement of distal clavicle relative to acromion.Consequently,a series of clinical symptom is resulted.Clavicular hook plate fixation was used to be applied in the treatment of acromioclavicular joint dislocation.However,there are complications such as the stress fractures of hook plate,the wear of acromion and the loss of reduction after plate removal.Currently,minimally invasive arthroscopyassisted Endobutton fixation has become the prior choice for the treatment of this disease.The key of the procedure is thein-depth understandingofthe anatomy and imaging of trapezoid ligament and conoid ligament.Objective To measure the radiological parameters of coracoclavicular ligament bone tunnel under different fluoroscopic positions in order to provide the anatomic basis for clinical coracoclavicular ligament reconstruction.Methods Twenty-two cadaver specimens of shoulder jointwere used to measure the direction,width of footprint and angle under perspective position of two parts of the coracoclavicular ligament(trapezoid ligamentand conoid ligament).Results The widths of trapezoid ligament footprint were(26.2±1.2)mm on the clavicle side and(22.7±1.6)mm on the coracoid side.The widths of conoid ligament footprintwere(24.6±1.4)mm on the clavicle side and(19.2±1.6)mm on the coracoid side.Radiological measurementof ligament angulation:the angle between trapezoid ligament and the longitudinal axis of clavicle was(81±4)°on the anteroposterior view of scapula.Lateral argumentation(83±3)°for trapezoid ligamentand(70±6)°for conoid ligament.Adjacent relationship with surgical marker:the distances between trapezoid ligament and the midpoint of long axis conoid ligament footprint were(21.9±4.8)mm on the clavicle side and(15.7±1.6)mm on the coracoid side.Conclusion The widths of trapezoid ligament and conoid ligamentfootprints are relatively constant.The angle of trapezoid ligamentinsertion is variable,while the angle of conoid ligament insertion is relatively constant.The anatomic characteristics of coracoclavicularligament can be taken for reference during the anatomic reconstruction of acromioclavicular joint.