胸小肌喙突骨瓣移位修复肩锁关节脱位的应用解剖

目的:为胸小肌喙突骨瓣移位修复肩锁关节脱位提供解剖学依据。方法:30侧经动脉内灌注红色乳胶的成人尸体标本,对胸小肌的形态、血管、神经及喙突的形态结构进行解剖学观察。结果:胸小肌中部长15.6±1.8cm,起始处宽7.2±1.2cm,中部厚5.1±1.9mm,附着部宽1.5±0.4cm。营养动脉主要源于胸肩峰动脉的占83.3％(25侧),肌门距肌起、止点分别为2.2±1.7cm、5.7±1.4cm,胸小肌的神经93.3％(28侧)由胸内侧神经分支支配,长2.9±2.4cm。喙突长4.0±0.3cm、宽1.6±0.2cm、厚0.9±0.2cm。结论:设计胸小肌喙突骨瓣移位修复肩锁关节脱位具有可行性。     

胸锁乳突出锁骨头蒂半片锁骨瓣转位颈椎融合术的应用解剖

在４０例成人颈部标本上，观察了胸锁乳突肌锁骨头的形态，血供及其与锁骨的关系，锁骨头无损伤可分离长度为８．３ｃｍ，其主要血供为甲状腺上动脉胸锁乳突肌支，入肌点在该肌前缘后１．７ｃｍ，距锁肯上缘６．８ｃｍ，处，可设计以胸锁乳突肌锁骨头为蒂半片锁骨瓣移位颈椎前植骨融合的新术式。     

胸小肌蒂喙突骨瓣移位术的应用解剖

目的:为胸小肌喙突骨瓣移位术提供应用解剖资料.方法:观测65例肩胛骨的喙突形态及26具52侧防腐尸体胸小肌与喙突的解剖关系.结果:肩胛骨喙突大小为4.1×1.4×1.0cm,胸小肌止于喙突者80.8%,不止于喙突者11.5%,部分止于喙突者7.7%.结论:并非所有患者均有胸小肌喙突骨瓣移位术的解剖学良好条件.拟行此术前应考虑相应的替代手术方案.     

肱二头肌短头腱转位修复肩锁关节脱位的解剖与临床

目的:为应用肱二头肌短头肌腱转位修复肩锁关节脱位提供解剖学基础和术式设计。方法:在31侧经动脉内灌注红色乳胶的成人尸体标本上,对肱二头肌短头肌腱的形态、血管及喙突的局部结构进行解剖学观察、摹拟手术设计并应用于临床11例。结果:肱二头肌短头肌腱长8.7±1.5cm,上部宽0.9±0.4cm,中部宽1.2±0.4cm,下部宽1.4±0.4cm,喙突尖至肩峰的距离4.7±0.5cm,喙突尖至锁骨肩峰端4.3±0.4cm。应用肱二头肌短头肌腱转位修复肩锁关节脱位疗效满意。结论:应用肱二头肌短头肌腱移位重建喙锁韧带、肩锁韧带及修复肩锁关节脱位,是一种行之有效的新术式。     

喙突移位加内固定术治疗肩锁关节脱位

目的：探讨喙突移位加内固定术治疗肩锁关节脱位的疗效。方法：对15例肩锁关节脱位的患者采用喙突移位加内固定术治疗，其中骨螺钉固定3例、钢丝固定2例、螺钉张力带固定10例。术后随访6月～2a。结果：按Karlsson标准评定功能，优11例，良3例，差1例。结论：喙突移位固定方法优良，能获得稳定较好的关节功能。     

四肢带血管蒂骨（膜）瓣移位术新供区的解剖学基础

目的:介绍上、下肢带血管蒂骨瓣、骨膜瓣移位术新供区的解剖学依据,指导术式设计和推广应用。方法:综合作者近年新发掘的四肢骨瓣、骨膜瓣新供区的解剖学资料,针对性地设计了常用的移位术式。结果:这一批供区以非主干知名血管或主干血管的小分支为血管蒂,设计的骨瓣、骨膜骨瓣.顺行或逆行移位修复四肢骨不连、骨缺损、骨缺血性坏死,临床应用获得了可靠的治疗效果。结论:四肢带血供的骨(膜)瓣移位术供区,术式设计合理,手术操作简便,对供区功能影响很小,适合在基层医疗单位推广。     

肱二头肌短头肌腱转位修复肩锁关节脱位的应用解剖

目的：为肱二头肌短头肌腱转位修复肩锁关节脱位提供解剖学基础。方法：３１侧经动脉内灌注红色乳胶的成人尸体标本,对肱二头肌短头肌腱的形态、血管及喙突的局部结构进行解剖学观察。结果：肱二头肌短头肌腱长８．７±１．５ｃｍ,上部宽０．９±０．４ｃｍ,中部宽１．２±０．４ｃｍ,下部宽１．４±０．４ｃｍ,喙突尖至肩峰的距离４．７±０．５ｃｍ,喙突尖至锁骨肩峰端４．３±０．４ｃｍ。结论：设计肱二头肌短头肌腱移位重建喙锁韧带及肩锁上韧带修复肩锁关节脱位具有可行性     

喙突周围肌腱与韧带转位治疗肩锁关节脱位的解剖及临床应用

目的 :探索肩锁关节脱位的治疗方法 ,并为临床提供解剖学基础。方法 :在 30侧成年尸体上对喙突、肌皮神经、肱二头肌短头腱、喙肱肌、喙肩韧带的形态、血供进行了观察 ,设计了用肱二头肌短头肌腱或喙肱肌腱并喙肩韧带转位治疗肩锁关节脱位的术式 ,并在临床验证。结果 :(1 )肱二头肌短头腱、喙肱肌腱、喙肩韧带都有足够的长度向锁骨翻转修复喙锁韧带 ;(2 )翻转的肌腱与韧带弹性差 ,抗拉力及强度大 ;(3)肌腱翻转后对原有的功能影响不大 ;(4)临床应用 1 6例 ,1 2例获随访 ,疗效满意。结论 :用肱二头肌短头腱、肱喙肌腱、喙肩韧带转位修复肩锁关节脱位的术式 ,有其形态学基础 ,可以在临床上推广应用     

骨间前血管腕背支骨膜瓣移位修复骨不连的临床应用

报道用骨间前血管腕背支骨膜瓣移位修复骨不连、骨坏死的手术方法及疗效。方法：根据应用解剖学研究，设计以骨间前动脉腕背支为蒂的骨膜瓣，顺行移位修复尺、桡骨骨不连，逆行移位修复手舟骨、月骨不连与骨坏死。结果：临床应用19例，随访1年，在术后3～6月均达到骨愈合和骨坏死修复，关节活动功能明显改善。结论：骨间前血管腕背支为蒂的骨膜瓣移位术适合邻近骨不连、骨坏死修复。     

以骨间前血管为蒂前臂骨膜骨瓣的临床应用

应用骨间前血管为蒂.桡、尺骨骨膜骨瓣移位治疗上肢骨不连或骨缺损38例,均获得成功。该术式与以桡、尺动脉为蒂的桡、尺骨骨膜骨瓣移位相比较,有不损伤前臂主要血管干、移位范围大、适应症较广和操作简便易推广等特点.     

Insertion abnormality of bilateral pectoralis minimus

Bilateral insertion abnormality of pectoralis minimus (sterno-costo- coracoidian muscle) muscle was examined. The variant muscle was lying under the pectoralis major muscle and was medial to the pectoralis minor muscle. This muscle started from the first costal cartilage to the manubrium sterni and ended in the upper surface of the shoulder joint on the right side. On the opposite side, it took origin from the second costal cartilage to the manubrium sterni and the second costochondral joint, afterwards became a tendinous structure and divided into two on the coracoid process. The thicker part ended on the upper surface of the articular capsule of the shoulder joint, the thinner part inserted on the lateral third of inferior part of clavicle and fascia of subclavius muscle.     

Unusual attachment of the pectoralis minor muscle

The authors report a presumably unusual bony attachment of the pectoralis minor muscle in an adult cadaver. The specimen's left pectoralis minor had no attachment to the coracoid process of the scapula but attached directly to the fibrous capsule of the glenohumeral joint. Some have theorized that the coracohumeral ligament represents fibers of the pectoralis minor that attach to this bone in some animals but that has degenerated in man. This case report seems to support this possibility.     

Bilateral unfused coracoid process: report of a case.

The coracoid process is a part of the scapula and plays an important role in shoulder function. The present case demonstrates bilateral separation of the coracoid processes from the scapular bodies. The cause of this condition was thought to be a failure of fusion of the ossification centers of the coracoid processes with the scapular bodies. Bilateral unfused coracoid processes was identified incidentally in a patient with recurrent dislocation in the left shoulder. However, history of antecedent trauma to the coradoid region was not found. It would be important to distinguish this condition from fracture or nonunion of the coracoid process.     

Relationships of the musculocutaneous nerve and the coracobrachialis during coracoid abutment procedure (Latarjet procedure)

Purpose  The aim of this study was first to define first the anatomical relationships between the musculocutaneous nerve and the coracobrachialis, and then the induced modifications of these relationships by a preglenoid transposition of the vertical part of the coracoid process. Materials and methods  Twenty-one embalmed adult trunks and upper limb were dissected. First the coracobrachialis and the musculocutaneous nerve were identified through a deltopectoral approach. We measured the distances between the lateral cord of the brachial plexus and the entry point of the nerve, between the inferior tip of the tip of the coracoid process and the penetration of the nerve or its twigs, and finally the angle between the general axis of the coracobrachialis and the axis of the musculocutaneous nerve. The same measures were performed after the coracoid bone block abutment. Results  Proximal motor branches destined to the coracobrachialis varied from 0 to 3. Mean distance between the lateral cord of the brachial plexus and entry point of the nerve into the muscle was 47.2 mm before and 48.43 mm after the coracoid transfer. Mean angulations between the nerve and the muscle was 121° before and 136° after the transfer of the coracoid process. Mean distance between the inferior tip of the coracoid process and entry point of the nerve into the muscle was 55.7 mm, reduced to 48.6 mm after the coracoid transposition. Finally, the distance between the tip of the coracoid and the first motor twig entering the coracobrachialis was less than 50 mm in 75% of the cases with a mean value of 40.6 mm. Conclusions  Lesion of the musculocutaneous nerve is a known complication of the coracoid bone block abutment procedure (Latarjet–Bristow). From this study we know that they are due to lengthening of the nerve and modification of the penetration angle of the nerve into the coracobrachialis. We also infer that some motor nerve destined to the coracobrachialis might be damaged during the proximal medial release of the muscle after the detachment of the pectoralis minor muscle.     

Anomalous pectoral musculature

Anomalous disposition of pectoral muscles was encountered in an adult female cadaver on the left side. A prominent cleft separating the sternocostal and clavicular portions of the pectoralis major was noticed. The fibers of pectoralis major were partially fused with the deltoid, resulting in obliteration of the deltopectoral groove. Interestingly, cephalic vein was seen traversing superficial to the clavicular portion of the pectoralis major and pierced it to drain into the axillary vein. The pectoralis minor was inserted mainly on the coracoid process and few fibers were found blending with the coracobrachialis and short head of biceps brachii. Further, pectoralis minimus, a rare anatomic variant, was also observed lying superior to pectoralis minor. It was innervated by a twig from the lateral pectoral nerve at its superficial surface. Awareness of possibility of such anomalous muscles is important for surgeons operating on the chest wall.     

Coexistence of a pectoralis quartus muscle and an unusual axillary arch: case report and review

A pectoralis quartus muscle and an unusual axillary arch were found on the left side of a female cadaver. The axillary arch was a musculoaponeurotic complex continuous with the iliacal fibers of the latissimus dorsi. The muscular part, together with the tendon of pectoralis major, inserted into the lateral lip of the bicipital groove of the humerus, whereas the aponeurotic part was formed by a fibrous band that extended deep to the pectoralis major to insert into the coracoid process between the attachments of the coracobrachialis and pectoralis minor. The pectoralis quartus originated from the rectus sheath, and joined the inferior medial border of the fibrous band of the axillary arch, at the lateral edge of the pectoralis major. The axillary arch muscle crossed anteriorly the axillary vessels and the brachial plexus. The clinical importance of these muscles is reviewed.     

喙锁韧带重建中锁骨钻孔位置的数字解剖学

背景：经喙锁骨道的喙锁韧带重建是一种治疗肩锁关节脱位的有效方法,锁骨钻孔位置直接决定骨道的质量及治疗的成败。 目的：观察锁骨不同钻孔位置对喙锁韧带重建过程中骨道位置的影响。 方法：使用Mimics 13.0软件对60个肩部的CT影像资料进行重建得到喙锁结构模型。根据目前2种主流喙锁韧带重建方案的钻孔位置及一种作者提出的理想的钻孔位置在模型上虚拟手术建立骨道,并进行相关的测量以评估其安全性。方案1：钻孔位置距锁骨远端30 mm,位于锁骨表面前后缘的正中;方案2：钻孔位置距锁骨远端40 mm,位于锁骨表面前后缘的正中;方案3：与锥状结节尖端和喙突基底部的中点在同一直线上,在锁骨上表面的后缘。 结果与结论：重建方案1的喙突骨道在男性模型中过于偏内侧。重建方案1和2的骨道均不在锁骨正中。重建方案3的喙突及锁骨骨道均位于正中。以距离锁骨远端一个固定数值来确定钻孔位置的方法在男女性的模型中得到的骨道差异很大。锁骨端的钻孔位置应与锥状结节尖端和喙突基底部的中点在同一直线上,并且应靠锁骨上表面的后缘,才能保证喙突及锁骨骨道的居中。     

Anatomy of the coracohumeral and coracoglenoidal ligaments

The Ligg. coracohumerale and coracoglenoidale are constant anatomical structures, represented in all the 34 preparations investigated. The Lig. coracoglenoidale is a strong band of dense connective tissue, running from the Processus coracoideus to the Tuberculum supraglenoidale. In 27 specimens out of 34 it was the continuation of the M. pectoralis minor tendon. The Lig. coracohumerale consists of two separate parts. The “inferior part” originates from the Processus coracoideus and the Lig. coracoglenoidale, which separates it from the base of the coracoid process. It is composed of the joint capsule anteriorly and a remnant of the M. pectoralis minor tendon posteriorly. The “superior part” arises from the medio-posterior surface of the Processus coracoideus, just below the Lig. coracoacromiale. Both parts of the Lig. coracohumerale run into the shoulder joint capsule under the M. supraspinatus tendon and insert into a capsular semicircular band. According to the shape and course of fibres between the greater and lesser tubercles of the Humerus, we propose to name it the “Lig. semicirculare humeri”. None of the two parts of the Lig. coracohumerale begins from the base of the Processus coracoideus, and fibres of the Lig. coracohumerale do not reach the Tuberculum majus et minus directly.     

Anatomic and functional aspects of the kinetics of the shoulder joint capsule and the subacromial bursa

This anatomic study was devoted to the kinetics of the shoulder joint and especially the subacromial region. Following dissection of the shoulder joint capsule and subacromial region of 80 unpreserved shoulder joints, the anatomic relationships of the subacromial space in the neutral position and in continuous abduction (30°, 60° and 90° with fixed scapulae) were examined. These investigations were supplemented by histologic preparations. In the course of our examinations we discovered a gliding mechanism of the subacromial bursa. Moreover, we found a subcoracoid attachment of the shoulder joint capsule and a precoracoid ligamentous connection running between the short head of the biceps brachii m. and the coracoacromial ligament. We termed this the coracoid aponeurosis, which facilitates gliding behaviour of the shoulder joint capsule beneath the coracoid process. In view of this gliding mechanism of the subacromial bursa and the coracoid aponeurosis, discovered in the course of our investigations, we have to reassess the kinetics of the sub-acromial and subcoracoid space. Further, we should reconsider our operative technique in cases of the subacromial or subcoracoid impingement syndrome.