肩胛下角的解剖形态学分型及临床意义

doi:10.13418/j.issn.1001-165x.2018.02.003

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (2): 132-136.doi: 10.13418/j.issn.1001-165x.2018.02.003

肩胛下角的解剖形态学分型及临床意义

张磊^{1, 2}，　覃波^{1, 2}，　郭晓光^{1, 2}，　祁冀³，　徐燕笑³，　扶世杰^{1, 2}

1. 西南医科大学附属中医医院，四川泸州 646600； 2. 泸州市院士工作站，四川泸州 46600；
3. 南方医科大学中医药学院，广州 510515

收稿日期:2018-01-08 出版日期:2018-03-25 发布日期:2018-05-04
通讯作者: 扶世杰，主任医师，硕士生导师，Tel:13882759783，E-mail:fushijieggj@126.com
作者简介:张磊（1987-），博士，主治医师，研究方向：骨关节的基础和临床研究，E-mail:307501597@qq.com
基金资助:
四川省科技支撑计划项目（2014SZ0185）；四川省教育厅科研项目（17ZB0472）；泸州市院士工作站在建项目（20180101）；泸州市科技局科技计划项目（2016-176-13）

Anatomic classification of the inferior angle of scapula and its clinical significance

ZHANG Lei^{1, 2}, QIN Bo ^{1, 2}, GUO Xiao-guang ^{1, 2}, QI Ji ³, XU Yan-xiao ³, FU Shi-jie ^{1, 2}

1. Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China; 2. Academician Workstation in Luzhou, Sichuan Province 646000, China; 3. School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China

Received:2018-01-08 Online:2018-03-25 Published:2018-05-04

摘要/Abstract

摘要：

目的　研究肩胛下角的解剖形态学特点，从而探讨其解剖学意义。方法　选取275例人体干燥肩胛骨标本，设肩胛下角为a点，盂下结节为b点，肩胛冈与肩胛骨内侧缘交点为c点，肩胛上角为e点，冈盂切迹为f点，经a点做cf连线的垂线，与cf交于d点；用游标卡尺、量角器分别测量a点厚度（以肩胛下角最厚处为准），ab、ac、ad长度，∠bac、∠ace（肩胛骨解剖学意义上矢状面投影）、∠ace′（肩胛骨解剖学意义上冠状面投影）角度。结果　根据形态学特点发现肩胛下角分为3型：副角型（145，52.73%）、U型（87，31.64%）、V型（43，15.64%）。其中，副角型与V型在a点厚度、ab上有统计学差异（P<0.05）；副角型与U型，副角型与V型在ac上有统计学差异（P<0.05）；副角型与V型，U型与V型在ad上有统计学差异（P<0.05）；副角型与U型在∠ace′上有统计学差异（P<0.05）。此外，左右两侧肩胛下角在∠bac上有统计学差异（P<0.05）。结论　在本次实验中，发现肩胛下角存在三种形态学变异，以副角型为主，其解剖形态学分型具有一定的临床指导意义。

关键词: 肩胛下角, 　形态学变异, 　骨折, 　肌骨皮瓣

Abstract:

Objective　To study the morphology of the inferior angle of scapula, and to explore its clinical significance.　Methods　The inferior angle of scapulae were measured in 275 dry scapular bones. Reference points: a: inferior angle; b: inferior glenoid tubercle; c: the intersection of the medial edge of the scapula and the scapular spine; e: scapular angle; f: spinoglenoid notch; d: the intersection of the line cf and the vertical line through point a. The parameters of inferior angles of 275 dry scapular bones, including the thickness of point a (the thickest part of inferior angle of the scapula), the length of the line ab, line ac, and line ad, and the angle of ∠bac, ∠ace (the projection of the scapular sagittal plane), and ∠ace′(the projection of the scapular coronal plane), were observed and measured using Vernier caliper and Goniometer.　Results　The morphology of the inferior angle of scapulae can be divided into 3 types, namely, Accessory angle-type (145, 52.73%), U-type (87, 31.64%) and V-type (43, 15.64%). In terms of the thickness of point a and the length of line ab, there were significant differences between the Accessory angle-type and V-type (P<0.05). With regard to the length of line ac, Accessory angle-type revealed a significant difference compared with U-type (P<0.05), or V-type (P<0.05). In terms of the length of line ad, there was a significant difference between the Accessory angle-type and V-type (P<0.05); Meanwhile, a statistical difference was found in U-type and V-type (P<0.05). With respect to ∠ace′, there was a statistical difference between Accessory angle-type and U-type (P<0.05). Besides, regarding ∠bac, the inferior angle of scapular of the right side was statistically different from that of the left side (P<0.05).　Conclusion　The inferior angle of scapulae have three anatomical types, with the Accessory angle-type as the main type, and the morphology and classification of it are of certain clinical implication.

Key words: Inferior angle of scapula, 　Morphological variation, 　Fracture, 　Osteocutaneous flap

张磊,覃波,郭晓光,祁冀,徐燕笑,扶世杰. 肩胛下角的解剖形态学分型及临床意义[J]. 中国临床解剖学杂志, 2018, 36(2): 132-136.

ZHANG Lei, QIN Bo, GUO Xiao-guang, QI Ji, XU Yan-xiao, FU Shi-jie . Anatomic classification of the inferior angle of scapula and its clinical significance[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(2): 132-136.

参考文献

[1] Cooperstein R, Haneline M, Young M. The location of the inferior angle of the scapula in relation to the spine in the upright position: a systematic review of the literature and meta-analysis [J]. Chiropractic & Manual Therapies, 2015, 23(1): 1-8.
[2] Da CB, Armijoolivo S, Gadotti I, et al. Reliability of scapular positioning measurement procedure using the palpation meter (PALM) [J]. Physiotherapy, 2010, 96(1): 59-67.
[3] Lapner P, Uhthoff HS. Scapula fractures [J]. Orthopedic Clinics of North America, 2008, 39(4): 459-474.
[4] Noguchi T, Mautner J F, Duncan S. Dorsal Plate Fixation of Scapular Fracture [J]. Journal of Hand Surgery, 2017, 42(10): 843.e1-843.e5.
[5] Chang AC, Phadnis J, Eardleyharris N, et al. Inferior angle of scapula fractures: a review of literature and evidence-based treatment guidelines [J]. Journal of Shoulder and Elbow Surgery, 2016, 25(7): 1170-1174.
[6] Akcal A, Gorgulu T, Savas SA, et al. Circumflex scapular artery myocutaneous and/or vascularized scapular chimeric flap [J]. Journal of Surgical Research, 2016, 206(1): 126-132.
[7] Ho MW, Brown JS, Shaw RJ. Refining the indications for scapula tip in mandibular reconstruction [J]. International Journal of Oral & MaxilloEACial Surgery, 2017, 46(6): 712-715.
[8] Sundine MJ, Sharobaro VI, Ljubic I, et al. Inferior angle of the scapula as a vascularized bone graft: an anatomic study [J]. J Reconstr Microsurg. 2000;16(3):207-211.
[9] Min KD, Hwang SH, Kim JB, et al. Treatment of Scapula Fractures of the Inferior Angle Causing Pseudowinging Scapula [J]. Journal of the Korean Orthopaedic Association, 2014, 49(2): 165-171.
[10]Ferrari S, Ferri A, Bianchi B, et al. Donor site morbidity after scapular tip free flaps in head-and-neck reconstruction [J]. Microsurgery, 2015, 35(6): 447-450.
[11]Dietrich TJ, Agten C A, Fürnstahl P, et al. The Legend of the Luschka Tubercle and Its Association With Snapping Scapulae: Osseous Morphology of Snapping Scapulae on CT Images [J]. AJR Am J Roentgenol,2017, 209(1):159-166.
[12]Shahar D, Sayers M G L. A morphological adaptation? The prevalence of enlarged external occipital protuberance in young adults [J]. Journal of Anatomy, 2016, 229(2): 286-291.
[13]Dua K, Barsi J M. Heterotopic Ossification of the Peroneus Brevis Tendon in a Pediatric Patient [J]. J Foot Ankle Surg, 2017, 56(6):1316-1319.
[14]Grenier G, Élisabeth Leblanc, Faucheux N, et al. BMP-9 expression in human traumatic heterotopic ossification: a case report [J]. Skeletal Muscle, 2013, 3(1): 1-29.
[15]Matsuo K, Irie N. Osteoclast-osteoblast communication [J]. Archives of Biochemistry & Biophysics, 2008, 473(2): 201-209.
[16]Kim HY, Mohan S. Role and Mechanisms of Actions of Thyroid Hormone on the Skeletal Development [J]. Bone Research, 2013, 1(2): 146-161.
[17] Xing W, Cheng S, Wergedal J, et al. Epiphyseal chondrocyte secondary ossification centers require thyroid hormone activation of Indian hedgehog and osterix signaling [J]. J Bone Miner Res, 2014, 29(10):2262-2275.
[18]Hayashi H, Fischer H. Incidental Anterior Cruciate Ligament Calcification: Case Report [J]. J Radiol Case Rep, 2016,10(3):20-27.
[19]Diaz MF, Vaidya AB, Evans SM, et al. Biomechanical forces promote immune regulatory function of bone marrow mesenchymal stromal cells [J]. Stem Cells, 2017, 35(5): 1259-1272.
[20]Zhang J, Valverde P, Zhu X, et al. Exercise-induced irisin in bone and systemic irisin administration reveal new regulatory mechanisms of bone metabolism [J]. Bone Research, 2017, 5(1): 49-62.
[21]Burke CS, Roberts CS, Nyland JA, et al. Scapular thickness-implications for fracture fixation [J]. Journal of shoulder and elbow surgery, 2006, 15(5): 645-648.
[22]Von Schroeder HP, Kuiper SD, Botte MJ. Osseous anatomy of the scapula [J]. Clin Orthop Relat Res. 2001, (383):131-139.
[23]Park IH, Chung CH, Yong JC, et al. Clinical Experiences with the Scapular Fascial Free Flap [J]. Archives of Plastic Surgery, 2016, 43(5): 438-445.
[24]Turan A, Tuncel U. Scapular Bone Grafts: Good Options for Craniofacial Defects[J]? Ann Plast Surg, 2014, 00(00): 1-8.
[25]Stephens BF, Hebert CT, Azar F M, et al. Optimal baseplate rotational alignment for locking-screw fixation in reverse total shoulder arthroplasty: a three-dimensional computer-aided design study [J]. J Shoulder Elbow Surg. 2015, 24(9):1367-1371.
[26]Suter T, Henninger HB, Zhang Y, et al. Comparison of measurements of the glenopolar angle in 3D CT reconstructions of the scapula and 2D plain radiographic views [J]. Bone & Joint Journal, 2016, 98-B(11): 1510-1516.
[27]李建赤, 黄必留, 梁江声,等. 肩胛骨结构特点与骨折不同内固定手术疗效的分析 [J]. 中国临床解剖学杂志, 2012, 30(5): 573-575.
[28] 叶林根, 黄海华, 周富根,等. 肩胛骨骨折内固定的应用解剖 [J]. 中国临床解剖学杂志, 2004, 22(5): 525-527.
[29] Pagedar NA, Gilbert RW, Chan H, et al. Maxillary reconstruction using the scapular tip free flap: a radiologic comparison of 3D morphology [J]. Head & Neck, 2012, 34(10): 1377-1382.
[30] Yoo J, Dowthwaite SA, Fung K, et al. A new angle to mandibular reconstruction: The scapular tip free flap [J]. Head & Neck, 2013, 35(7): 980-986.
[31] Distefano JG, Park AY, Nguyen TQD, et al. Optimal screw placement for base plate fixation in reverse total shoulder arthroplasty [J].J Shoulder Elbow Surg, 2011, 20(3):467-476.
[32] Cole BJ, Sayegh ET, Yanke AB, et al. Fixation of Soft Tissue to Bone: Techniques and Fundamentals [J]. J Am Acad Orthop Surg, 2016, 24(2):83-95.

肩胛下角的解剖形态学分型及临床意义

Anatomic classification of the inferior angle of scapula and its clinical significance

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 12

Metrics

本文评价

推荐阅读 0

[1]	黄海, 欧阳钧. 内固定治疗成人股骨颈骨折的研究进展[J]. 中国临床解剖学杂志, 2023, 41(6): 751-753.
[2]	杨华, 向磊, 蒋红兵, 胡兵兵, 曾参军, 张彬, 刘伟. 改良腹直肌旁入路与改良Stoppa入路治疗髋臼骨折临床疗效比较[J]. 中国临床解剖学杂志, 2023, 41(5): 603-607.
[3]	常树森, 何春念, 陈伟, 周健, 张芳, 聂开瑜, 邓呈亮, 魏在荣. 旋股外侧动脉降支Flow-through皮瓣联合MIPPO于急诊胫腓骨Gustilo IIIC型骨折中的应用研究[J]. 中国临床解剖学杂志, 2022, 40(6): 733-737.
[4]	彭昌贵, 罗鹰, 蓝国湖, 李日旺, 袁志坤, 包国庆, 李旭明, 潘剑英. 股骨干骨折三维闭合复位器的研制与临床应用[J]. 中国临床解剖学杂志, 2022, 40(5): 605-609.
[5]	吴铭杰, 庄伟达, 郑杰, 李修往, 陈敏, 樊晓海, 吴家昌, 桑宏勋. 计算机导航系统辅助置入空心螺钉内固定术治疗股骨颈骨折[J]. 中国临床解剖学杂志, 2021, 39(4): 454-459.
[6]	范辉, 陈代全, 张勤, 吴启龙, 施建兴, 高飞, 包其能, 伍维昌. 骨水泥封闭经皮克氏针外固定支架治疗第5掌骨颈骨折疗效[J]. 中国临床解剖学杂志, 2021, 39(1): 105-107.
[7]	赵虹瑾, 刘洋, 李静, 张磊. 冈盂切迹的解剖形态学测量及临床意义[J]. 中国临床解剖学杂志, 2019, 37(3): 245-248.
[8]	吴耿,张振伟,张美超,李征. 钢板骨折区增加螺钉帽对胫骨骨折内固定影响的有限元分析[J]. 中国临床解剖学杂志, 2019, 37(2): 185-189.
[9]	郭晓光,关钛元,张磊,扶世杰,周鑫,刘刚,陈跃. 少阳生骨方对SD大鼠胫骨骨折断端18F-NaF分布的影响[J]. 中国临床解剖学杂志, 2018, 36(5): 545-550.
[10]	许博文，张青松，安思琪，裴宝瑞，李浩，戴世龙，吴啸波. 髋臼前壁骨折模型的建立及不同内固定方式的生物力学稳定性比较[J]. 中国临床解剖学杂志, 2017, 35(4): 425-430.
[11]	张宜, 邓羽平, 王勉, 谭晋川, 欧阳汉斌, 黄文华. 基于3D偏差分析的成人桡骨远端解剖对称性研究[J]. 中国临床解剖学杂志, 2017, 35(4): 388-393.
[12]	何哲, 乔贵宾, 欧阳钧. 国人第3~7肋影像解剖学测量及其临床意义[J]. 中国临床解剖学杂志, 2015, 33(1): 33-36.