Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany, Ismaninger Strasse 22, 81675, Munich, Germany.
Eur J Med Res. 2018 Oct 23;23(1):50. doi: 10.1186/s40001-018-0348-3.
The primary goal of this study was to analyse the anatomic configuration of the acromio-clavicular joint in a healthy population to be able to develop a classification in a second step. On the basis of the primary findings a secondary goal was to find potential clinical indications in refer to AC-joint dislocation and lateral clavicle fractures.
The upper thoracic aperture including both shoulder joints as well as both sterno-clavicular joints was retrospectively reformatted in a bone kernel in axial orientation with 0.6 mm slice thickness out of existing multiple trauma or post mortem computed tomography (CT) scans. The DICOM data was converted into the STL file format using a three dimensional (3D) reconstruction software (Smartbrush, Brainlab, Feldkirchen, Germany). The data analysis was performed using a 3D-Computer Aided Detection (CAD) Software (BioCAD, Technical University Munich, Germany). For the analysis, the angle between the cranial surface of the acromion and the tangent to its articular surface was evaluated. Accordingly, the angle between the cranial surface of the clavicle and the tangent to its articular surface was assessed.
Overall CT-datasets of 80 healthy patients (40 males, 40 females, mean age 45 ± 8 years) were enrolled and evaluated regarding the configuration of the AC-joint. In this context, three statistically significant (p < 0.001) different configurations of the AC-joint in terms of overhanging acromion, neutral type, overhanging clavicle were identified. The "overhanging acromion" type of AC-joint configuration turned out to be the most common type (46.2%) followed by the "neutral type" (38.4%) and finally the "overhanging clavicle type" (15.4%).
We assume that the shown differences of the AC joint congruency might play an important role in the development of different shoulder injuries resulting from the similar trauma mechanism. However, the proof of these assumptions will be the focus of future studies.
本研究的主要目的是分析健康人群肩锁关节的解剖结构，以便在下一步进行分类。基于主要发现，第二个目的是在肩锁关节脱位和锁骨外侧骨折方面寻找潜在的临床指征。
回顾性地对来自于现有的多发创伤或尸检 CT（计算机断层扫描）的轴向位的含双侧肩关节和双侧胸锁关节的上胸区域进行骨核重建，层厚为 0.6mm。使用三维（3D）重建软件（Smartbrush，Brainlab，德国费尔德基希）将 DICOM 数据转换为 STL 文件格式。使用三维计算机辅助检测（CAD）软件（BioCAD，慕尼黑工业大学，德国）进行数据分析。在分析中，评估了肩峰颅面与关节面切线之间的夹角。相应地，评估了锁骨颅面与关节面切线之间的夹角。
总共纳入并评估了 80 名健康患者（40 名男性，40 名女性，平均年龄 45±8 岁）的 CT 数据集，以评估肩锁关节的形态。在这方面，确定了三种在肩锁关节突出肩峰、中性型、锁骨突出方面具有统计学意义（p<0.001）的不同关节形态。“突出肩峰”型肩锁关节形态最为常见（46.2%），其次是“中性型”（38.4%），最后是“突出锁骨型”（15.4%）。
我们假设显示的肩锁关节一致性差异可能在相似创伤机制导致的不同肩部损伤的发展中发挥重要作用。然而，这些假设的证明将是未来研究的重点。
