CT三维重建评估自体肩胛冈骨块移植修复肩盂缺损的价值

安明扬; 鹿鸣; 李春宝; 齐玮; 张佳; 吴毅东; 于康康; 肇刚; 刘玉杰

doi:10.3969/j.issn.2095-5227.2021.08.014

CT三维重建评估自体肩胛冈骨块移植修复肩盂缺损的价值

Repair of glenoid bone defects by scapular spinal autograft: Evaluating by three-dimensional reconstruction of CT images

摘要

摘要:
背景骨性Bankart损伤造成的肩盂缺损常采用喙突或髂骨骨块移植进行修复。但这两种方式都存在一定的并发症。
目的通过CT三维重建测量肩胛冈、喙突和肩盂的数据，探究肩胛冈骨块作为修复骨性Bankart损伤的骨移植材料的可行性。
方法随机选取2019年1月- 2020年1月于解放军总医院第四医学中心行胸部CT的成年患者，男性23例，女性37例，年龄(41.48±12.97)岁，进行双侧肩胛骨CT三维重建。将肩关节盂横径的25%作为肩盂缺损的宽度。将肩胛冈内侧4 ~ 8 cm区域作为取骨区。分别测量喙突和肩胛冈内侧4 cm、8 cm处的长、宽、高以及肩盂纵径和肩盂横径的25%。
结果肩盂横径的25%为(6.44±0.82) mm。肩胛冈取骨的长度大于肩盂纵径(40.04±0.45) mm vs (34.12±3.79) mm，P＜0.001，与喙突长度差异无统计学意义(40.0±0.45) mm vs (39.20±4.13) mm，P＞0.05。肩胛冈取骨内侧的宽度大于肩盂横径的25%(9.76±1.94) mm vs (6.44±0.82) mm，P＜0.001，肩胛冈取骨外侧的宽度大于肩盂横径的25%(12.69±2.84) mm vs (6.44±0.82) mm，P＜0.001。肩胛冈取骨内侧的高度大于喙突的高度(17.67±3.18) mm vs (9.40±1.54) mm，P＜0.001，肩胛冈取骨外侧的高度大于喙突的高度(25.39±8.86) mm vs (9.40±1.54) mm，P＜0.001。
结论自体肩胛冈取骨可以满足骨性Bankart损伤的植骨需求。

Abstract:
Background The defect of shoulder glenoid caused by bony Bankart lesion is often repaired by coracoid process or iliac bone graft. However, both methods have certain complications.
Objective To explore the feasibility of the scapular spine as a bone graft material for repairing bony Bankart lesion by measuring the data of the scapular spine with three-dimensional reconstruction of CT images.
Methods Adult patients who underwent chest CT in the Fourth Medical Center of Chinese PLA General Hospital from January 2019 to January 2020 were randomly selected, including 23 males and 37 females, aged (41.48±12.97) years, for CT three-dimensional reconstruction of bilateral scapula. The area from 4 cm to 8 cm of the medial scapular spine was considered as the bone extraction area. The width of the glenoid defect was defined as 25% of the transverse diameter of the glenoid. The length, width, and height of the coracoid process and the scapular spine at medial 4 cm and 8 cm, respectively, and the longitudinal diameter and 25% of transverse diameter of the glenoid were measured.
Results Twenty-five percent of the transverse diameter of the glenoid was (6.44±0.82) mm. The length of bone from scapular spine was greater than the longitudinal diameter of shoulder glenoid (40.04±0.45 mm vs 34.12±3.79 mm, P＜0.001). There was no significant difference between the length of bone from scapular spine and the length of coracoid process (40.04±0.45 mm vs 39.20±4.13 mm, P＞0.05). The width of medial side of bone from scapular spine was greater than 25% of the transverse diameter of the glenoid (9.76±1.94 mm vs 6.44±0.82 mm, P＜0.001), and the width of lateral side of bone from scapular spine was greater than 25% of the transverse diameter of the glenoid (12.69±2.84 mm vs 6.44±0.82 mm, P＜0.001). The height of medial side of bone from scapular spine was greater than that of coracoid process (17.67±3.18 mm vs 9.40±1.54 mm, P＜0.001), and the height of lateral side of bone from scapular spine was greater than that of coracoid process (25.39±8.86 mm vs 9.40±1.54 mm, P＜0.001).
Conclusion Bone removal from the scapular spine can meet the requirements of bone grafting for severe bony Bankart lesion.

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