上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

锁骨钩钢板对肩关节三维瞬时运动影响的FSA分析

李 雨1，刘至原2*，王金武2，胡志刚3，戴尅戎2   

  1. 1.河南科技大学 机电工程学院，洛阳 471003；2.上海市骨科内植物重点实验室，上海交通大学 医学院附属第九人民医院骨科，上海 200011；3河南科技大学 医学技术与工程学院，洛阳 471003
  • 出版日期:2016-08-29 发布日期:2016-08-31
  • 通讯作者: 王金武，电子信箱：jinwu_wang@163.com；胡志刚，电子信箱：hu.robert@163.com。
  • 作者简介:李 雨(1990—)，女，硕士生；电子信箱：liyu0373@126.com。刘至原（1984—），男，硕士生；电子信箱：ultraaardvark@163.com。*并列第一作者。
  • 基金资助:

    国家重大科学研究计划（2012CB933604，2011CB013300）；国家高技术研究发展计划（“863”计划）（2015AA020308）；国家自然科学基金（81171707, 8157090044，81560356）；上海市科学技术委员会产学研医项目（14DZ1941102，15dz1942104）；上海市卫生系统重要疾病联合攻关项目（2013ZYJB0501）；上海市卫生计生系统重要薄弱学科建设项目（2015ZB0404）；上海市教育委员会高峰高原学科建设计划（20152224）；上海交通大学医学院转化医学创新基金项目

FSA analysis of the effects of clavicular hook plate on the three-dimensional instantaneous motion of shoulder joints

#br# LI Yu1, LIU Zhi-yuan2*, WANG Jin-wu2, HU Zhi-gang3, DAI Ke-rong2   

  1. 1.School of Mechatronics Engineering, Henan University of Science and Technology, Luoyang 471003, China; 2. Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 3.Medical Technology and Engineering College, Henan University of Science and Technology, Luoyang 471003, China
  • Online:2016-08-29 Published:2016-08-31
  • Supported by:

    National Key Basic Research Project, 2012CB933604, 2011CB013300; National High Technology Research and Development Program of China, “863” Program, 2015AA020308; National Natural Science Foundation of China, 81171707, 8157090044, 81560356; Project of Shanghai Municipal Science and Technology Commission, 14DZ1941102, 15dz1942104; Joint Research Project of Major Diseases of Health System in Shanghai, 2013ZYJB0501; Important Weak Discipline Construction Project of Health and Family Planning System in Shanghai, 2015ZB0404; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152224; Innovation Fund of Translational Medicine, Shanghai Jiao Tong University School of Medicine

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摘要：

目的·探讨锁骨钩钢板对锁骨骨折术后肩关节三维瞬时运动的影响。方法·选取采用锁骨钩钢板固定术治疗的锁骨骨折患者。采用平板型荧光镜透视系统结合螺旋CT检查技术，通过薄层CT建立锁骨和钢板的三维重建模型，根据锁骨的解剖标记点建立局部坐标系，并与锁骨钩钢板一同匹配到荧光镜透视系统捕捉的不同体位的锁骨X线透视图像上，在计算机上模拟生理载荷下锁骨钩钢板和锁骨共同作用的三维运动状态。根据在锁骨和钢板上建立的三维坐标系，测量在不同体位变化时，锁骨和锁骨钩钢板在3个坐标轴方向的位移和旋转数值。分析在骨折愈合后，锁骨钩钢板对肩关节运动的影响。结果·锁骨钩钢板对患者的肩关节外展内收和内外旋活动均有影响。本研究中患者的锁骨和锁骨钩钢板在内外旋变化中同正常人的锁骨旋转角度（27°）几乎无差异，锁骨远端在向前的位移（均值6.8 mm）同正常人（5.1 mm）比较有增大趋势，并且患者平均外展角度只能达到84.79°。结论·带有锁骨钩钢板的患者，在骨折临床愈合后且未实行全肩关节活动前，即术后3～6个月，应及时取出内固定，防止形成肩峰撞击。

关键词: 锁骨骨折, 锁骨钩钢板, 2D-3D匹配

Abstract:

Objective · To explore the effects of clavicular hook plate on the three-dimensional instantaneous motion of shoulder joints after clavicular fracture operation. Methods · Three patients with clavicle fracture who underwent clavicular hook plate fixation were enrolled. A flat type fluoroscopic imaging system and spiral CT were used and a 3D reconstruction model of the clavicle and hook plate was built via thin layer CT. The local coordinate system was established according to anatomical landmarks of the clavicle. The clavicular hook plate and the local coordinate system were matched on X ray images of the clavicle at different postures captured by the fluoroscopic imaging system. The 3D motion resulted from the interaction of the clavicular hook plate and the clavicle under physiological load was simulated by the computer. The displacement and rotation values of the clavicular hook plate and the clavicle at three axis directions were measured for different postures according to the 3D coordinate system established based on the plate and the clavicle. The effects of clavicular hook plate on the motion of shoulder joints after fracture healing were analyzed. Results · The clavicular hook plate affected both abduction, intorsion and extorsion of shoulder joints. In this study, the clavicular hook plate and the clavicle had a rotation angle similar to the rotation angle of the clavicle in normal people (27°) and a larger forward displacement (average 6.8 mm) of distal clavicle as compared with normal people (5.1 mm). The average abduction angle in patients was 84.79°. Conclusion · Patients with the clavicular hook plate should remove the internal fixation timely 3-6 months after surgery in order to avoid the subacromial impingement syndrome.

Key words: fracture of clavicle, clavicular hook plate, 2D-3D matching