Wang Daofeng, Li Jiantao, Xu Gaoxiang, Zhang Hao, Xu Cheng, Zhang Wupeng, Li Hua, Gan Xuewen, Xiong Ying, Zhang Licheng, Li Li, Tang Peifu
Medical School of Chinese PLA, Beijing, China.
Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.
Surg Radiol Anat. 2023 Feb;45(2):215-224. doi: 10.1007/s00276-022-03058-8. Epub 2022 Dec 12.
To perform quantitative measurements of the anatomic morphology of the proximal ulna and establish the morphologic references based on Chinese for the surgical protocol and implant design.
The computed tomography data of 156 upper extremities were involved in this study. The ulna model was reconstructed in Mimics. Ten distance and 6 angle parameters were measured by 4 independent investigators with a new quantitative measurement method. The intraclass correlation coefficient was used to evaluate the measuring reliability. Gender and side differences of measured parameters were evaluated.
Measurements showed a mean coronoid height of 15 mm, which was 42% of ulnar height with gender-specific differences (mean 16 mm in men and 14 mm in women, P < 0.001). A mean unsupported anteromedial facet width of 8 mm was 61% of the coronoid anteromedial facet. A larger opening angle correlates to a larger olecranon-diaphysis angle (P < 0.001) and larger coronoid height (P = 0.001). A mean proximal ulna dorsal angulation of 4.7° is present in 80% of models at an average of 52 mm distal to olecranon tip. The average proximal ulna varus angulation was 16° at a mean of 74 mm distal to the olecranon tip. Morphological features between the left and right sides were highly consistent. The ICC was between 0.789 and 0.978 for inter-observer and between 0.696 and 0.997 for intra-observer reliability.
The proximal ulna features variable morphology but minor side differences among individuals. Over half of the anteromedial facet was not supported by the proximal ulnar diaphysis, making the coronoid vulnerable to elbow trauma. Preconditioning or customized design of the ulnar plate in the clinical setting with the help of contralateral morphology may be a good choice.
对尺骨近端的解剖形态进行定量测量，并建立基于中国人的形态学参考标准，以用于手术方案和植入物设计。
本研究纳入了156例上肢的计算机断层扫描数据。在Mimics中重建尺骨模型。由4名独立研究人员采用一种新的定量测量方法测量10个距离参数和6个角度参数。采用组内相关系数评估测量的可靠性。评估测量参数的性别和左右侧差异。
测量显示冠突平均高度为15mm，占尺骨高度的42%，存在性别差异（男性平均16mm，女性平均14mm，P<0.001）。冠突前内侧小关节面无支撑部分的平均宽度为8mm，占冠突前内侧小关节面的61%。较大的开口角度与较大的鹰嘴-骨干角（P<0.001）和较大的冠突高度（P=0.001）相关。80%的模型中尺骨近端背侧平均成角为4.7°，平均位于鹰嘴尖远端52mm处。尺骨近端平均内翻成角为16°，平均位于鹰嘴尖远端74mm处。左右侧之间的形态特征高度一致。观察者间的组内相关系数在0.789至0.978之间，观察者内可靠性的组内相关系数在0.696至0.997之间。
尺骨近端形态多样，但个体间左右侧差异较小。超过一半的前内侧小关节面没有尺骨近端骨干的支撑，使得冠突易受肘部创伤。在临床环境中，借助对侧形态对尺骨钢板进行预处理或定制设计可能是一个不错的选择。
