Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Shoulder Elbow Surg. 2010 Jan;19(1):121-9. doi: 10.1016/j.jse.2009.04.002.
For treatment of acute acromioclavicular separations, we have been using a reproducible radiographic view of the coracoid-the cortical ring sign-that we believe allows for placement of percutaneous coracoclavicular fixation safely and reliably in the center of the coracoid base, while avoiding the coracoid tip. This study evaluates the coracoid anatomy that the cortical ring sign represents, its utility for guiding fixation trajectory, and the proximity of neurovascular structures to this proposed trajectory.
Kirschner wires were used to measure the orientation of the fluoroscopic beam in relation to the scapula and the proposed fixation trajectory using this radiographic view.
The cortical ring sign is achieved by first directing the x-ray beam perpendicular to the medial border of the scapula in the parasagittal plane and 49 degrees off the axis of the scapular spine in the axial plane, then fine-tuning until the coracoid cortical ring becomes evident. The nearest neurovascular structures to the fixation trajectory are the suprascapular artery and nerve (< 2 cm).
The cortical ring sign view targets the coracoid base and, as such, allows reliable, safe, percutaneous fixation in the center of the coracoid base.
Basic Science.
对于急性肩锁关节分离的治疗，我们一直使用一种可重复的喙突影像学表现，即皮质环征，我们认为这可以安全、可靠地将经皮喙锁固定在喙突基底的中心，同时避免喙突尖端。本研究评估了皮质环征所代表的喙突解剖结构、其在指导固定轨迹方面的实用性，以及神经血管结构与该拟议轨迹的接近程度。
使用克氏针测量透视束相对于肩胛骨的方向和使用该影像学视图的拟议固定轨迹。
皮质环征的实现方法是首先在矢状位上将 X 射线束垂直于肩胛骨的内侧缘，在轴位上与肩胛骨脊柱的轴成 49 度角，然后进行微调，直到喙突皮质环变得明显。固定轨迹上最接近的神经血管结构是肩胛上动脉和神经（<2 厘米）。
皮质环征视图针对喙突基底，因此允许可靠、安全的经皮固定在喙突基底的中心。
基础科学。
