Fontana Arabella D, Hoyen Harry A, Blauth Michael, Galm André, Schweizer Marcel, Raas Christoph, Jaeger Martin, Jiang Chunyan, Nijs Stefaan, Lambert Simon
R&D Department, DePuy Synthes, Zuchwil, Switzerland.
Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
JSES Int. 2020 Jun 19;4(3):413-421. doi: 10.1016/j.jseint.2020.05.004. eCollection 2020 Sep.
The anatomy of the clavicle is specific and varied in reference to its topography and shape. These anatomic characteristics play an important role in the open treatment of clavicle fractures. The complex and variable topography creates challenges for implant placement, contouring, and position. Hardware prominence and irritation does influence the decision for secondary surgical intervention.
Computerized tomographic scans of 350 adult clavicles with the corresponding patients' metadata were acquired and digitized. Morphologic parameters determining the shape of the clavicle were defined and computed for each digitized bone. The extracted morphologic parameters were correlated with patient metadata to analyze the relationship between morphologic variability and patient characteristics.
The morphologic parameters defining the shape, that is, the radius of the medial and lateral curves, the apparent clavicle height and width, and the clavicle bow position, correlate with the clavicle length. The clavicle length correlates with the patients' height. Gender differences in shape and form were dependent and related to individual height distribution and clavicle length. Asian populations showed a similarly predictable, but shifted, correlation between shape and clavicle length.
This anatomic analysis shows that the clavicle shape can be predicted through the clavicle length and patients' stature. Smaller patients have shorter and more curved clavicles, whereas taller patients have longer and less curved clavicles. This correlation will aid surgeons in fracture reduction, implant curvature selection, and in optimal adaptation of clavicle implants, and represents the basis for anatomically accurate solutions for clavicle osteosynthesis.
锁骨的解剖结构在其局部解剖位置和形状方面具有独特性和多样性。这些解剖特征在锁骨骨折的切开治疗中起着重要作用。复杂多变的局部解剖结构给植入物的放置、塑形和定位带来了挑战。内植物的突出和刺激确实会影响二次手术干预的决策。
获取了350例成人锁骨的计算机断层扫描图像以及相应患者的元数据，并进行了数字化处理。为每个数字化的骨骼定义并计算了决定锁骨形状的形态学参数。将提取的形态学参数与患者元数据相关联，以分析形态学变异性与患者特征之间的关系。
定义锁骨形状的形态学参数，即内侧和外侧曲线的半径、锁骨的表观高度和宽度以及锁骨弓的位置，与锁骨长度相关。锁骨长度与患者身高相关。形状和形态的性别差异取决于个体身高分布和锁骨长度。亚洲人群在形状和锁骨长度之间也表现出类似的可预测但有所偏移的相关性。
这项解剖学分析表明，锁骨形状可以通过锁骨长度和患者身高来预测。身材较小的患者锁骨较短且弯曲度更大，而身材较高的患者锁骨较长且弯曲度较小。这种相关性将有助于外科医生进行骨折复位、选择植入物的曲度以及使锁骨植入物实现最佳适配，并为锁骨接骨术的解剖学精确解决方案奠定基础。
