小针刀治疗肩胛上神经嵌压症的应用解剖

目的为小针刀减压治疗肩胛上神经嵌压症提供形态学基础.方法在34侧常规固定的成人尸体标本上解剖出冈上孔、冈下孔和肩胛上神经及血管,观察冈上孔、冈下孔及其与肩胛上神经、血管的走行位置关系,测量有关数据.结果冈上孔位于锁骨锥状结节的后端深面,由肩胛切迹和横架于其上方的肩胛上横韧带围成,距体表(4.75±0.79)cm.冈下孔位于肩胛冈中外1/3交界处下方2cm处的深面,由冈盂切迹和连于肩峰根部及肩胛骨背面的肩胛下横韧带围成,距体表(3.93±0.95)cm.肩胛上神经起自臂丛上干,行向后外下,穿冈上孔人冈下窝,再向后穿冈下孔入冈下窝,沿途发支至冈上肌、冈下肌和肩关节.肩胛上血管经肩胛上横韧带的外上方入冈上窝与神经伴行.结论本文提出同时扩大或开放两孔进行治疗的新思路,提供的有关数据和定位方法,可提高小针刀治疗肩胛上神经嵌压症的准确性和安全性.     

肩胛上神经卡压机制的临床解剖学研究

目的　探讨肩胛上神经卡压症的解剖学机制,为临床诊断和治疗提供解剖学依据。 方法　22具(男13具,女9具)44侧成尸标本,解剖观测肩胛上切迹,冈盂切迹的形态特点以及肩胛上神经走行、分支及分布的解剖学特点,所测数据统计学处理。 结果　肩胛上切迹类型：U型占40.91%（18侧）,浅U型占22.73%（10侧）,大弧型占27.27%（12侧）,方形占9.01%（4侧）四种。肩胛上切迹的厚度为（1.55±0.36）mm。肩胛上神经主干与冈上肌支所成角为(86.04±1.28)°。冈下肌支的入肌点,有22.73%在该肌的起点处,77.27%在中或外1/3处。冈盂切迹的厚度在（6.82±1.21）mm 。肩胛上神经自肩胛上孔穿出点至肩胛冈基底部的高度为（11.13±0.21）mm;至冈盂切迹的水平距离为（14.03±0.64）mm 。肩胛上神经转折角为（49.65±1.63）°。 结论　肩胛上切迹的类型、肩胛上切迹和冈盂切迹的厚度,肩胛上神经转折角的大小、神经主干与冈上肌支的角度以及冈下肌支的入肌点等均是肩胛上神经卡压的危险因素。     

关节镜Bristow-Latarjet术中打内固定骨道时CT定位肩胛上神经的应用价值

文题释义： Bristow-Latarjet术：是带有联合腱的喙突骨块，穿过被横断的肩胛下肌腱后，固定于肩盂前缘，是治疗复发性肩关节前脱位的有效方法。神经损伤是该术式常见并发症。 肩胛上神经：在肩胛盂上方穿过肩胛上横韧带与肩胛切迹组成的纤维骨性通道即肩胛上孔，进入冈上窝。肩胛上神经的冈上窝段紧贴着冈上肌深面向外下走行，穿过肩胛下孔(由冈盂切迹和连于肩峰根部及肩胛骨背面的肩胛下韧带构成)并绕着冈盂切迹向内下而到冈下窝，发出分支支配冈下肌。 背景：Bristow-Latarjet术是治疗复发性肩关节前脱位的可靠方法。然而据报道，其中1.6%的患者伴有神经损伤。因此全关节镜Latarjet术式越来越受欢迎，由于外科医生不能触诊神经，神经的定位和保护变得困难。 目的：研究肩胛上神经在肩胛颈后上方的CT定位，提高对Bristow-Latarjet术临床操作安全范围的认知。 方法：选用经甲醛常规固定的成年尸体上肢标本12侧，男8侧，女4侧，实验方案符合东莞市中医院对研究的相关伦理要求。解剖并使用显影线标记12侧标本肩胛上神经的主干和分支，CT水平位上测量肩胛上孔、冈盂切迹、最外侧神经分支入肌点3个位置在肩关节内旋45°和外旋45°体位时到肩胛盂前后缘连线的距离、成角以及与肩胛盂的高度比，所得数据进行统计学处理。 结果与结论：①Pearson 相关性分析：盂的高度分别与冈盂切迹、入肌点到关节面的距离呈正相关；②内旋45°与外旋45°两个体位比较：肩胛上孔处的距离和成角度数差异无显著性(P均> 0.05)；冈盂切迹处的距离和成角差异有显著性意义(P均< 0.01)，高度比差异无显著性意义(P > 0.05)；入肌点处的距离、成角和高度比差异均有显著性意义(P均< 0.01)，表明与内旋位相比，外旋位具有更大的角度和距离的安全范围；③内外旋45°位时，冈盂切迹处与入肌点处的角度、距离、高度比差异均有显著性意义(P均< 0.01)，表明相比冈盂切迹，入肌点与关节面的角度更小、距离更短，相对盂的高度比更大；④提示关节镜下Bristow-Laterjet术打内固定骨道时建议外旋位操作，以减少神经损伤的发生概率。 ORCID: 0000-0002-6828-042X(袁胜超) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

针刀微创手术治疗肩胛上神经卡压的解剖学研究

目的观测肩胛上横韧带,肩胛上动脉、肩胛上神经及其冈上肌支,为针刀治疗肩胛上神经卡压提供解剖学依据。方法解剖观测肩胛上横韧带的长度、宽度和厚度;观察肩胛上动脉和肩胛上神经以及它们的冈上肌支与肩胛上横韧带的位置关系,测量它们在肩胛切迹处的直径;以韧带内侧附着处下点的骨面为基点,确定体表穿刺点和穿刺深度。结果肩胛上横韧带下缘长(0.901±0.234)cm,韧带中间窄厚,内、外侧附着点宽薄;肩胛上神经走行于肩胛切迹内,肩胛上横韧带的下方;肩胛上动脉有16.67%走行于切迹内神经的外侧,83.33%走行在切迹外韧带外上方;肩胛上神经的冈上肌支经肩胛切迹内上角走行入冈上肌;体表穿刺定位角为(24.102±3.681)°。穿刺定位距离计算的回归方程是:Y=2.560+0.615X,穿刺深度为(4.342±0.629)cm。结论针刀切断韧带的方向应从韧带内侧部下缘切向内上,可避免损伤韧带下方的肩胛上神经和韧带外上的肩胛上动脉,且可更有效地解除对肩胛上神经及其冈上肌支的卡压;直线回归方程使穿刺的体表定位因人而异,更为准确。     

冈盂切迹的解剖形态学测量及临床意义

目的探讨干燥标本的冈盂切迹解剖形态学测量及其临床意义。方法收集282例干燥肩胛骨标本,观测冈盂切迹宽度(关节盂内侧缘至肩胛冈直线距离)、冈盂切迹厚度(冈盂切迹最低点厚度)、冈盂切迹深度、冈盂切迹转折角(肩胛切迹,冈盂切迹最低点连线与肩胛冈基底部所成的夹角)等。结果冈盂切迹宽度、深度分别为(12.75±1.06)mm、(11.65±1.89)mm,且右侧更宽更深,双侧对比P0.05有统计学差异;冈盂切迹厚度(9.93±1.57)mm,肩胛上切迹至冈盂切迹距离为(18.73±3.18)mm,且双侧对比P0.05;冈盂切迹转折角为(40.24±8.69)°,双侧对比P0.05有统计学差异。结论冈盂切迹的厚度、深度、宽度和转折角均是肩胛上神经卡压症的危险因素,且冈盂切迹越深,冈盂切迹转折角越小,发生肩胛上神经卡压的几率越大。本研究解剖数据可为临床在手术入路和内固定物植入位置选择等提供参考,降低术中神经损伤风险。     

肩胛上神经穿肩胛上横韧带1例

作者在处理废旧男尸体标本时见其左侧肩胛上神经穿过纵置型的肩胛上横韧带 ,此种变异少见 ,现报道如下。据林萍等分型 (中国临床解剖学杂志 ,1994,12 (4 ) :2 77～2 79) ,左侧肩胛切迹呈圆形 ;迟焕方等分型 (中国临床解剖学杂志 ,1994,12 (4 ) :2 80～ 2 82 ) ,韧带呈纵置型。本例变异的肩胛上横韧带分为上、下两束 ,两束均呈附着端宽而中部窄的带状。上束长 1.61cm ,中部宽 0 .19cm ,厚 0 .4mm。下束长 1.10cm ,中部宽 0 .11cm ,厚 0 .3mm。两束围成横椭圆形的上孔。上孔长 1.14cm ,中部宽 0 .3 3cm ,在孔的最宽处有肩胛上神经穿过 ,在肩胛…     

肩胛上神经冈下肌支卡压1例

1临床资料 患者,男,25岁,喜欢打篮球。右肩胛部疼痛3月,理疗无效,右肩部肌肉萎缩、活动乏力而就诊。查体：右肩胛部冈下肌明显萎缩,肩胛冈中外1／3交界下方压痛,压痛范围1cm×1cm。皮肤感觉正常,右肩关节各向活动范围正常,外旋肌力减弱。肌电图表现为传导速度减慢,潜伏期延长。行手术治疗,沿肩胛冈中点向外侧切开至肩峰,切断部分斜方肌、三角肌在肩胛冈上的附着部,分别将冈上、下肌自肩胛冈两侧剥离并牵开,于外侧见肩胛上神经冈下支神经血管束穿行于冈盂切迹与肩胛下韧带构成的骨纤维孔道,肩胛上神经冈下支水肿及瘢痕增生。切除肩胛下韧带及冈盂切迹内侧部分骨质,骨蜡涂抹切骨处,神经外膜松解。术后肩胛部疼痛消失。术后半年两侧肩部肌肉对称。     

肩胛上神经卡压症针刀手术入路研究

目的提供肩胛上神经卡压症针刀手术入路的解剖学基础。方法在30侧经10％福尔马林固定及灌注红色乳胶的成人上肢标本上行局部层次解剖。①观察肩胛上神经位置，行程和分布，以及与周围结构的相互毗邻关系。②测量肩胛上下孔；肩胛上下横韧带的相关数据。③设定肩胛上神经的体表测量标志，并测量相关数据。结果：①肩胛上神经由臂丛C5、6形成后，越过颈后三角向外，经肩胛上孔入冈上窝，分出冈上肌支、上关节支，其主干改名为冈下肌支穿肩胛下孔入冈下窝，分出冈下肌支、下关节支。②肩胛上孔横径7．90±3．0mm；纵径6．2±1．2mm；肩胛下孔横径9．81±1．53mm纵径7．81±2．40mm；肩胛上横韧带长13．4±0．5mm；肩胛下横韧带长25．3～3．9mm。③引用黄德清所测数值：设定肩胛上孔为A点，肩胛下孔为B点，肩胛上角为C点，肩峰外侧端为D点。肩胛冈内侧端与肩胛骨内侧缘相交处为E点。AD／AC相对值为1．26±0．47；BD／BE相对值为0．60±0．08。结论肩胛上神经卡压症的解剖学研究数据能为肩胛上神经卡压症针刀手术提供较安全的入路及定位标志。     

肩袖合并肩胛上神经损伤原因的解剖学研究

目的:探讨肩袖损伤合并肩胛上神经损伤的解剖学原因及其临床意义。方法:在44侧经常规防腐处理的成人尸体上肢标本上解剖观测肩袖和肩胛上神经,观测肩胛上神经及其分支的数目、直径、起始、走行、分布以及与肩袖的解剖关系。结果:肩胛上神经行程迂曲,有起点、入肌点两个固定点,另有肩胛上孔、肩胛下孔两个约束点,在冈盂切迹处形成大约50°左右的转折角,发出冈上肌支44支、冈下肌支44支、上关节支42支、下关节支53支、感觉支37支,分布于冈上肌、冈下肌和肩关节等处。肩胛上神经分别在肩胛上、下孔处贴近肩胛上韧带、肩胛下韧带,活动余地较小,肩部外展活动时神经张力增大,肩袖和肩胛上神经干之间有筋膜相隔。结论:肩胛上神经内在的解剖因素是肩袖合并肩胛上神经损伤的基础,肩袖的牵拉是其受伤的直接原因,肩袖损伤时可合并肩胛上神经损伤。     

肩胛冈和肩峰角的骨性观测及临床意义

目的为肩胛冈及肩峰角的定位和肩部疾病的诊治提供解剖形态学基础。方法对200例成人干燥肩胛骨的肩胛切迹、肩胛冈以及肩峰角的形状、走形及定位方法等特点进行研究。结果肩胛切迹宽度为(10.52±4.27)mm,深度为(6.12±2.24)mm;肩胛切迹到肩胛冈的垂线交点到肩峰角的距离为(43.12±4.82)mm,从交点至肩胛切迹的深度为(31.42±4.01)mm;肩胛冈部位表浅,走形恒定。长度为(118.28±4.37)mm,基底长度为(81.12±4.56)mm,冈中隆凸宽度为(11.38±2.64)mm,冈中隆凸高度为(18.72±2.67)mm;肩峰角分为三型,肩峰角(119.9±8.53)°,其中C型占68.00%,肩峰角(124.6±6.49)°;L型占22.50%,肩峰角(104.8±5.54)°;双角型占9.50%。结论 (1)肩胛冈上缘及肩峰角走形恒定,部位表浅可作为肩部疾病的诊治定位标志。(2)从肩峰角沿肩胛冈上缘水平向内约4cm,再向前约3cm即为肩胛切迹。(3)不同类型肩峰角在定位时的特点不同。     

肩胛上神经卡压综合征的基础和诊断治疗

目的：探讨肩胛上神经卡压征的诊断依据和治疗方法，提高对该病的诊治水平。方法：对收治的12例肩胛上神经卡压的临床症状、体征、影像学资料及诊疗方法进行回顾性分析。结果：保守治疗6例中4例有效，有效率66．67%。手术治疗8例，随访2－3年，症状完全消失，肌力较术前恢复至Ⅳ-Ⅴ级，未发现有复发者，但肌肉萎缩无明显改善。结论：本征早期用保守疗法可使部分患者治愈，如治疗2个月无效或出现明显肌肉萎缩者，应积极手术治疗。     

肩胛上神经致肩部疼痛的临床观察

目的探讨肩胛上神经致肩部疼痛的治疗效果。方法回顾性分析18例肩部疼痛病人的临床资料。13例患者在冈上窝中部有深部压痛,在肩胛骨背面一定的区域内有痛觉改变,疑为肩胛上神经有皮肤分支于此。全部病例均用强的松龙加局部麻药注射至冈上窝肩胛上切迹处的方法治疗。结果治疗1周后痊愈15例。1周、2周和2年后复发各1例,经再次封闭痊愈。结论强的松龙加局部麻药封闭治疗疑似肩胛上神经皮支致肩痛患者的疗效肯定。     

The spinoglenoid ligament: an anatomic study

The spinoglenoid ligament and its anatomic variations are described in 27 shoulders from 15 cadavers. In each shoulder one or two distinct spinoglenoid ligaments originated from the base of the spine of the scapula; they inserted on the neck of the scapula or the shoulder joint capsule. In the 19 shoulders in which only one spinoglenoid ligament was present, it inserted into the neck of the scapula in 14 cases and into the shoulder joint capsule in five instances. In the eight shoulders in which there were two ligaments, one inserted into the neck of the scapula and the other into the shoulder joint capsule. We did not observe any hypertrophic spinoglenoid ligaments that may have compressed the suprascapular nerve.     

Destination of the C4 component of the prefixed brachial plexus

This study was carried out to elucidate the destination of the C4 ventral ramus that forms the prefixed brachial plexus. A total of 43 sides of Korean adults (male, 22; female, 18; unknown: 3 and right, 23; left, 20) were investigated. The various C4 destinations and their frequencies were as follows: suprascapular nerve, 97.7% (42/43); musculocutaneous nerve, 79.1% (34/43); the axillary nerve, 48.8% (21/43); and the nerve to subclavius, 16.2% (7/43). The mean quantity of nerve fibers destined to the suprascapular, musculocutaneous, and axillary nerves and the nerve to subclavius was 441.8 ± 316.5 (Mean ± S.D.), 298.2 ± 209.8, 245.8 ± 239.0, and 66.4 ± 17.2, respectively. The mean nerve fibers number of C4 contributing to the brachial plexus was 983.6 ± 618.0 (range: 100-1729). The main component that contributes to the terminal nerves (suprascapular, musculocutaneous, axillary nerves, and nerve to subclavius) is C5. These results may be useful to surgeons and clinicians dealing with terminal nerves of the brachial plexus, especially the suprascapular, musculocutaneous, and axillary nerves.     

Localization of important facial foramina encountered in maxillo-facial surgery

Knowledge of the location of foramina in the maxillo-facial region is necessary in clinical situations requiring regional nerve blocks and in open as well as endoscopic surgical procedures to avoid injury to corresponding nerves. In this study, measurements were taken on 79 adult dried human skulls to determine the position of the supraorbital, infraorbital, and mental foramina. Supraorbital foramina were found to be approximately 25 mm lateral to the midline, 30 mm medial to the temporal crest of the frontal bone, and 2-3 mm superior to the supraorbital rim. Additional exits for branches of the supraorbital nerve were present in 14% of skulls. The intersection of the zygomatico-maxillary suture with the inferior orbital rim was a readily palpable landmark for locating the infraorbital foramen. This foramen was approximately 7 mm inferior to the inferior orbital rim and 28.5-mm lateral to the midline. Mental foramina were on average, 25.8-mm lateral to the midline and about 13-mm superior to the inferior mandibular margin. Both the infraorbital and mental foramina were most often on a vertical line with the second premolar (Position 3). The distances of the foramina from the midline were similar on both sides demonstrating facial symmetry. In about 80% of skulls, the supraorbital, infraorbital, and mental foramina/notches were along the same vertical line. These measurements may be of value to clinicians in localizing and safeguarding these nerves and providing effective nerve blocks.     

中国人颅骨腭大小孔的观测

本文观察测量200个(400例)成人颅骨的腭大孔、腭小孔的位置、大小(长宽径),为临床麻醉上颌神经、蝶腭神经节及一些分支提供解剖学依据.腭大孔位置分有无第3磨牙两种,有第3磨牙的多数位于第3磨牙内侧,无第3磨牙的多数位于第2磨牙内后方;腭小孔的位置分在腭大孔正后、内后、外后3组,以正后方最多,最少的是后外方.     

Accessory suprascapular artery

During the dissection of a 94-year-old female cadaver, an accessory suprascapular artery (SSA) was found in addition to the SSA proper.     

Variable morphology of the suprascapular notch: an investigation and quantitative measurements in Chinese population

Although several morphological variations and classification of the suprascapular notch (SSN) were reported in western populations, little attention has been paid to this anatomic issue in the Chinese population. In this research of SSN morphology in Chinese people, 295 specimens of intact dry Chinese adult scapulas were investigated and measured thoroughly and systematically. Morphological features of SSN variations were observed by visual inspection, and correlation parameters of variability and classification were measured in digital images with image processing software and bones with a vernier caliper, respectively. The incidence of different subtypes of SSN classification and comparative analysis of correlation parameters were calculated. It was interesting that a new variable morphology of SSN with a double suprascapular foramen had been found. We found the most prevalent groups were Type II (an incisura that was longer in its transverse diameter) and Type III (an incisura that was longer in its vertical diameter) which accounted for 58.16 and 28.23%, respectively. The circumference and area of Type II and Type III was larger than those of Type IV. The thickness of 1 mm below the lowest point of the SSN ranges from 0.55 to 3.00 mm. Eight cases with a narrow groove on the lowest point of SSN and four cases with bony canals formed by the ossified superior transverse scapular ligament were found. Further, the distance between the SSN and bony landmarks were varied. For AD (the distance between the lowest point of the SSN and the supraglenoid tubercle), Type I was largest, followed by the Type II, Type III, and Type IV. For AE (the distance between the lowest point of the SSN and the base of the spinoglenoid notch), Type IV was the shortest and there was no statistical difference between other types. This study reveals that SSN variations are common in Chinese population. This anatomic information is important in the management of entrapment neuropathy or interventional procedure of the SSN.