Anatomical Measurement Of Coracoid Process In Chinese And Its Clinical Application

Part I Anatomical measurement of coracoid processObjectives:Referring to the glenoid plane,the angle and linear size of the superior and posterior coracoid column were quantitatively evaluated,and the gender differences of measurement parameters were determined.Materials and Methods:51 adult dry scapulae(25 left and 26 right)were collected.The average age of donors was 55.4 years,ranging from 22 to 84 years.There were 33 males and 18 females.The length,width and thickness of each coracoid column were measured,as well as the angle of each coracoid column relative to the glenoid in each plane.Results:Linear measurement results(mm):(1)L l:32.3+2.3 in males and 29.2+1.4 in females,P<0.05.(2)L 2:44.2+3.8 in males and 38.1+3.1 in females,P<0.05.(3)L 3:23.1+2.5 in males and 21.2+2.9 in females,P<0.05.(4)L 4:21.1+3.2 in males and 16.3+2.4 in females,P<0.05.(5)W l:17.5+1.7 in males and 15.1+1.8 in females,P<0.05.(6)W 2:15.4+1.6 in males and 13.3+1.5 in females,P<0.05.(7)T 1:10.2+1.9 in males and 8.4+1.8 in females,P<0.05.(8)T 2:9.1+1.4 in males and 7.4+1.6 in females,P<0.05.(9)T 3:6.6+1.1 in males and 6.2+0.9 in females,P<0.05.Angle measurements(°):(1)a:147.4±7.4 in males and 144.4±7.3 in females,P>0.05.(2)?:85.3+8.4 in males and 84.5+6.2 in females,P>0.05.(3)y:52.2+7.6 in males and 49.9+9.4 in females,P>0.05.(4)?:126.5+10.2 in males and 125.0+7.9 in females,P>0.05.(5)?:135.1+5.4 in males and 134.1+5.7 in females,P>0.05.Statistical analysis showed that there were significant differences in linear measurements of scapula between men and women(p<0.05).The length,width and thickness of coracoid column in males were significantly larger than those in females(p<0.05).There was no significant difference in coracoid column angle between males and females(p>0.05).Conclusions:In this study,the linear and angular data of the superior and posterior coracoid column were obtained through anatomical measurement,which deepened the understanding of the overall anatomical shape and spatial position of the coracoid process.Based on this study,a new fluoroscopy method was designed to clearly display each single coracoid column.It also provided data for determining the optimal size and direction of the internal fixation in coracoid fractures.Part ? Clinical effect of screw fixation for coracoid basal fracturesObjectives:To explore the surgical technique and clinical effect of coracoid basal fractures fixed with hollow lag screw.Materials and Methods:The clinical data of 30 patients with coracoid basal fractures admitted to our department from April 2016 to April 2018 were retrospectively analyzed.Among them,there were 19 males and 11 females,aged from 22 to 63 years,with an average age of 45.1 years.The classification of coracoid process fractures were as follows:according to 3D-CT images,all of them are coracoid basal fractures;according to Eyres classification,2 cases were type III A,7 cases were type III B,3 cases were type IVA,6 cases were type IVB,3 cases were type V A,9 cases were type V B;according to Ogawa classification,all of them were type I.All patients were treated with open reduction and the coracoid basal fractures were fixed with hollow lag screws.The operation time,intraoperative bleeding volume,fluoroscopy times,reduction quality of fracture,complications during and after operation,fracture healing during follow-up and shoulder function score were recorded.Results:In this study,30 patients with coracoid basal fracture were operated for 70-200 minutes,with an average of 128.0 minutes;intraoperative bleeding was 150-300 ml,with an average of 211.7 ml;intraoperative fluoroscopy was 4-13 times,with an average of 6.5 times.All incisions healed well without complications such as infection,vascular and nerve injury.All 30 patients were followed up for an average of 12.5 months.All fractures achieved good bone healing,with an average healing time of 3.3 months.During the follow-up period,the screws were in good position,and no penetration or fracture or failure occurred.At the last follow-up,the average Neer score was 91.2,of which 24 were excellent,5 were good,l was good,and the excellent and good rate was 96.7%.The average Constant-Murley score was 90.5,of which 22 were excellent,6 were good,2 were good,and the excellent and good rate was 93.3%.Conclusions:Open reduction combined with hollow lag screws can achieve good reduction and firm fixation of coracoid base fractures,and achieve good clinical efficacy.Among them,the selection of screw entry point,screw angle and screw length are important factors which determine the surgical effect.The application of intraoperative vertical biplane fluoroscopy and multi-angle fluoroscopy can effectively avoid the risk of intraoperative vascular nerve injury and joint penetration.