Clinical Anatomy Study Of Scapula

Objective and SignificanceThe scapula is a flat width shape irregular bone, assumes triangle, microfront is raised, on the wall adapts after the chest, not only has protects thechestcavity, but also has the fixed upper limb function, In the upper arm process, 2 /3 activity occurs in the shoulder joint, 1/3 activity has between scapula and chestcavity. The scapula and chestcavity although does not have the model joint structure dissection characteristic, but actually provides equal to the joint function activity。Attach in the distribution from the shoulder blade function and its muscle to look, the scapula outflow boundary and the acromion attaching muscle most, therefore ossein strongest, this bones is long and hard。the scapula' s superior view although is thin and are short, but it has coracoid strengthened, has the bigger strut function to scapula。The scapula general anatomy had the enough data, but lacks the big sample the big union clinical application anatomy research。In recent years, the scapula surgery every year had the increaseing the tendency; Enters the road inview of the scapula surgery also in the increaseing improvement the consummation。But, each kind of surgery entered the road the influence which supplied to the scapula and its the blood supply to lack the thorough research, lacked the big sample the close union clinical application anatomy research, the different disease surgery entereing road, the main choice basis pathological change spot and the surgery custom, lacked the explicit anatomy basis。Now it was restricted in the external shape to the scapula research, this article has studied the scapula detailed contour, the blood supply, the act, dividing which supplied for the characteristic and the scapula blood, the caliber, the distributed rule。In clinics, scapula fracture, tumor, growth exceptionallyand shoulder joint, and so on commonly used surgery way treatment, proposed to the scapula detailed contour and the blood for the characteristic clinical anatomy research a higher request, this research may be helpful to deepen the understanding which supplies to the scapula blood, in order to scapula surgery processing。Materials and Methods1.50 sides (left 28, right 22) the adult scapula dry specimen, the specimen integrity does not have the damage, first observes the specimen roughly the shape characteristic, then surveys its length and thickness with the micrometer, precisely arrives 0.1mm, surveys its angle with the goniometer, precisely to 1°。All specimens are measured with Similar by the identical person。2. Selects 20 specimen after the anticorrosion fixed processing adult corpsespecimen (male 12, female 8), after pours into the red emulsion, all specimens not are abnormal, the bone fracture, the infection and the tumor, also scapula surgery history。Dissects the instrument 1 set, vernier caliper (precision 0. 02mm), the angle gauge, measuring tool and so on straight edge, the dissection exposed the suprascapular artery, the scapular dorsal artery and the circumflexa scapular artery, the observation has surveyed the sscapu]a blood' s origin, the act, dividing which supplied for the situation and the scapula blood, the caliber, the distributed rule。Vernier caliper (aspreciselyas 0.1mm) surveys the scapula to donate the blood vessel outer diameter。3. Selects 1 fresh adult specimen, pours the polystyrene into the abdomen aorta (PS), in casts on the specimen to observe the scapular artery branch, the distribution and tallies。4. 25 cases of scapular fractures were reviewed from January 2003 to January 2007, According to Hardegger' s classification, 18 fractures of the scapular body , 12 fractures of the scapular neck, 5 fractures of the glenoid rim , 3 fractures of the glenoid fossa, 9 fractures of scapular spine, 6 fractures of the acromion, 5 fractures of the coracoid process, 18 complex fractures of scapular, 16 cases had association injures。All cases were fixed with reconstruction plate and lag screws。Results1. Anatomy research1.1 scapula are in front of the block the concave irregular triangle bone, behind is divided into two parts by the scapula post, in the post the nest and the ossein weakest, above the scapula post root, quite is constant, diameter approximately 2mm。the scapula by muscle encystation, it is important in the shoulder department function, connects the torso and the upper limb' s important structure。1.2 scapula correlation important structure observed valuesinclude: the scapula length for154.7±10.7mm, in thescapulareason center point place thickness (is apart from reason 0. 5cm) is 3.6±0.7mm, under the scapular glenoid 1cm, 2cm, 4cm (are apart from outflow boundary 0. 5cm) thickness for 14.0±2.1mm, 9.5±1.9mm, 8.8±2.6mm, is apart from scapular glenoid 0.5cm, 1cm, 2cm place scapular glenoid neck thickness for 23.1±3.4mm, 18.1±1.8mm, 13.5±1.5mm, the dimensions of the glenbid fossa is (28.3±2.7) mm, (39.2±2.4) mm, the scapular spine inside4cm, the8cm thickness for3.1±3.4mm, 34.3±1.7mm, acromion' s thickness is 7.4±1. 1mm, The glenoid tilt angle is(18.8±2.3)。1.3 scapular blood supplies originates from the suprascapular artery, the scapular dorsal artery and the circumflexa scapular artery, each other tallies, the scapularspine, the scapula inflow boundary and the scapula outflow boundary separately has the suprascapular artery, the scapular dorsal artery and the circumflexa scapular artery to supply the blood。The scapular blood belongs to the dissemination to donate blood, the blood supplies richly, between the artery all has the transportation。2. scapular fractures surgery treatment 25 examples scapular fracture, damages in latter 7day surgery 12, in 3 weeks surgery 7, above 3 weeks surgery 6. The surgery revealed that, (1) the posteriorsuperior approach 6 examples, used to process the acromion, scapular glenoid fracture。(2) the posterior approach 12 examples, uses to process the body department, scapular spine, scapular glenoid fossea, scapular neck fracture。(3) the anterior approach 5 examples, uses to process coracoid and scapular glenoid' s anterior department fracture。(4) the posterior and anterior approach 2 examples。This group of scapular fracture applicationre construction steel plate fixed 14 examples, the scapular containerbone bolt absorbed 4 examples, the pulling force bolt 3 examples; scapular neck bone fracturereconstruction steel plate fixed 8 examples, after scapular spine postpulling force bolt suspension fixed 4 examples; coracoid fracture pulling force bolt 5 examples; The acromion fractureis slanting "6" the shape steel plate fixed 3 examples, the pullingforce bolt 3 examples; scapular post bone fracturereconstruction steel plate fixed 3 examples, steel wire fixed 1 example。15 examples patients obtain a follow-up visit, make a follow-up visit for 10～25 months, the average 16.5months, according to Rowe curative effect evaluation criteria, superior 11 examples, good 2 examples, general 1 example, bad lexample, fine rate is 86.6%. After the surgery, the illnesscomplication mainly includes: The margin infects 1 example, the shoulder joint wound arthritis 2 examples, the shoulder joint limited and the myo- strength weakened 2 examples。Conclusion1. The scapula is a flatwidth shape irregular bone, assumes triangle, microfront is raised, on the wall adapts after the chest, not only has protects the chestcavity, but also has the fixed upper limb function。In the upper arm process, 2/3 activity occurs in the shoulder joint, 1/3 activity has between scapula and chestcavity。The scapula and chestcavity although does not have the model joint structure dissection characteristic, but actually provides equal to the joint function activity。Attach in the distribution from the shoulder blade function and its muscle to look, the scapula outflow boundary and the acromion attaching muscle most, therefore ossein strongest, this bones is long and hard。the scapula' s superior view although is thin and are short, but it has coracoid strengthened, has the bigger strut function to scapula2. scapular outflow boundaries and the scapular glenoid have the enough bone quantity to be allowed to support fixture implanting, like the bolt, the steel needle, the steel wire and the steel plate, and so on, in the fixture application is belpfulto the stable shoulder。scapular spine inside 4cm, the 8cm thickness is 3.1±3.4mm, 34.3±1.7mm, acromion thickness is 7. 4±1.1mm, therefore this also may use the line fixture implanting, used to treat acromion and the scapular spine' s fracture, scapular inside and outside and the scapular spine constituted the entire shoulder blade strut system. To the scapular fracture, its outflow boundary bone extremely is suitable in the placement the fixture, also the surgery revealed in the reason is easier. Although the pate bone fracture has the many kinds of in fixtures to be possible to supply the choice, besides the container nest small bone fracture, the fixed effect is not good with the sole bolt in, this place bone fracture position, even if the bone fracture also may good reposition, but threads a needle or the bolt along the this place compact bone is noteasy to control the direction, but it locates the ossein weakly, the bolt cannot effectively cause the bone fracture block to be fixed。At the same time, the pate bone fracture many will be inlays inserts the natural and the smashing bone fracture, after the bone fracturefragment excises with is unitary inevitably will be able to create the pate to shorten, bone fracture also with difficulty to position, therefore the steel plate might play in this place or the strut role to the bone fracture。3. The glenoid tilt angle is 13.3°～6.1°, the scope is 1°～22°, this angle of the fixture implants the direction regarding the scapular fracture have the vital significance。4. 3 scapular blood supplies originates from the suprascapular artery, the scapular dorsal artery and the circumflexa scapular arteryo The scapula belongs to the dissemination to donate blood, the blood supplies richly, in the scapular post and its the scapular post in the nest, the scapular spine and scapular outflow boundary and so on each region has mainly the artery supply, all of the artery has transportation。5. the scapular spine and the scapular outflow boundary and the scapular outflow boundary may make the scapula transplant with artery。6. The scapula fracture choice surgery treats and strong fixition, causes the patient to obtain the muscle, the bone fracture spot neighbor joint early time non-pain function exercise, in order to avoid the nonsurgery treats the shoulder joint permanentfunction barrier whichapplies the brake to create for a long time。...