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。

Anatomic research on needle-knife minimally invasive surgery in the treatment of suprascapular nerve entrapment

Objective To observe and measure the superior transverse scapular ligament, suprascapular artery, suprascapular nerve and their supraspinatus branches and provide anatomic data for needle-knife treatment of suprascapular nerve entrapment. Methods The superior transverse scapular ligament, suprascapular artery, suprascapular nerve and their supraspinatus branches were dissected firstly; Then the length, width and thickness of the superior transverse scapular ligament were measured; The position relation of the artery and nerve correlated to superior transverse scapular ligament were observed and their diameter were measured too; Based on the bony surface at the inferior point of the medial attachment of the superior transverse scapular ligament, the puncture point on the body surface and the depth of puncture were determined. Results The superior transverse scapular ligament is narrow and thick at the middle part, wide and thin at medial and lateral attachments. Its inferior border is about (0.901 ±0.234)cm long; All the suprascapular nerves and 16.67% of the suprascapular arteries run through the scapular notch beneath the ligament, the other 83.33% cross the ligament superiorly and laterally outside the notch; The supraspinatus branch of Suprascapular nerve run into supraspinatus at the superomedial corner of the scapular notch ; The locating angle of puncture on body surface is (24.102±3.681)°, and the depth of puncture is (4.342±0.629)cm; The locating distance can be calculated according to the regression equations:Y= 2.560+0.615X. Conclusion It’s an optimal approach to disconnect the superior transverse scapular ligament from the inferior border at the medial part of the ligament along a superomedial direction, which can protect the artery superolateral to the ligament and nerve inferior to the ligament from injure , and can remove suprascapular nerve entrapment effectively. The linear regression equation can make the puncture more accurate.