基于CT三维重建肩胛骨冈盂切迹的形态学分析及测量

Morphological analysis and measurement of spinoglenoid notch of scapula based on 3D reconstruction of CT

目的通过CT三维重建正常成人肩胛骨,观察肩胛骨冈盂切迹解剖结构,根据形状进行分型和测量,为临床评估肩胛上神经(SN)卡压风险、肩胛上神经卡压治疗及肩关节手术操作提供参考。方法对335例正常成人肩胛骨进行CT三维重建,根据冈盂切迹解剖形状进行分型;测量冈盂切迹宽度(MN)、冈盂切迹深度(OP)、冈盂切迹厚度(XY)、冈盂切迹角度(∠MON)、O点到肩胛骨内上角距离(OA)、O点到肩胛冈内侧缘距离(OB)、O点到肩胛下角距离(OC)和O点到肩胛上切迹最低点距离(OD),对测量结果进行分析。结果1.冈盂切迹形态学上可分为4种类型,即U型(41.79%)、鳍型(42.99%)、L型(8.36%)和梯型(6.86%),以U型和鳍型最常见。4种形状比较发现,鳍型最窄(11.58±1.74)mm,最深(14.58±1.81)mm,∠MON最小(45.62±6.43)°,最易发生SN卡压;梯型最宽(14.20±2.67)mm,最浅(10.80±0.79)mm,∠MON最大(57.69±2.22)°,最不易发生SN卡压。2.MN、OP、XY、∠MON、OA、OB、OC和OD左右侧对比,差异均无显著性。3.在性别之间比较差异有显著性,男性MN、OP、XY、OA、OB、OC和OD数据均明显大于女性,但∠MON小于女性,说明男性比女性冈盂切迹更厚、宽、深,肩胛骨更宽、长。结论CT三维重建成像测量冈盂切迹形态解剖学特征有助于肩胛上神经卡压风险的评估及肩胛上神经卡压的治疗,并为临床肩关节手术操作提供指导。

Objective To observe the anatomical structure of spinoglenoid notch of scapula by 3 D reconstruction of normal adult scapula by computed tomography(CT),and to provide reference for clinical assessment of suprascapular nerve compression risk,suprascapular nerve compression treatment and shoulder joint operation.Methods Totally 335 cases of normal adult scapula were reconstructed by CT,and classified according to the anatomical shape of spinoglenoid notch;the spinoglenoid notch width(MN),spinoglenoid notch depth(OP),spinoglenoid notch thickness(XY),spinoglenoid notch angle(∠MON),distance from O point to the inner upper corner of scapula(OA),distance from O point to medial lateral edge of scapula(OB),distance from O point to inferior angle of scapula(OC)and distance from O point to the lowest point of suprascapular notch(OD)were observed and analyzed.Results 1.The morphology of spinoglenoid notch was divided into four types:U type(41.79%),fin type(42.99%),L type(8.36%)and ladder type(6.86%).U type and fin type were the most common types.Comparison of the four shapes:fin type was the narrowest(11.58±1.74)mm and the deepest(14.58±1.81)mm,the∠MON was the smallest(45.62±6.43)°and the ladder type was the widest(14.20±2.67)mm and the shallowest(10.80±0.79)mm,the∠MON was maximum(57.69±2.22)°and the least prone to suprascapular nerve compression.2.There was no significant difference in MN,OP,XY,∠MON,OA,OB,OC and OD between left and right sides.3.The data of MN,OP,XY,OA,OB,OC and OD of men were larger than those of women significantly,but∠MON was smaller than that of women,indicating that men’s spinoglenoid notch was thicker,wider and deeper,and scapula was wider and longer than that of women.Conclusion The measurement of the morphological and anatomical characteristics of spinoglenoid notch with CT three-dimensional reconstruction is helpful to evaluate the risk of suprascapular nerve compression,the treatment of suprascapular nerve compression,and provide guidance for clinical shoulder surgery.