【作者】 张浩；

【导师】 李翔；

【作者基本信息】 南京医科大学 ， 临床医学（专业学位）， 2019， 硕士

【摘要】 目的:提出正位X线上锁骨远端倾斜角的测量方法,验证锁骨远端倾斜角越小越容易发生肩锁关节脱位的假设,分析其临床应用价值。材料与方法:实验组选取41例肩锁关节脱位患者,男33例,女8例,年龄43.5±10.8(23-63)岁,对照组选取100例正常人群,男性50例,女性50例,年龄52.2±15.7(14-84)岁。测量实验组患侧以及对照组的肩关节正位X线片上锁骨远端机械倾斜角及解剖倾斜角,并进行形态学分组。比较141例样本中两种角度测量值的差异及相关性,锁骨远端倾斜角与年龄的相关性,不同形态学分组间的差异。对比不同性别间锁骨远端倾斜角的差异以及相同性别间的患者与正常人群间的角度差异。结果:141例样本中,两种不同测量方法的角度值存在显著差异同时也存在显著正相关性,倾斜角的大小与年龄无关,倾斜型的肩锁关节倾斜角显著小于其余两组,剩余两组间角度无差异。正常男性机械角与解剖角为68.1°±12.9°和75.9°±11.1°,显著低于正常女性的76.8°±9.3°和83.1°±7.9°,男性患者机械角与解剖角为65.0°±9.5°和71.3°±9.2°,显著低于女性患者的75.6°±15.8°和82.4°±20.1°。男性患者的解剖倾斜角小于正常男性并存在差异,女性患者与正常女性间无角度差异。结论:锁骨远端倾斜角度与年龄无关,倾斜型角度显著小于其他类型。锁骨远端倾斜角男性显著小于女性,男性中患者解剖角小于正常人。锁骨远端倾斜角度与肩锁关节脱位的发生存在联系,存在锁骨远端倾斜角越小越容易在外伤中发生肩锁关节脱位的趋势。锁骨远端倾斜角可以作为诊断参考指标避免漏诊,作为潜在手术指征可以指导治疗方案的制定,具有一定的临床应用潜力。更多还原

【Abstract】 Object: Propose a method for measuring the inclination angle of distal clavicle on anteroposterior x-ray.Prove the hypothesis that the inclination of the distal clavicle is related to the acromioclavicular joint dislocation and analyse the clinical application value of it.Materials and methods: In the experimental group,41 patients with acromioclavicular dislocation,33 males and 8 females,aged 43.5±10.8(23-63)years,were selected.In the control group,100 normal population,50 male and 50 female were selected,and the age was 52.2-15.7(14-84)years.Measurement of mechanical tilt angle and anatomical tilt angle of distal clavicle on AP view of shoulder X-ray of dislocated side in experimental group and normal shoulder in control group,make acromioclavicular joint morphological grouping.Test the difference and correlation of two kinds of angle measurement in 141 samples,correlation between age and distal clavicle tilt angle and differences among different morphological groups.Test the differences of distal clavicle angle in gender and compared the differences of patients and normal population.Result: In 141 samples,the angle values of two different measurement methods were significantly different and also correlate with each other significantly.No correlation was found between angle values and age.In the three different morphological group,oblique type showed smaller angle values than other type significantly but no difference between flat type and curved type.The mechanical and anatomical angles of normal males were 68.1 °±12.9 °and 75.9 °±11.1 °respectively,lower than 76.8 °±9.3 °and83.1 °±7.9 °significantly of normal women.The mechanical angle and the anatomical angle of the male patient were 65.0°±9.5°and 71.3°±9.2°,and were significantly lower than 75.6°±15.8°and 82.4°±20.1°for female patients.In male,there was a significant anatomical angle value difference between patientsand normal males.But no difference was revealed in female patient and normal females.Conclusion: Two different measurement of inclination is not affected by age but lower value in oblique type when compared with flat and curved type.The significant difference of angle value in gender,and between patient and normal were authenticated by statistics analyse.There is a relationship between the tilt angle of the distal clavicle and the occurrence of acromioclavicular joint dislocation and a trend that the smaller the inclination angle of the distal clavicle is,the more likely it is to occur acromioclavicular joint dislocation in trauma is revealed.Distal clavicle tilt angle can be a diagnostic reference indicator to avoid missed diagnosis,also as a potential surgical guidelines and has a great potential for clinical application.更多还原