喙肱韧带的应用解剖

目的:探讨喙肱韧带(coracohumeral ligament,CHL)的解剖学特点。方法:观察20侧正常成人肩关节标本的CHL位置、形态、起止点及与盂肱上韧带的关系;CHL在肩关节各种活动中所处的状态;CHL与关节囊融合处、CHL根部组织、关节囊及喙肩韧带组织学特点。结果:20侧CHL全部起于喙突基底部的外侧缘;9侧止于冈上肌腱,7侧止于肩袖间隙,3侧止于冈上肌腱和肩胛下肌腱,1侧止于肩胛下肌腱;其中11侧可见CHL与盂肱上韧带存在纤维组织连接;CHL于肩关节旋外、前屈、后伸、内收、肱骨头前后平动时紧张,于旋内、中立位、外展位时松弛;CHL与关节囊融合处、CHL根部组织与关节囊组织学特点相似,均呈现关节囊组织的典型特点,喙肩韧带呈现出韧带的特有表现。结论:CHL位置与形态相对固定,起点一致,但止点呈多样性;CHL与盂肱上韧带复合体不固定;CHL在不同运动状态其紧张度不一;CHL与关节囊组织形态相似,是关节囊增厚部。     

健康志愿者肩关节肱二头肌长头肌腱位置、方向及形态学的MRI测量

背景：以往的研究中仅对肱二头肌长头肌腱在肱二头肌腱沟入口偏离度进行定性描述,未进行定量测量。 目的：通过分析健康志愿者肩关节中立位、外旋位和内旋位MRI之轴位图像上肱二头肌长头肌腱位置、方向及形态学改变,探讨肱二头肌长头肌腱 MRI形态学特征以利临床评价肱二头肌长头肌腱。 方法：纳入35名无症状志愿者,在肩关节中立位、外旋位、内旋位进行MR扫描。2名评价者对MR图像进行评价,排除标准为具有肩袖、喙肱韧带、上盂肱韧带、滑车韧带病灶或退行性改变者。一名测量者在轴位3D WATSc序列的上、中、下3个测量层面上对肱二头肌长头肌腱位置、方向及形态进行测量。 结果与结论：健康志愿者肩关节中立位、外旋位和内旋位MR轴位图像上肱二头肌长头肌腱改变结果：①肱二头肌长头肌腱位置：中立位肱二头肌长头肌腱在内外方向的偏离度最大。②肱二头肌长头肌腱方向：肱二头肌长头肌腱的方向角度均为锐角,在中、下测量层面上,肩关节3个体位的肱二头肌长头肌腱角度之间的差异具有显著性意义。③形态：在下测量层面上,肩关节3个体位肱二头肌长头肌腱形态的改变具有显著性意义。结果显示健康志愿者肱二头肌长头肌腱位置、方向、形态与肩关节旋转体位具有潜在关联。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

肩袖间隙的解剖学研究及其临床意义

目的：研究肩袖间隙的组成部分和解剖学特点，及其在肩关节运动中的稳定机制。方法：在12具成人尸体24例肩关节标本上，解剖观察肩袖间隙的位置、组成和形态学特点，以及在肩关节活动中的稳定作用。结果：肩袖间隙是冈上肌腱与肩胛下肌腱之间的三角形区域，主要由喙肱韧带和盂肱上韧带组成；在肩内收位时有限制肩关节外旋和肱骨头下移的作用。结论：①肩袖间隙结构的研究对于RI病变的临床诊治具有重要意义；②肩袖间隙损伤后的修补对于维持肩关节稳定具有重要作用。     

肱二头肌多肌腹伴额外肌异常1例

在教学中发现,一成年男尸左臂的肱二头肌多肌腹伴额外肌异常1例。异常肱二头肌与额外肌呈五条分离条索状肌腹,经解剖学追踪发现,肱二头肌短头起于肩胛骨喙突,长头出现异常三肌腹均起于肩胛骨盂上结节;长头三肌腹汇合成一肌腱与短头的肌腱呈“Y”字形止于桡骨粗隆,额外肌肌腹起于肱骨中上三分之一,行于肱二头肌长头与短头间,止于肱骨下端。五条肌腹间可见肌皮神经穿行其中,正中神经外侧根发分支行于肱二头肌长头下方(图1)。     

成人结节间滑液鞘和肩峯下囊的观测

为肩周炎有关诊治提供结节间沟滑液鞘和肩峰下囊的资料,本文观测了30侧成人肩关节标本,剖检前用有色明胶溶液分别注射到肩峰下囊和肩关节腔内。 一:结节间沟滑液鞘 肱二头肌长头腱起自肩胛骨盂上结节,通过肩关节的关节腔,其腱周包有滑膜,并随肌腱伸出关节囊达给节间沟处,即结节间滑液鞘。从肱骨大结节上缘中点开始测量,此鞘平均长度4.4cm,均与肩关节腔相通。结节间沟的沟嵴上有薄层横韧带将肌腱限制在沟内。     

肱二头肌短头腱喙肱肌腱喙肩韧带重建喙锁韧带的应用解剖

目的为肱二头肌短头腱、喙肱肌腱和喙肩韧带复合转位修复肩锁关节脱位提供解剖学基础.方法用50侧成人尸体标本,对喙锁韧带(锥状韧带和斜方韧带),肱二头肌短头腱、喙肱肌腱、喙肩韧带的形态结构进行解剖学观察.结果锥状韧带基底宽(1.3±0.3)cm,高(1.5±0.4)mm,斜方韧带长、宽、厚分别为(1.1±0.2)、(1.3±0.2)、(2.4±0.8)mm;肱二头肌短头和喙肱肌联合腱的长、宽、厚分别为(7.1±0.7)、(1.7±0.4)、(1.1±0.3)mm;喙肩韧带前、后缘长为(3.1±0.5)、(2.5±0.2)cm,喙锁间隙为(0.5±0.1)cm.结论以肱二头肌短头腱、喙肱肌腱和喙肩韧带复合转位重建喙锁韧带可有效地治疗肩锁关节脱位.     

肱三头肌额外头异常一例

解剖发现肱三头肌起始处异常1例。该尸为中年女性,其左侧肱三头肌起始处共有4个头,长头起自肩胛骨的盂下结节,外侧头和内侧头分别起自肱骨桡神经沟的外上方和下方,在长头和外侧头之间的额外头起于肩胛冈中部,四头汇合形成肌腹,以肌腱止于尺骨鹰嘴,桡神经的一分支在额外头与外侧     

肱二头肌联合腱部分转位治疗肩锁关节脱位

目的：探索利用肱二头肌短头及喙肱肌联合腱部分转位重建喙锁韧带治疗新鲜或陈旧肩锁关节脱位的临床价值。方法：在同一切口内，切取肱二头肌短头及喙肱肌联合腱额面部分，经锁骨外端性状结节骨性隧道反折固定原位重建喙锁韧带，同时以张力带钢丝固定治疗新鲜或陈旧性肩锁关节完全脱位。结果：本组24例，随访22例，均复位良好，无反遗疼痛，肩关节活动正常。结论：利用肱二头肌短头及喙肱肌联合腿部分转位重建喙锁韧带治疗肩锁关节脱位，手术操作简便，安全可靠，创伤小，疗效好，是治疗肩锁关节脱位的一种可行方法。     

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     

肱三头肌额外头多肌腹异常1例

在教学中发现,肱三头肌额外头多肌腹异常1例。该成年男尸左臂肱三头肌长头上方出现额外头,额外头起于肩胛冈外侧端,止于肱骨外科颈稍下方。肱三头肌长头异常发达,起于盂下结节,其肌纤维由内上向外下走行,呈螺旋状,内外侧头均有异常双肌腹出现,外侧头双肌腹均起于肱骨桡神经沟上外,内侧头两条肌腹并列起于桡神经沟下内,独立走行,在尺骨鹰嘴上方汇合成一条肌腱与长头和外侧头的肌腱共同止于尺骨鹰嘴(图1)。肌腹间均可见桡神经的分支,其中支配内侧头的分支为桡神经穿桡神经管后发出,当肱骨中部骨折,损伤桡神经时,除出现垂腕,同时会伴有屈肘力减弱的症状。     

Transverse humeral ligament: Does it exist?

The insertion of the tendon of subscapularis is accepted as being on the lesser tubercle of the humerus. The transverse humeral ligament (THL) is described as a distinct entity in most textbooks, overlying the long tendon of biceps as it emerges from the capsule of the shoulder joint. In this study, we dissected 85 embalmed shoulders to clarify the anatomy of the THL and variation in the insertion of the tendon of subscapularis. In all specimens no distinct THL could be identified, but in every shoulder a fibrous expansion arose from the posterior lamina of the tendon of pectoralis major overlying the long tendon of biceps. In 86% of shoulders, fibres from the tendon of subscapularis passed over the long tendon of biceps within this fibrous expansion and inserted on to the greater tubercle of the humerus where one would expect to find the THL. In 33% of dissections, fibres from the tendon of subscapularis lay deep to the long tendon of biceps, inserting either into the bicipital groove or on to the greater tubercle. In only 8% of cases did the tendon of subscapularis insert exclusively on to the lesser tubercle. We conclude that the THL does not exist as a separate entity. We suggest that in the majority of cases, the structure overlying the long tendon of biceps as it emerges from the capsule of the shoulder joint consists of tendinous fibres from subscapularis, contained within a fibrous expansion derived from the posterior lamina of the tendon of pectoralis major. In the minority of shoulders, where the tendon of subscapularis inserts exclusively on to the lesser tubercle, we hypothesise that this fibrous expansion acts as a retinaculum preventing the long tendon of biceps from "bowstringing."     

Absence of the long head of the biceps tendon associated with glenoid dysplasia and posterior labral tear

Anatomic variations in the insertion of the long head of the biceps tendon and superior labral complex have been described (Erickson et al. [1992] AJR Am. J. Roentgenol. 158:1091-1096; Kreitner et al. [1998] AJR Am. J. Roentgenol. 170:599-605; Mariani et al. [1997] Arthroscopy 13:499-501; Vangsness Jr. et al. [1994] J. Bone Joint Surg. Br. 76:951-954). To the authors' knowledge, there have been only five reported cases of congenital absence of the long head of the biceps tendon. Three of these cases were associated with anterior shoulder instability, one with a superior labral anterior posterior lesion and one simply with shoulder pain. This is the first reported case of congenital absence of the biceps tendon associated with glenoid dysplasia and a posterior labral tear.     

The role of soft tissues in downward stability of the glenohumeral joint--an experimental study with fresh cadavers

Inferior stabilizing mechanism was studied after anatomical dissection of vertical stabilizing tissues in 98 fresh shoulder joints from human autopsies and measuring relative restraint by stabilizing tissues in 8 fresh shoulder specimens from monkeys. This results demonstrated that the coracohumeral ligament and supraspinatus tendon were most important structure as static and dynamic stabilizers, and closely interacted with each other in preventing inferior subluxation of the glenohumeral joint.     

Role of the long head of the biceps brachii muscle in axial humeral rotation control

This anatomical and biomechanical study focuses on the specific influence of the long head of biceps brachii muscle in controlling axial humeral rotation. The tendon of the long head of the biceps brachii (biceps tendon) is shown to either facilitate or restrict axial humeral rotation. Its effect on axial humeral rotation is strongly related to firstly the amount of biceps tendon load, secondly glenohumeral scapular plane elevation, and thirdly the rotatory position of the humerus. At 0° glenohumeral elevation, biceps tendon load caused an increase of internal humeral rotation, from 0° at 2.25 N biceps tendon load to 23° at 82.25 N. Under 45° glenohumeral elevation, biceps tendon load can restrict and facilitate as well internal and external axial humeral rotation, increasing the rotatory range of motion. Above 45° glenohumeral elevation biceps tendon load restricts internal and external axial humeral rotation, increasing actively joint stability by increasing torsional rigidity. These findings on the function of the biceps tendon could have consequences for the clinical interpretation. In the elevated arm position, extreme rotation loads the long head of the biceps tendon and may turn out to biceps or bicepslabrum complex injuries.     

背阔肌腱下滑囊炎的应用解剖研究

目的    为临床诊治背阔肌腱下滑囊炎提供应用解剖学基础。  方法　20侧成人肩关节标本（右11侧、左9侧），对背阔肌腱下滑囊及与其邻近易误诊的解剖结构进行观测。  结果　背阔肌腱下滑囊位于肱骨结节嵴间沟底、肱骨小结节嵴、大圆肌附着部与背阔肌腱止点之间。肱骨结节间沟可分为肱骨大、小结节间沟和大、小结节嵴间沟，确定该滑囊的上下位置，即从肱骨小结节最高点至背阔肌腱下滑囊上端距离为（27.43±4.71）mm，可以确定该滑囊的上下位置，背阔肌腱下滑囊的内外位置关系，从肱二头肌长头腱内侧缘距背阔肌腱下滑囊中点为（8.12±1.23）mm，可以确定该滑囊的内外位置关系。背阔肌腱下滑囊的相关数据，在肱骨结节嵴间沟上、下高度为（36.5±4.79）mm，中点宽度为（8.62±1.83）mm。背阔肌腱下滑囊周围易发生炎症的有肱二头肌长头腱滑液鞘、大圆肌腱下滑囊、喙突下滑囊、胸大肌骨管等。  结论　本研究为背阔肌腱下滑囊的诊疗提供了形态学依据。     

肱骨二头肌沟及其腱鞘的观察

在181侧成人干燥肱骨及30侧上肢标本观察了二头肌沟的形态及肱二头肌长头腱鞘的构造。沟可分为浅沟、中间及深沟型。沟内侧壁与肌腱的关系更为密切。小结节上方有一滑膜皱襞加强内侧壁。腱鞘的内侧壁长于外侧壁。讨论了其功能和临床意义。