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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 34 -42. doi: 10.3877/cma.j.issn.2095-5790.2022.01.007

论著

喙锁韧带的MRI影像学测量与临床意义
朱天昊1, 黄长明1,†(), 范华强1, 傅仰攀1, 甘志勇1, 刘镇煌1, 刘昌华2, 杨林根3, 罗明辉3, 陈晔3   
  1. 1. 361003　解放军陆军第73集团军医院骨科厦门大学附属成功医院骨科
    2. 361003　解放军陆军第73集团军医院MRI影像科厦门大学附属成功医院MRI影像科
  • 收稿日期:2021-08-25 出版日期:2022-02-05
  • 通信作者: 黄长明
  • 基金资助:
    厦门市科技计划项目(3502Z20209151)

MRI imaging measurement and clinical significance of coracoclavicular ligament

Tianhao Zhu1, Changming Huang1,†(), Huaqiang Fan1, Yangpan Fu1, Zhiyong Gan1, Zhenhuang Liu1, Changhua Liu2, Lingen Yang3, Minghui Luo3, Ye Chen3   

  1. 1. Department of Orthopedics, Hospital of PLA 73rd Group Army, Chenggong Hospital Affiliated to Xiamen University, Xiamen 361003, China
    2. Department of MRI Imaging, Hospital of PLA 73rd Group Army, Chenggong Hospital Affiliated to Xiamen University, Xiamen 361003, China; Department of MRI Imaging, Hospital of PLA 73rd Group Army, Chenggong Hospital Affiliated to Xiamen University, Xiamen 361003, China
    3. Department of MRI Imaging, Hospital of PLA 73rd Group Army, Chenggong Hospital Affiliated to Xiamen University, Xiamen 361003, China
  • Received:2021-08-25 Published:2022-02-05
  • Corresponding author: Changming Huang
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引用本文：

朱天昊, 黄长明, 范华强, 傅仰攀, 甘志勇, 刘镇煌, 刘昌华, 杨林根, 罗明辉, 陈晔. 喙锁韧带的MRI影像学测量与临床意义[J]. 中华肩肘外科电子杂志, 2022, 10(01): 34-42.

Tianhao Zhu, Changming Huang, Huaqiang Fan, Yangpan Fu, Zhiyong Gan, Zhenhuang Liu, Changhua Liu, Lingen Yang, Minghui Luo, Ye Chen. MRI imaging measurement and clinical significance of coracoclavicular ligament[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(01): 34-42.

目的

探讨核磁共振成像（magnetic resonance imaging,MRI）影像测量喙锁韧带解剖学数据的可行性与临床意义。

方法

选择2020年6月至2021年5月在厦门大学附属成功医院进行肩关节MRI检查的患者54例，平均年龄39.76岁，男36例、女1例，使用PACS软件测量喙锁韧带数据。通过SPSS23分析比较男女间的数据差异，并根据年龄将54例患者分为18~44岁、45~59岁、≥60岁3组，进行年龄间的数据差异比较，使用皮尔逊相关分析计算喙锁韧带长度、宽度、到锁骨外侧端距离与身高体重之间的关系。

结果

MRI测量得出，斜方韧带长度（17.23±2.74） mm，宽度（4.72±1.24） mm；锥状韧带长度（11.80±2.69） mm，宽度（6.14±1.76） mm；肩锁韧带上束长度（15.13±3.36）mm，肩锁韧带下束长度（7.63±2.45）mm；斜方韧带到锁骨外侧端距离（19.31±3.14）mm，锥状韧带到锁骨外侧端距离（37.40±3.81）mm；斜方韧带与水平面角度（41.58±13.28）°，斜方韧带与矢状面角度（48.42±13.28）°；锥状韧带与水平面角度（63.30±15.92）°，锥状韧带与矢状面角度（26.71±15.92）°；喙锁韧带间角度（69.21±18.04）°。男性斜方韧带长度（17.49±2.92）mm,宽度（4.94±1.27）mm；锥状韧带长度（12.14±2.94）mm，宽度（6.22±1.78）mm；肩锁韧带上束长度（15.44±3.56）mm，下束长度（7.61±2.49）mm；斜方韧带到锁骨外侧端距离（19.73±3.10）mm，锥状韧带到锁骨外侧端距离（38.54±4.06） mm；斜方韧带与水平面角度（42.49±15.05）°，与矢状面角度（47.51±15.05）°；锥状韧带与水平面角度（61.24±13.67）°，与矢状面角度（28.76±13.67）°；喙锁韧带间角度（70.98±18.50）°。女性斜方韧带长度（16.72±2.31） mm,宽度（4.29±1.10） mm；锥状韧带长度（11.13±2.02） mm，宽度（5.99±1.76） mm；肩锁韧带上束长度（14.50±2.90） mm，下束长度（7.66±2.43） mm；斜方韧带到锁骨外侧端距离（19.58±3.42） mm，锥状韧带到锁骨外侧端距离（36.14±3.18） mm；斜方韧带与水平面角度（39.78±8.85）°，与矢状面角度（50.22±8.85）°；锥状韧带与水平面角度（67.41±19.45）°，与矢状面角度（22.59±19.45）°；喙锁韧带间角度（65.65±17.02）°。18~44岁组斜方韧带长度（17.39±2.92）mm,宽度（4.83±1.25）mm；锥状韧带长度（11.93±2.88）mm，宽度（5.95±1.62） mm；肩锁韧带上束长度（14.88±3.21） mm，下束长度（7.18±2.31） mm；斜方韧带到锁骨外侧端距离（19.61±3.30） mm，锥状韧带到锁骨外侧端距离（38.07±4.04） mm；斜方韧带与水平面角度（44.67±15.57）°，与矢状面角度（45.33±15.57）°；锥状韧带与水平面角度（59.07±16.06）°，与矢状面角度（30.93±16.06）°；喙锁韧带间角度（69.82±20.31）°。45~59岁组斜方韧带长度（16.61±2.41） mm，宽度（4.69±1.28） mm；锥状韧带长度（11.31±2.31） mm，宽度（6.44±1.84） mm；肩锁韧带上束长度（15.86±3.60） mm，下束长度（8.18±2.69） mm；斜方韧带到锁骨外侧端距离（19.90±3.28） mm，锥状韧带到锁骨外侧端距离（37.43±3.89） mm；斜方韧带与水平面角度（37.86±8.87）°，与矢状面角度（52.14±8.87）°；锥状韧带与水平面角度（68.56±12.37）°，与矢状面角度（21.44±12.37）°；喙锁韧带间角度（68.55±15.53）°。≥60岁组斜方韧带长度（19.61±2.11） mm,宽度（4.13±1.14） mm；锥状韧带长度（13.59±3.21） mm，宽度（5.87±2.47） mm；肩锁韧带上束长度（12.87±2.05） mm，下束长度（7.77±1.72） mm；斜方韧带到锁骨外侧端距离（18.97±2.01） mm，锥状韧带到锁骨外侧端距离（37.12±4.29） mm；斜方韧带与水平面角度（40.44±13.82）°，与矢状面角度（49.56±13.82）°；锥状韧带与水平面角度（63.92±26.69）°，与矢状面角度（26.09±26.69）°；喙锁韧带间角度（68.53±18.53）°。男女之间锥状韧带到锁骨外侧端距离的差异有统计学意义（P<0.05），斜方韧带长度45~59岁与≥60岁之间差异有统计学意义（P<0.05），锥状韧带与水平面角度18~44岁与45~59岁之间差异有统计学意义（P<0.05），锥状韧带与矢状面角度18~44岁与45~59岁之间差异有统计学意义（P<0.05），身高与锥状韧带到锁骨外侧端距离的相关系数为0.417，呈正相关（P<0.05）。

结论

通过MRI影像测量出的喙锁韧带数据，为解剖重建喙锁韧带提供了精确的依据。术前通过MRI测量健侧喙锁韧带解剖数据，用于指导术中患侧的个体化解剖重建，具有一定的创新性。

关键词: 核磁共振成像, 喙锁韧带, 解剖, 重建
Background

Acromioclavicular dislocation is one of the common clinical injuries, accounting for about 9% of shoulder injuries, and about 9.2 out of 1 000 people occur acromioclavicular dislocation every year. There are many surgical options for acromioclavicular dislocation, including Kirschner wire, tension band, hook plate, etc. However, according to the anatomical characteristics of the acromioclavicular joint, the main structures to maintain its stability are the acromioclavicular ligament and the coracoclavicular ligament, which also includes the trapezoid ligament and the conical ligament. Therefore, reconstruction of the coracoclavicular ligament at the anatomical position has the advantage of biomechanics. Its strength is closer to that of the coracoclavicular ligament itself, which has gradually become a new method for the clinical treatment of acromioclavicular dislocation. Patients with coracoclavicular ligament reconstruction at non-anatomic locations were found to have tunnel enlargement during follow-up. Tunnel enlargement can increase the risk of coracoid process or clavicle fracture, further leading to loss of reduction and redislocation after surgery, which rarely attracts doctors' attention in clinical practice. Therefore, to improve surgical skills, reduce postoperative complications, and relieve patients' pain and economic burden, it is of certain importance to study the coracoclavicular ligament anatomy.

Objective

To explore the feasibility and clinical significance of magnetic resonance imaging (MRI) imaging in measuring coracoclavicular ligament anatomical data.

Methods

From June 2020 to May 2021, 54 patients (36 males and 18 females) with a mean age was 39.76 years underwent shoulder joint MRI. The PACS software was used to measure the coracoclavicular ligament data, and the SPSS23 was used to analyze and compare the data between males and females. All patients were divided into three groups according to ages: 18-44 years old group, 45-59 years old group, and≥60 years old group, and the data differences were compared between groups. Pearson correlation analysis was used to calculate the relationship between the coracoclavicular ligament lengths, widths, distances to the distal clavicle, and the body heights and weights.

Results

The length and width of the trapezoid ligament were (17.23±2.74) mm and (4.72±1.24) mm. The length and width of the conoid ligament were (11.80±2.69) mm and (6.14±1.76) mm. The length of the acromioclavicular ligament of the upper bunch was (15.13±3.36) mm, and the length of the acromioclavicular ligament of the lower bunch was (7.63±2.45) mm. The distance from the trapezoid ligament to the lateral end of the clavicle was (19.31±3.14) mm, and the distance from the conoid ligament to the lateral end of the clavicle was (37.40±3.81) mm. The angle between the trapezoid ligament and horizontal plane was (41.58±13.28) °, and the angle between the trapezoid ligament and sagittal plane was (48.42±13.28) °. The angle between the conoid ligament and horizontal plane was (63.30±15.92) °, and the angle between the conoid ligament and sagittal plane was (26.71±15.92) °. The angle between the trapezoid ligament and the conoid ligament was (69.21±18.04) °. Among men, the length and width of the trapezoid ligament were (17.49±2.92) mm and (4.94±1.27) mm, and the length and width of the conoid ligament were (12.14±2.94) mm and (6.22±1.78) mm. The length of the acromioclavicular ligament of the upper bunch was (15.44±3.56) mm, and the length of the acromioclavicular ligament of the lower bunch was (7.61±2.49) mm. The distance from the trapezoid ligament to the lateral end of the clavicle was (19.73±3.10) mm, and the distance from the conoid ligament to the lateral end of the clavicle was (38.54±4.06) mm. The angle between the trapezoid ligament and horizontal plane was (42.49±15.05) °, and the angle between the trapezoid ligament and sagittal plane was (47.51±15.05) °. The angle between the conoid ligament and horizontal plane was (61.24±13.67) °, and the angle between the conoid ligament and sagittal plane was (28.76±13.67) °. The angle between the trapezoid ligament and the conoid ligament was (70.98±18.50) °. Among women, the length and width of the trapezoid ligament were (16.72±2.31) mm and (4.29±1.10) mm, and the length and width of the conoid ligament were (11.13±2.02) mm and (5.99±1.76) mm. The length of the acromioclavicular ligament of the upper bunch was (14.50±2.90) mm, and the length of the acromioclavicular ligament of the lower bunch was (7.66±2.43) mm. The distance from the trapezoid ligament to the lateral end of the clavicle was (19.58±3.42) mm, and the distance from the conoid ligament to the lateral end of the clavicle was (36.14±3.18) mm. The angle between the trapezoid ligament and horizontal plane was (39.78±8.85) °, and the angle between the trapezoid ligament and sagittal plane was (50.22±8.85) °. The angle between the conoid ligament and horizontal plane was (67.41±19.45) °, and the angle between the conoid ligament and sagittal plane was (22.59±19.45) °. The angle between the trapezoid ligament and the conoid ligament was (65.65±17.02) °. In the 18-44 years old group, the length and width of the trapezoid ligament were (17.39±2.92) mm and (4.83±1.25) mm, and the length and width of the conoid ligament were (11.93±2.88) mm and (5.95±1.62) mm. The length of the acromioclavicular ligament of the upper bunch was (14.88±3.21) mm, and the length of the acromioclavicular ligament of the lower bunch was (7.18±2.31) mm. The distance from the trapezoid ligament to the lateral end of the clavicle was (19.61±3.30) mm, and the distance from the conoid ligament to the lateral end of the clavicle was (38.07±4.04) mm. The angle between the trapezoid ligament and horizontal plane was (44.67±15.57) °, and the angle between the trapezoid ligament and sagittal plane was (45.33±15.57) °. The angle between the conoid ligament and horizontal plane was (59.07±16.06) °, and the angle between the conoid ligament and sagittal plane was (30.93±16.06) °. The angle between the trapezoid ligament and the conoid ligament was (69.82±20.31) °. In the 45-59 years old group, the length and width of the trapezoid ligament were (16.61±2.41) mm and (4.69±1.28) mm, and the length and width of the conoid ligament were (11.31±2.31) mm and (6.44±1.84) mm. The length of the acromioclavicular ligament of the upper bunch was (15.86±3.60) mm, and the length of the acromioclavicular ligament of the lower bunch was (8.18±2.69) mm. The distance from the trapezoid ligament to the lateral end of the clavicle was (19.90±3.28) mm, and the distance from the conoid ligament to the lateral end of the clavicle was (37.43±3.89) mm. The angle between the trapezoid ligament and horizontal plane was (37.86±8.87) °, and the angle between the trapezoid ligament and sagittal plane was (52.14±8.87) °. The angle between the conoid ligament and horizontal plane was (68.56±12.37) °, and the angle between the conoid ligament and sagittal plane was (21.44±12.37) °. The angle between the trapezoid ligament and the conoid ligament was (68.55±15.53) °. In the ≥60 years old group, the length and width of the trapezoid ligament were (19.61±2.11) mm and (4.13±1.14) mm, and the length and width of the conoid ligament were (13.59±3.21) mm and (5.87±2.47) mm. The length of the acromioclavicular ligament of the upper bunch was (12.87±2.05) mm, and the length of the acromioclavicular ligament of the lower bunch was (7.77±1.72) mm. The distance from the trapezoid ligament to the lateral end of the clavicle was (18.97±2.01) mm, and the distance from the conoid ligament to the lateral end of the clavicle was (37.12±4.29) mm. The angle between the trapezoid ligament and horizontal plane was (40.44±13.82) °, and the angle between the trapezoid ligament and sagittal plane was (49.56±13.82) °. The angle between the conoid ligament and horizontal plane was (63.92±26.69) °, and the angle between the conoid ligament and sagittal plane was (26.09±26.69) °. The angle between the trapezoid ligament and the conoid ligament was (68.53±18.53) °. There was a statistical difference in the distance from the conoid ligament to the lateral end of the clavicle between males and females (P<0.05) . There was a statistical difference in the trapezoid ligament length between the 45-59 years old group and the ≥60 years old group (P<0.05) . There was a statistical difference in the angle between the conoid ligament and horizontal plane between the 18-44 years old group and the 45-59 years old group (P<0.05) . There were statistical differences in the angle between the conoid ligament and sagittal plane between the 18-44 years old group and the 45-59 years old group (P<0.05) . The correlation coefficient between the body height and the distance from the conical ligament to the lateral end of the clavicle was 0.417, which was positive (P<0.05) .

Conclusion

The data of coracoclavicular ligament measured by MRI images provided an accurate basis for anatomic reconstruction of the coracoclavicular ligament. Preoperative MRI measurement of anatomical data of the coracoclavicular ligament on the healthy side can guide the intraoperative personalized anatomic construction of the affected side, which is innovative to some extent.

Key words: Magnetic resonance imaging, Coracoclavicular ligament, Anatomy, Reconstruction
表1 年龄、身高、体重及BMI数据
变量 平均值（范围）
年龄（岁） 39.76（18~67）
身高（cm） 168.65（152~187）
体重（kg） 66.31（42~100）
BMI（㎏/m2） 23.24（15.43~33.06）
图1 在平行于锁骨外侧端的T1斜冠状位上显影清晰的喙锁韧带图像注：黑白箭头示斜方韧带；白色箭头示锥状韧带
图2 斜方韧带长度（A）和宽度（B）测量示意图
图3 锥状韧带长度、宽度测量示意图
图4 斜方韧带到锁骨外侧端距离测量示意图
图5 锥状韧带到锁骨外侧端距离测量示意图
图6 肩锁韧带长度的测量
图7 斜方韧带与水平面、矢状面之间角度的测量
图8 锥状韧带与水平面、矢状面之间角度的测量
图9 斜方韧带与锥状韧带间角度的测量
表2 肩锁韧带上下束长度与喙锁韧带长度、宽度、角度的测量值（±s）
韧带 长度（mm） 宽度（mm） 与水平面的角度（°） 与矢状面的角度（°）
斜方韧带 17.23±2.74 4.72±1.24 41.58±13.28 48.42±13.28
锥状韧带 11.80±2.69 6.14±1.76 63.30±15.92 26.71±15.92
肩锁韧带上束 15.13±3.36 - - -
肩锁韧带下束 7.63±2.45 - - -
表3 喙锁韧带到锁骨外侧端距离、喙锁韧带间的角度（±s）
测量项目 测量值
斜方韧带到锁骨外侧端距离（mm） 19.31±3.14
锥状韧带到锁骨外侧端距离（mm） 37.40±3.81
喙锁韧带间角度（°） 69.21±18.04
表4 不同性别喙锁韧带数据比较（±s）
性别 例数 斜方韧带到锁骨外侧端距离（mm） 锥状韧带到锁骨外侧端距离（mm） 斜方韧带长度（mm） 斜方韧带宽度（mm） 锥状韧带长度（mm） 锥状韧带宽度（mm）
男性 36 19.73±3.10 38.54±4.06 17.49±2.92 4.94±1.27 12.14±2.94 6.22±1.78
女性 18 19.58±3.42 36.14±3.18 16.72±2.31 4.29±1.10 11.13±2.02 5.99±1.76
t值 0.163 2.186 0.974 1.85 1.310 0.445
P值 0.871 0.033 0.335 0.07 0.196 0.658
性别 例数 肩锁韧带上束长度（mm） 肩锁韧带下束长度（mm） 斜方韧带与水平面角度（°） 斜方韧带与矢状面角度（°） 锥状韧带与水平面角度（°） 锥状韧带与矢状面角度（°） 喙锁韧带间角度（°）
男性 36 15.44±3.56 7.61±2.49 42.49±15.05 47.51±15.05 61.24±13.67 28.76±13.67 70.98±18.50
女性 18 14.50±2.90 7.66±2.43 39.78±8.85 50.22±8.85 67.41±19.45 22.59±19.45 65.65±17.02
t值 0.968 -0.081 0.703 -0.703 -1.353 1.353 1.025
P值 0.338 0.936 0.485 0.485 0.182 0.182 0.310
表5 不同年龄段喙锁韧带数据比较（±s）
组别 例数 斜方韧带到锁骨外侧端距离（mm） 锥状韧带到锁骨外侧端距离（mm） 斜方韧带长度（mm） 斜方韧带宽度（mm） 锥状韧带长度（mm） 锥状韧带宽度（mm）
18~44岁 28 19.61±3.30 38.07±4.04 17.39±2.92 4.83±1.25 11.93±2.88 5.95±1.62
45~59岁 22 19.90±3.28 37.43±3.89 16.61±2.41 4.69±1.28 11.31±2.31 6.44±1.84
≥60岁 4 18.97±2.01 37.12±4.29 19.61±2.11 4.13±1.14 13.59±3.21 5.87±2.47
t1值 -0.319 0.564 1.025 0.400 0.816 -0.978
P1值 0.751 0.575 0.310 0.691 0.419 0.333
t2值 0.368 0.447 -1.554 1.043 -1.159 0.085
P2值 0.714 0.657 0.126 0.302 0.252 0.932
t3值 0.529 0.144 -2.065 0.816 -1.568 0.596
P3值 0.599 0.886 0.044 0.418 0.123 0.554
组别 例数 肩锁韧带上束长度（mm） 肩锁韧带下束长度（mm） 斜方韧带与水平面角度（°） 斜方韧带与矢状面角度（°） 锥状韧带与水平面角度（°） 锥状韧带与矢状面角度（°） 喙锁韧带间角度（°）
18~44岁 28 14.88±3.21 7.18±2.31 44.67±15.57 45.33±15.57 59.07±16.06 30.93±16.06 69.82±20.31
45~59岁 22 15.86±3.60 8.18±2.69 37.86±8.87 52.14±8.87 68.56±12.37 21.44±12.37 68.55±15.53
≥60岁 4 12.87±2.05 7.77±1.72 40.44±13.82 49.56±13.82 63.92±26.69 26.09±26.69 68.53±18.53
t1值 -1.037 -1.435 1.822 -1.822 -2.143 2.143 0.242
P1值 0.305 0.157 0.074 0.074 0.037 0.037 0.810
t2值 1.129 -0.454 0.603 -0.603 -0.583 0.583 0.131
P2值 0.264 0.652 0.549 0.549 0.562 0.562 0.896
t3值 1.653 0.306 -0.362 0.362 0.550 -0.550 0.002
P3值 0.104 0.761 0.719 0.719 0.585 0.585 0.998
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