Humerus’un Morfometrik Olarak Değerlendirilmesi ve Klinik Önemi

Abstract

Giriş: Humerus’un üzerindeki morfometrik yapıların ve humerus retroversiyon açılarının bilinmesi ortez ve protez tasarımı açısından önemlidir. Kuru kemiklerde humerus’un morfometrik ölçüm değerlerinin belirlenmesi, sağ ve sol taraflar arası farkların tanımlanması amaçlanmıştır. Materyal-Metot: Çalışmamızda toplam 54 humerus kullanıldı. 10 morfometrik veriye bakıldı. Kemiklerin fotoğrafları aynı açıdan bir cetvel eşliğinde çekildi. Image-J programı ile ölçümler yapıldı. Çevre ölçümleri milimetrik esnemeyen mezura yardımıyla ölçüldü. Bulgular: Humerus’un ortalama uzunluğu 311,54±29,14 mm, ortalama retroversiyon açısı ise 33,42°±5,8° olarak bulundu. Ortalama sulcus intertubercularis derinliği 3,25±0,67 mm, ortalama sulcus intertubercularis genişliği 7,52±0,74 mm, ortalama fossa olecrani genişliği 22,32±2,7 mm, ortalama fossa olecrani derinliği 6,73±1,3 mm, ortalama epicondyler genişlik 56,66±4,8 mm, ortalama cerrahi boyun çevresi 75,80±9,6 mm ve distal humerus çevresi 72,19±8,7 mm idi. Yapılan ölçümlerde taraflar arasında anlamlı bir fark bulunmamıştır. Yapılan ölçümlere göre epicondyler genişlik, trochlea humeri genişliği ve fossa olecrani genişliği arasında, humerus’un retroversiyon açısı, sulcus intertubercularis genişliği ve humerus uzunluğu arasında, ayrıca cerrahi boyun çevresi ve humerus distalinin çevresi arasında pozitif yönlü iyi bir korelasyon olduğu tespit edilmiştir. Sonuç: Humerus’un açısal değerlerinin yanı sıra normal anatomik yapısını da bilmek yaralanma sonrası ortez ve protez tasarımında, görüntüleme yöntemlerinin etkinliği açısından ve cerrahi girişimlerde önemlidir. Ayrıca çalışmamız, adli ve antropolojik araştırmalarda da humerus boyutlarına ilişkin veriler sağlayacaktır.

Keywords

• Humerus
• Morfometri
• Image-J
• Retroversiyon açısı

Morphometric Evaluation of Humerus and Its Clinical Significance

Abstract

Introduction: It is important to the morphometric structures on the humerus and the humerus retroversion angles are important in terms of orthosis and prosthesis design. It is aimed to determine the morphometric measurement values of the humerus in dry bones and define the differences between the right and left sides.Materials and Methods: A total of 54 humerus were used in this study. Ten morphometric data were analyzed. The photographs of the bones were taken from the same angle with a ruler. Measurements were made with Image-J program. The circumference measurements were made with the help of millimetric non-stretch tape.Results: The average length of the humerus was found 311.54±29.14 mm, and the mean retroversion angle was found 33.42°±5.8°. Average intertubercular sulcus depth was 3.25±0.67 mm, intertubercular sulcus length was 7.52±0.74 mm, olecranon fossa width was 22.32±2.7 mm, olecranon fossa depth was 6.73±1.3 mm, epicondylar width was 56.66±4.8 mm, surgical neck circumference was 75.80±9.6 mm, and circumference of the distal humeral was 72.19±8.7 mm. No significant difference was found between the parties in the measurements. According to the measurements, a positive correlation was found between epicondylar width, trochlea of humerus width, and olecranon fossa width, between retroversion angle of humerus, intertubercular sulcus width and humerus length, and between surgical neck circumference and the circumference measurements were made of the distal humerus.Conclusion: It is important to know the angular values and normal anatomical structure of the humerus is important in post-injury orthosis and prosthesis design in terms of the effectiveness of imaging methods and surgical interventions. Besides, our study will provide data on humerus dimensions in forensic and anthropological studies.

References

1. Gray H. Gray's anatomy The Anatomical Basis of Clinical Practice.UK:Churchill Livingstone Elsevier;2008:796.
2. Krahl VE. The phelogeny and ontogeny of humeral torsion. J Phys. 1976;45:595-600.
3. Krahl VE, Evens FG. Humeral torsion in man. 1945;3:229-53.
4. Cowgill LW. Humeral torsion revisited: A functional and ontogenetic model for popula-tional variation. American Journal of Physıcal Anthropol. 2007;134:472-80.
5. Martin CP. The couse of torsion of the humerus and of the notch on the anterior egde of the glenoid cavity of the scapula. J Anat. 1933;67:572-82.
6. Schwab L, Blanch P. Humeral torsion and passive shoulder range in elite volleyball players. Physical Therapy in Sport. 2009;10(2):51-6.
7. Roux, A, Decroocq L, El Batti, S, Bonnevialle N, Moineau G, Trojani C, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthopaedics & Traumatology: Surgery & Research. 2012;98(6):715-19.
8. Adla DH, Stanley D. The management options for adult distal humeral fractures. Stanley D, Trail I, editors. Operative Elbow Surgery. China: Churchill Livingstone. 2012:253-65.

9. Sinha P, Bhutia KL, Tamang BK. Morphometric measurements of segments in dry humerus. Journal Of Evolutıon Of Medıcal And Dental Scıences-Jemds. 2017;6(67):4819-22.
10. Desai SD, Shaik HSA. Morphometric study of humerus segments. Journal of Pharmaceutical Sciences and Research. 2012;4(10):1943.
11. Akman ŞD, Karakaş P, Bozkır MG. The morphometric measurements of humerus segments. Turkish Journal of Medical Sciences. 2006;36(2):81-5.
12. Niraj P, Dangol PMS, Ranjit, N. Measurement of length and weight on non-articulated adult humerus in Nepalese corpses. Journal of Kathmandu Medical College. 2013:2(1); 25-7.
13. Krahl VE. The phelogeny and ontogeny of humeral torsion. J Phys. 1976;45:595-600.
14. Patil S, Sethi M, Vasudeva, N. Determining angle of humeral torsion using image software technique. Journal of Clinical and Diagnostic Research. 2016;10(10):6.
15. Cowgill LW. Humeral torsion revisited: Afunctional and ontogenetic model for popula-tional variation. American Journal of physıcal Anthropol. 2007; 134: 472-80.
16. Chant CB, Litchfield R, Griffin S, Thain LM. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. Journal of Orthopaedic & Sports Physical Therapy. 2007;37(9):514-20.
17. Hernigou P, Duparc F. Determınıng humeral retroversion with computed tomography. The Journal of Bone and Joint Surgery. 2002;84(10):1753-62.
18. Cassagnaud X, Maynau C, Petroff E, Dujardin C, Mestdagh H. A study of reproducibility of an original method of CT measurement of the lateralization of the intertubercular groove and humeral retroversion. Surg Radiol Anat. 2003;25:145-51.
19. Pieper HG. Humeral torsion in the throwing arm of handball players. The American Journal of Sports Medicine, 1998;26(2):247-53.
20. Roux A, Decroocq L, El Batti, S, Bonnevialle N, Moineau, G, Trojani C. et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthopaedics & Traumatology: Surgery & Research. 2012;98(6):715-19.
21. Gorschewsky O, Puetz A, Klakow A, Pitzl, M, Neumann W. The treatment of proximal humeral fractures with intramedullary titanium helix wire by 97 patients. Archives of Orthopaedic and Trauma Surgery. 2005;125(10):670-5.
22. Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M et al. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Archives of Orthopaedic and Trauma Surgery. 2007;127(3):205-10.
23. Cil A, Veillette CJ, Sanchez-Sotelo J, Morrey BF. Linked elbow replacement: a salvage procedure for distal humeral nonunion. J Bone Joint Surg. 2008;90(9):1939–50.
24. Donders JCE, Lorich DG, Helfet DL, Kloen P. Surgical technique: Treatment of distal humerus nonunions. HSSJ. 2017;13(3):282–91.