胸小肌喙突骨瓣移位修复肩锁关节脱位的解剖与临床

为带蒂胸小肌喙突骨瓣移位修复肩锁关节脱位提供解剖学依据。在30侧经动脉内灌注红色乳腔的成人尸体标本上，解剖观测胸小肌的形态、血供和神经分布特点。设计并应用胸小肌喙突骨瓣向上移位至锁骨修复肩锁关节脱位的新术式。临床应用8例，经1．5-2．5年的随访后，肩锁关节脱位未有复发，肩关节功能正常，证实该术式是治疗肩锁关节脱位的有效方法。     

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。     

双侧胸小肌止点变异1例

在解剖一具６０岁左右男性尸体过程中,发现其双侧胸小肌止点变异,报道如下：其双侧胸小肌起点正常,起于第３、４、５肋骨前面;止点以肩胛骨喙突为滑车,以肌腱绕过喙突在冈上肌肌腱上方止于内侧肩关节囊的内层。腱长度为３ｃｍ。在胸小肌肌腱绕行喙突的行程中,有一束增厚的扇形纤维将该肌腱与喙锁韧带相连。胸小肌血液供应是来自胸肩峰动脉和胸外侧动脉,神经支配为胸前神经。作者单位：１１６０２７　大连医科大学生物塑化研究所附图　双侧胸小肌止点变异双侧胸小肌止点变异1例@孟文件!116027$大连医科大学生物塑化研究所@常宝林!1160…     

胸小肌移位修复习惯性肩关节前脱位的应用解剖

在１５具（３０侧）新鲜尸体标本上解剖观测了胸小肌的形态、血供和神经支配。胸小肌血供主要来自胸肩峰动脉的胸肌支，外径约１．６±０．４ｍｍ，长约４．７±０．９ｃｍ．胸小肌主要由胸内侧神经支配，神经长５．２±１．０ｃｍ，横径为１．２±０．４。血管神经从胸小肌的中、外１／３处入肌。依据解剖学观察，设计将胸小肌止点连同喙突切取，移位固定到肱骨上端治疗习惯性肩关节前脱位１０例，术式设计符合力学原理，且对胸小肌     

胸锁乳突肌锁骨头锁骨瓣修复下颌骨缺损的应用解剖

目的:为带胸锁乳突肌锁骨头为蒂锁骨瓣移位术提供解剖学基础。方法:在40侧成人尸体标本上,解剖观察胸锁乳突肌的形态,血供来源,分布特点及其与锁骨的关系;2例新鲜标本上作模拟术式。结果:胸锁乳突肌血供丰富,其锁骨头的主要血供为甲状腺上动脉胸锁乳突肌支,外径1.52±0.1mm,其入肌点相当于胸锁乳突肌前缘中下1/3交界处;锁骨内侧端主要血供由甲状腺上动脉胸锁乳突肌支(82.5%)的骨膜支及其与颈横动脉(10%)或肩胛上动脉的锁骨支(2.5%)构成的丰富吻合支供血。结论:以胸锁乳突肌锁骨头带半片锁骨瓣转位修复下颌骨缺损是可行的。     

背阔肌多止端1例

在解剖一具成年女尸时，发现其左侧背阔肌有3处止端，分别位于肱骨小结节嵴、胸大肌止端腱和肩胛骨喙突。此种变异少见，现报道如下：     

胸大肌胸肋部肌蒂胸肋骨(膜)瓣移位术的应用解剖

目的:为带胸大肌胸肋部肌蒂骨(膜)瓣转位术提供解剖学依据。方法:在30侧成人尸体标本上,观测了胸大肌胸肋部的形态、血供及其与胸肋骨的关系。结果:胸肋部肌腹上缘长(18.8±1.3)cm,下缘长(19.5±1.4)cm,中部长(20.2±1.2)cm,止腱长)1.1±0.2)cm,肌蒂游离长度为(16.8±0.9)cm,血供主要来自胸肩峰动脉胸肌支,其外径(1.8±0.2)mm,长度为(5.6±0.6)cm,其分支在肌内沿肌束走行。结论:可设计艺胸大肌胸肋部为蒂带肋软骨膜、胸骨骨瓣转位修复锁骨不连、锁骨肩峰端及顽固性肱骨骨不连。     

肩胛上血管肩峰支肩胛冈骨瓣移位术的应用解剖

目的:为锁骨肩峰端骨不连修复提供新的手术方法。方法:在40侧成人尸体标本上,解剖观测肩胛上血管肩峰支的走行、分支及分布;1 侧标本上摹拟手术设计。结果:肩峰支自肩胛上动脉发出后,向外走行于斜方肌、冈上肌之间,穿斜方肌在肩峰处的附着点达肩峰,并与胸肩峰动脉的肩峰支吻合构成肩峰动脉网。其长度为4.6±1.1cm,外径1.7±0.4mm。其主要分支肩胛冈支外径0.8±0.1mm,长度2.0±0.5cm。结论:可以肩峰支为蒂设计切取肩胛冈骨瓣移位修复锁骨肩峰端骨不连。     

肩胛上血管肩峰支肩胛冈骨瓣移位术的应用解剖

目的为锁骨肩峰端骨不连修复提供新的手术方法.方法在40侧成人尸体标本上,解剖观测肩胛上血管肩峰支的走行、分支及分布;1侧标本上摹拟手术设计.结果肩峰支自肩胛上动脉发出后,向外走行于斜方肌、冈上肌之间,穿斜方肌在肩峰处的附着点达肩峰,并与胸肩峰动脉的肩峰支吻合构成肩峰动脉网.其长度为4.6±1.1cm,外径1.7±0.4mm.其主要分支肩胛冈支外径0.8±0.1mm,长度2.0±0.5cm.结论可以肩峰支为蒂设计切取肩胛冈骨瓣移位修复锁骨肩峰端骨不连.     

左侧胸大肌多止点变异一例

正笔者在解剖1具成年男性尸体标本时,发现其左侧胸大肌以肌腱、腱膜形式止于肱骨、喙突等多处,现报道如下。笔者发现,该具标本其胸大肌上部约1/3的肌束先平行向外,进而稍向下,以肌腱结构止于肱骨大结节嵴,肌腱长     

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.     

基于MRI喙锁韧带的解剖学参数分析

目的　研究喙锁韧带的形态特点及其对骨隧道建立的指导意义。 方法　收集2017年1月1日至2020年1月1日480例肩胛骨MRI扫描数据,在斜冠状位和斜矢状位图像上测量4个角度和7个距离,并采用SPSS 20.0进行分析。 结果　在斜冠状位图像上,肩锁关节中点到锁骨钻孔点的距离男性平均值大于女性,有统计学差异（P<0.05）;在斜矢状位图像上,男性的喙锁韧带锁骨附着处中心到喙突附着处中心的距离,喙锁韧带锁骨附着处中心到喙突尖端的距离,锁骨上表面的中点到喙突下表面最远端的距离,喙锁韧带锁骨附着处直径平均值均大于女性,差异有统计学意义（P<0.05）。 结论　这些解剖参数能够完整地描述喙锁韧带的解剖学特征,指导骨隧道的准确建立,利于对肩锁关节脱位的个体化治疗。     

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.     

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.     

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.     

Coracoclavicular ligament attachment regions of the Chinese population: a quantitative anatomic study

It is reported that the coracoclavicular (CC) ligaments arise at a constant region, which is proportional to the size of the clavicle and the coracoid process. However, all cadavers in those studies were from whites or African-Americans. The aim of this study was to evaluate dimension and orientation of CC footprints in Chinese cadavers and to determine whether race-dependent differences in these measurements exist. A total of 172 shoulders from 87 Chinese cadavers were used in this study, and the CC ligaments including the coracoid and the lateral clavicle were exposed. After measurement of the length of the CC ligaments, the ligaments were dissected and the insertion sites as well as the footprint centers were identified and marked. Each CC insertion dimension and its distance to the bony landmarks were recorded. Ratios representing the distance from the clavicular landmarks to each footprint center divided by clavicular length and clavicular width were calculated. These ratios were calculated for the coracoid process as well. The mean length of the clavicle and the coracoid process was 139.9 ± 9.4 and 40.5 ± 4.0 mm. The distance from the lateral edge of the clavicle to the conoidal center and to the trapezoidal center was 35.7 ± 3.4 and 21.8 ± 2.7 mm, respectively. The distance from the tip of the coracoid to the conoidal center and to the trapezoidal center was 35.1 ± 3.2 and 29.7 ± 2.9 mm, respectively. The ratios of the distance to the conoidal center and to the trapezoidal center divided by clavicular length and coracoidal length were 25.5, 15.6, 86.8 and 73.4 %, respectively. While absolute differences in the origin of the CC ligaments exist between different races, the ratio of these origins to the size of the clavicle and the coracoid process is constant.     

胸小肌移植重建拇对掌功能的临床解剖研究

目的:为吻合血管神经的选择性胸小肌移植重建拇对掌功能术式提供解剖学依据。方法:在20侧成人胸部及手部标本中,解剖观察胸小肌的血管神经分布及胸小肌和大鱼际肌的形态、大小并将二者进行比较;然后按照大鱼际肌纤维走行方向,参考血管神经位置,将胸小肌修剪合适后移植固定于同侧手部大鱼际,模拟正常手部拇对掌功能予以牵拉,观察标本手部拇对掌过程。结果:胸小肌位置恒定,具备独立的动、静脉和神经支配;有针对性地选择部分胸小肌进行移植模拟,获得了标本手部的拇对掌过程。结论:在标本上选取部分胸小肌移植于手部大鱼际重建拇对掌功能的术式是可行的。     

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.     

胸大肌、胸小肌的肌梭形态、分布及其与梭外肌纤维型的关系

目的：探讨人胸大肌、胸小肌肌梭的形态、分布及其与梭外肌纤维型的关系。方法：用HE染色结合体视学方法并肌球蛋白ATPase染色，观察肌梭形态、分布及肌纤维型构成。结果：胸大肌锁骨部和胸小肌肌梭密度较高，存在较多的肌梭联合体，Ⅰ型肌纤维比例高于Ⅱ型。结论：肌梭在不同肌之间以及同一肌各亚部之间密度不等，肌梭密度较高部位，肌梭以联合体形式存在的比例较高，梭外肌纤维以Ⅰ型占优势。