基于CT的髌骨下极骨折分型

目的 基于三维CT图像对髌骨下极骨折分型。 方法 回顾性分析本院2018年5月至2020年11月67例髌骨下极骨折的三维CT图像并分型。用Kappa系数评估观察者间可信度和观察者自身可信度。 结果 髌骨下极骨折分为无移位骨折（Ⅰ型）和移位骨折（Ⅱ型）两型。移位骨折可分为3个亚型：Ⅱa型，大块型骨折，包括髌骨下极1枚孤立性骨折块，或2枚较大的骨折块；Ⅱb型，粉碎性骨折，多枚较小的骨折块，包括冠状位和矢状位骨折块；Ⅱc型，袖套样撕脱骨折，沿髌骨下极整个弧面的呈内外方向的长弧形骨折，多为粉碎性的，骨折块非常薄。本研究中Ⅰ型8例，Ⅱa型11例，Ⅱb型42例，Ⅱc型6例。观察者之间的可信度平均K值为0.782（0.682 ~ 0.896），基本可信；观察者自身可信度平均K值为0.837（0.786 ~ 0.884），完全可信。 结论 本文髌骨下极骨折分型方法有较高的可信度及可重复性，对临床有一定的指导意义。

CT localization study of brachial plexus branches and its clinical significance in Bristow-Latarjet

Objective　To study the CT localization of the brachial plexus in front of the subscapularis muscle and to improve the knowledge of the safe range of Bristow-Latarjet surgical procedures. Methods　A total of 16 shoulder cadaver specimens were selected from Guangdong Medical University. Sixteen shoulder specimens were dissected and the position and stroke of the brachial plexus (musculocutaneous nerve, axillary nerve, radial nerve) trunk in front of the subscapularis muscle were marked using the development line. The distance between the musculocutaneous nerves to the anterior edge of the scapular glenoid (at the 2~5 o'clock position of the internal rotation 45° position, the neutral position and the external rotation 45° position) as well as its angular regularity with the line connecting the anterior and posterior margin of thescapular glenoid was measured at the CT level. The resulting data was processed and analyzed statistically.　Results 　(1) The brachial plexus was in front of the subscapularis muscle and the arrangement of the nerves from the inside to the outside was: the axillary nerve, the radial nerve and the musculocutaneous nerve. (2)The data of musculocutaneous nerve measured in three positions on CT horizontal position were compared among groups: angle comparison showed that there were significant differences between the internal rotation position and neutral position and external rotation position at 2~5 o'clock (all P<0.05). Distance comparison showed that there were significant differences between the external rotation position and neutral position at 2 o'clock and between the internal rotation position (all P<0.05). There was no statistical difference between the neutral position and the internal rotation position (P=0.15). There was statistical difference between the internal rotation position and the neutral position and the external rotation position at 3~5 o'clock (P<0.05). There was no significant difference between the 5 o'clock position and the neutral position (P=0.07). Intra-group comparison: the angle of 2 o'clock position of internal rotation was significantly different from that of 3~5 o'clock position (all P<0.05), and there was no significant difference between the two positions of 3~5 o'clock (all P>0.05). Pearson's analysis showed that the height of the pelvis HL was negatively correlated with the angle of 2-point position of the internal rotation position, positively correlated with the angle of 3-point position, negatively correlated with the distance of 2 o'clock position of the internal rotation position and positively correlated with the distance of 3~5 o'clock position.　Conclusions　The safe range of the musculocutaneous nerve at the internal rotation 45° position of the shoulder joint is significantly larger than that at the neutral position and the external rotation 45°position. Operation at the internal rotation position is recommended.