摘要
目的:使用Mimics软件对国人肩胛骨的骨性三角支点三角区(DFT)进行三维测量并进行形态学分析。方法:纳入2021年3月在河北医科大学第三医院行肩胛骨CT薄层平扫的92名健康成人志愿者，无肩胛骨及肩部外伤及手术史，无肩关节炎、风湿、类风湿性疾病等。使用Mimics软件将患者影像学资料进行三维重建，确定DFT区域，并测量DFT三边及各角，喙突前外侧点、肩峰前外侧角顶点及后外侧角后缘分别到盂心和肩胛骨平面的距离；喙突前外侧点－盂心－肩胛下角、肩峰前外侧角顶点－盂心－肩胛下角之间的角度以及肩峰后外侧角后缘－盂心－肩胛下角之间的角度。所有患者按照20岁一个年龄段进行分组，采用卡方检验和t检验分别比较不同性别年龄之间各指标是否存在差异，并进行相关性分析。结果:DFT在所有志愿者中均呈现不等边三角形态，喙突前上点和肩峰后侧点的距离(AFPF)最长，对应的角A最大。不同年龄分组的肩胛骨各参数差异无统计学意义(均为P>0.05)；男性的喙突－盂心(F＝0.377，P<0.05)、喙突－肩胛骨平面(t＝110.122，P<0.05)、肩峰前外侧角顶点－盂心(t＝36.9882，P<0.05)、肩峰前外侧角顶点－盂心(t＝117.164，P<0.05)、肩峰后外侧角后缘－盂心(t＝68.705，P<0.05)、肩峰－肩胛骨平面(t＝63.741，P<0.05)、喙突前上点和肩峰前外侧角顶点之间的距离(AFLAC)(t＝63.185，P<0.05)，肩峰前外侧角顶点和肩峰后侧点的距离(LACPF)(t＝44.804，P<0.05)、喙突前上点和肩峰后侧点的距离(AFPF)(t＝125.943，P<0.05)、肩峰下面积(t＝84.761，P<0.05)均高于女性，差异具有统计学意义。肩峰前外侧角顶点－盂心－肩胛下角同肩峰后外侧角后缘－盂心－肩胛下角存在高度正相关(r＝0.537，P<0.05)，AFPF同LACPF和AFPF均存在高度正相关(r＝0.584、0.636，均为P<0.05)，角A同角B、C呈高度负相关(r＝－0.765、－0.585，均为P<0.05)。结论:DFT三角男性和女性在长度指标上存在差异，AFPF是决定冈上肌出口大小的主要指标，该三角可作为肩峰下撞击综合征等疾病时的参考依据。
Abstract
Objective:To measure and analyze the morphology of delto-fulcral triangle (DFT) of scapula in three dimensions using Mimics software.Methods:Ninety-two healthy adult volunteers who underwent CT thin-section scanning of the scapula at the Third Hospital of Hebei Medical University in March 2021 were included, No history of trauma or surgery to the scapula or shoulder, no arthritis of the shoulder, rheumatism, rheumatoid disease, etc. Data were reconstructed into three dimensions using Mimics software, the delto-fulcral triangle was determined based on three points including the anterosuperior point of the coracoid process, the most lateral and the most posterior points of the scaphoid, edges and angles of deltofu-lcral triangle, distances between the three points to the glenoid and to the scapular plane, angles of the three point-glenoid-subscapula (angles between anterosuperior point of the coracoid process-glenoid-subscapular angle, vertex of posterolateral angle of acromion, and posterior edge of posterolateral angle of acromion-glenoid-subscapular angle)were measured. Patients were divided into three groups with a interval age of 20 years; differences in each index were compared between the genders and ages using chi square test and t test, as well as correlation analysis.Results:The DFT showed an unequal triangular pattern in all the volunteers, with largest length of anterior fulcrum and posterior fulcrum landmarks (AFPF) and corresponding to the largest angle A. There was no statistically significant difference in the parameters of the scapula in different age subgroups(all P>0.05). In male volunteers, the rostral-glenoid centre (F=0.377, P<0.05), the rostral-scapular plane (t=110.122, P<0.05), the vertex of the anterior-lateral angle of the acromion-glenoid centre (t=36.9882, P<0.05), and the vertex of the anterior-lateral angle of the acromion-glenoid centre (t= 117.164, P<0.05), posterior edge of posterior lateral angle of acromion - glenoid centre (t=68.705, P<0.05), acromion-scapular plane (t=63.741, P<0.05), distance between anterior fulcrum and lateral acromion landmarks (AFLAC) (t=63.185, P<0.05), and lateral acromion and posterior fulcrum landmarks (LACPF) (t=44.804, P<0.05), AFPF (t=125.943, P<0.05), and the area under the acromion (t=84.761, P<0.05) were higher than those of the females, and the difference was statistically significant. There was a highly positive correlation between the anterolateral acromion apex-glenoid heart-subacromial angle and the posterior edge of the posterior lateral acromion-glenoid heart-subacromial angle (r=0.537, P<0.05), a highly positive correlation between the AFPF and both the LACPF and AFPF (r=0.584, 0.636, both P<0.05), and a highly negative correlation between angle A and angle B and C (r=-0.765, -0.585, both P<0.05) .Conclusions:DFT triangle differs between males and females in terms of length indicators. AFPF is the main indicator of the size of the supraspinatus outlet, and this triangle can be used as a reference in the case of conditions such as subacromial impingement syndrom
万方数据