肋头关节骨性关节面的形态特征及其临床意义

Morphological characteristics and clinical significance of the bone articular surface of the rib head joint

目的通过对肋头关节骨性关节面的形态学测量探讨其形态特征规律,为临床诊疗、置钉设计及相关生物力学研究提供理论依据。方法选取40套(80侧)成人胸廓干骨标本,进行相关指标观测,并按不同节段统计分析。结果T_(1~9)的肋凹大部分为上位椎骨平面形、下位椎骨凹面形,T_(10~12)单肋凹多为平面形;椎骨肋头关节肋凹的位置C_(7)~T_(3)上、下肋凹均在椎体上;T_(4)开始肋凹逐渐后移,出现根-体各半型,从T_(7)出现根为主型,并渐增多,T_(12)全部是根为主型;R_(1)、R_(2)、R_(11)及R_(12)均为单肋头关节面,从R_(3~10)均既有单肋头又有双肋头关节面,后者出现率先渐增高后又渐降低;R_(1~5)单肋头关节平面型从52.1%降至15.0%,而R_(6)、R_(7)、R_(9)未见平面型;凹面型:R_(1~6)从47.5%渐降至6.3%,而R_(8~12)则从8.8%渐升至48.7%。双肋头关节均以上平下凹型为主,其次为上下双凹型。R_(3~8)双肋头关节中,上平下凹型出现率从8.8%增至66.2%,而R_(8~10)该型出现率渐低;R_(4~10)上下双凹型出现率小于上平下凹型。结论临床应用应根据第1~12肋的相关参数选取适合的诊疗方案。

Objective To investigate the morphological characteristics of the skeletal articular surface of the rib head joint by morphological measurement,and provide a theoretical basis for clinical diagnosis and treatment,nail placement design and related biomechanical research.Methods 40 sets(80 sides)of adult thoracic bone specimens were selected,and related indicators were observed,and statistical analysis was performed according to different segments.Results Most of costal fovea of T_(1~9)were in the plane of the upper vertebrae,the lower vertebrae were concave,and the single costal fovea of T_(10~12)were mostly flat.The positions of the ribs of the vertebral rib head joint costal fovea C_(7)~T_(3)were both in the vertebrae.On the body,T_(4)began to gradually move back ribs,the root-body half-type appeared,from T_(7)to the root-based type,and gradually increased,T_(12)were all root-based.R_(1),R_(2),R_(11)and R_(12)were single.The articular surface of the rib head,from R_(3)to R_(10),had both single rib head and double rib head articular surface.The latter appeared to increase first and then gradually decreased.R_(1)to R_(5)single rib head joint plane type decreased from 52.1%to 15.0%,and R_(6),R_(7),R_(9)did not see the flat type.R_(1~6)concave type gradually decreased from 47.5%to 6.3%.R_(8~12)concave type gradually increased from 8.8%to 48.7%.Double rib head joints were mainly flat and concave,followed by double concave.In R_(3~8)double rib head joint,the appearance rate of upper flat and lower concave type increased from 8.8%to 66.2%,while the appearance rate of R_(8~10)was gradually lower.the appearance rate of R_(4~10)upper and lower double concave type was lower than that of upper and lower concave type.Conclusions The clinical application should be based on the relevant parameters of 1-12 ribs to select a suitable diagnosis and treatment plan.