肩胛骨孔洞的分类与形态学观测及其临床意义

Classification and morphological parameters of scapular foraminal defects and its clinical significance

背景:肩胛骨孔洞可影响临床上对肩胛骨及其周围解剖结构疾病诊断和治疗的临床决策。然而,肩胛骨孔洞缺乏分型,国人的肩胛骨孔洞分布及其形态计量研究等仍缺乏。目的:研究中国人群干燥肩胛骨孔洞的分类、分布和形态计量学,探讨其临床意义。方法:定义了一个新的肩胛骨孔洞分类系统,包括3个类别和A-F等6个亚型。Ⅰ类对应于肩胛骨的神经和血管孔,Ⅱ类对应于肩胛骨的非神经血管孔洞,Ⅲ类为Ⅰ类和Ⅱ类的混合型。Ⅰ类包括2种类型:A型为肩胛上孔,B型为营养血管孔;Ⅱ类分C-E亚型;Ⅲ类仅包括F型(即为A-E的混合型)。同时分析统计了336个非配对干燥国人肩胛骨的分类、分布和形态计量学数据。结果与结论:(1)观察者间的信度优秀。在336个肩胛骨中,共观察到92个肩胛骨上分布118个肩胛骨孔洞,肩胛骨孔洞发生率为27.38%,其中Ⅰ、Ⅱ、Ⅲ类分别占2.81%,16.96%和7.61%,A-F型肩胛骨孔洞占比分别为7.61%,19.57%,9.78%,10.87%,40.22%和11.96%,E型最多;(2)A-F型肩胛骨孔洞总直径分别为(8.09±1.29),(1.98±0.80),(6.60±3.10),(11.19±6.67),(16.80±11.04)和(17.43±13.88)mm,F型总直径最大;A-F型肩胛骨孔洞总面积分别为(37.62±19.48),(2.13±2.23),(32.52±24.85),(77.56±124.32),(150.69±181.34)和(109.98±193.50)mm~2,E型总面积最大;(3)结果表明,肩胛骨孔洞的变异是常见的,需要临床医生注意,以避免因肩胛骨孔洞的出现而对诊断产生干扰,同时治疗时需要加以关注,避免侵入性操作时引起并发症。

BACKGROUND:Scapular foraminal defects can affect the clinical diagnoses and treatments of diseases around the scapula.However,the classification of scapular foraminal defects is lacking,and less is reported on the distribution and morphological parameters of scapular foraminal defects in Chinese people.OBJECTIVE:To investigate the classification,distribution,and morphometric parameters of scapular foraminal defects in dry scapulae in a Chinese population.METHODS:A novel classification system with three categories and six subtypes of scapular foraminal defects was defined.CategoryⅠcorresponds to the foramina of the scapular body for nerves and blood vessels,CategoryⅡcorresponds to the variation in non-neurovascular holes or defects,and CategoryⅢis a mixture of CategoryⅠand CategoryⅡ.CategoryⅠcomprises two subtypes:Type A,suprascapular foramina;Type B,nutrient foramina.The scapula is divided into three partitions that correspond to Types C to E in CategoryⅡ.CategoryⅢincludes only Type F,a mixture of Type A to Type E.The distribution,classifications and morphometric data for 336 unpaired dry scapulae from Chinese adults were analyzed.RESULTS AND CONCLUSION:The interobserver reliability was excellent.Of 336 scapulae,92 scapulae had 118 scapular foraminal defects.The incidence rate of scapular foraminal defects was 27.38%,of which CategoryⅠtoⅢaccounted for 2.81%,16.96%,and 7.61%,respectively.The proportion of Types A-F was 7.61%,19.57%,9.78%,10.87%,40.22%,and 11.96%,respectively.The proportion of Type E was the most.The total diameters of Types A-F were(8.09±1.29),(1.98±0.80),(6.60±3.10),(11.19±6.67),(16.80±11.04),and(17.43±13.88)mm,respectively.The total diameter of Type F was the largest.The total areas of Types A-F were(37.62±19.48),(2.13±2.23),(32.52±24.85),(77.56±124.32),(150.69±181.34),and(109.98±193.50)mm~2,respectively.The total area of Type E was the largest.To conclude,variations in scapular foraminal defects are common,which require the attention of clinicians to avoid interfering with the diagnosis due to the appearance of scapular foraminal defects.Attention should also be paid to the treatment at the same time to avoid complications caused by invasive operation.