肱骨大结节上方的解剖分型及临床意义

doi:10.13418/j.issn.1001-165x.2021.05.003

PDF(1507 KB)

中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (5) : 513-517. DOI: 10.13418/j.issn.1001-165x.2021.05.003

应用解剖

肱骨大结节上方的解剖分型及临床意义

张磊¹，何雪²，周鑫¹，熊鹿静²，张梦瑶²

作者信息 +

Clinical anatomical study on the classification of the superior aspect classification of the greater tuberosity

Zhang Lei¹, He Xue², Zhou Xin¹, Xiong Lujing², Zhang Meng-yao²

Author information +

文章历史 +

摘要

目的通过对肱骨大结节上面观的形态学分型，探讨其临床意义。方法将296例肩关节CT扫描图像根据大结节上面观形态进行分型，分别测量冈上肌、冈下肌和小圆肌肌腱在大结节上的止点长度，肩胛下肌肌腱在小结节上的止点长度，大结节最高点至肱骨头最高点的距离以及结节间沟的宽度和深度。结果肱骨大结节上面观形态可分为3型：弧形45.60%（135例），平坦形44.26%（131例），丘形10.14%（30例）。弧形的肱骨大结节，其冈上肌肌腱止点长度短于平坦形和丘形；丘形的肱骨大结节，其冈上肌肌腱在大结节上的止点长度、肩胛下肌肌腱在小结节上的止点长度、结节间沟的宽度和深度均短于弧形和平坦形；丘形的大结节最高点至肱骨头最高点的距离大于弧形和平坦形，差异均有统计学意义（P＜0.05），其他解剖学形态差异无统计学意义（P>0.05）。结论不同分型的肱骨大结节上面观对临床肱骨大结节相关疾病诊治有一定的指导意义。

Abstract

导出引用

张磊, 何雪, 周鑫, 熊鹿静, 张梦瑶. 肱骨大结节上方的解剖分型及临床意义[J]. 中国临床解剖学杂志. 2021, 39(5): 513-517 https://doi.org/10.13418/j.issn.1001-165x.2021.05.003

Zhang Lei, He Xue, Zhou Xin, Xiong Lujing, Zhang Meng-yao. Clinical anatomical study on the classification of the superior aspect classification of the greater tuberosity[J]. Chinese Journal of Clinical Anatomy. 2021, 39(5): 513-517 https://doi.org/10.13418/j.issn.1001-165x.2021.05.003

中图分类号： R323.71

参考文献

[1] Rangan A, Handoll H, Brealey S, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial[J]. JAMA, 2015, 313(10): 1037-1047. DOI: 10.1001/jama.2015.1629.
[2] Cibulas A, Leyva A, Cibulas G 2nd, et al. Acute shoulder injury[J]. Radiol Clin North Am, 2019, 57(5): 883-896. DOI: 10.1016/j.rcl.2019.03.004.
[3] White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management[J]. Emerg Radiol, 2018, 25(3): 235-246. DOI: 10.1007/s10140-018-1589-8.
[4] 潘昭勋, 崔岩, 孙超, 等. 肱骨头的相对高度与肩峰下撞击综合征的相关性研究[J]. 中国临床解剖学杂志, 2014, 32(3): 354-356. DOI: 10.13418/j.issn.1001-165x.2014.03.027.
[5] Huegel J, Williams AA, Soslowsky LJ. Rotator cuff biology and biomechanics: a review of normal and pathological conditions[J]. Curr Rheumatol Rep, 2015, 17(1): 476. DOI: 10.1007/s11926-014-0476-x.
[6] 童建军, 肖德明. 肩袖损伤的形态学研究进展及其临床意义[J]. 中国矫形外科杂志, 2005, 13(14): 1102-1104. DOI: 10.3969/j.issn.1005-8478.2005.14.021.
[7] Kukkonen J, Kauko T, Virolainen P, et al. The effect of tear size on the treatment outcome of operatively treated rotator cuff tears[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(2): 567-572. DOI: 10.1007/s00167-013-2647-0.
[8] Heuberer PR, Smolen D, Pauzenberger L, et al. Longitudinal long-term magnetic resonance imaging and clinical follow-up after single-row arthroscopic rotator cuff repair: clinical superiority of structural tendon integrity[J]. Am J Sports Med, 2017, 45(6): 1283-1288. DOI: 10.1177/0363546517689873.
[9] Neer CS, Poppan NK. Supraspinatus outlet[J]. Orthop Trans, 1987, 11(2): 234.
[10] Mutch J, Laflamme GY, Hagemeister N, et al. A new morphological classification for greater tuberosity fractures of the proximal humerus: validation and clinical implications[J]. Bone Joint J, 2014, 96-B(5): 646-651. DOI: 10.1302/0301-620X.96B5.32362.
[11]Li XY, Xu W, Hu N, et al. Relationship between acromial morphological variation and subacromial impingement: a three-dimensional analysis[J]. PloS One, 2017, 12(4): e0176193. DOI: 10.1371/journal.pone.0176193.
[12]Rouleau DM, Mutch J, Laflamme GY. Surgical treatment of displaced greater tuberosity fractures of the humerus[J]. J Am Acad Orthop Surg, 2016, 24(1): 46-56. DOI: 10.5435/JAAOS-D-14-00289.
[13]Dala-Ali B, Penna M, McConnell J, et al. Management of acute anterior shoulder dislocation[J]. Br J Sports Med, 2014, 48(16): 1209-1215. DOI: 10.1136/bjsports-2012-091300.
[14] Greenspoon JA, Petri M, Warth RJ, et al. Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes[J]. J Shoulder Elbow Surg, 2015, 24(9): 1493-1505. DOI: 10.1016/j.jse.2015.04.005.
[15]Deprés-Tremblay G, Chevrier A, Snow M, et al. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development[J]. J Shoulder Elbow Surg, 2016, 25(12): 2078-2085. DOI: 10.1016/j.jse.2016.06.009.
[16]Mihata T, McGarry MH, Kahn T, et al. Biomechanical effects of acromioplasty on superior capsule reconstruction for irreparable supraspinatus tendon tears[J]. Am J Sports Med, 2016, 44(1): 191-197. DOI: 10.1177/0363546515608652.
[17]Piper CC, Hughes AJ, Ma Y, et al. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis[J]. J Shoulder Elbow Surg, 2018, 27(3): 572-576. DOI: 10.1016/j.jse.2017.09.032.
[18]Seo SS, Choi JS, An KC, et al. The factors affecting stiffness occurring with rotator cuff tear[J]. J Shoulder Elbow Surg, 2012, 21(3): 304-309. DOI: 10.1016/j.jse.2011.04.011.
[19] 曾浪清, 陈云丰, 曾路路, 等. 单纯肱骨大结节骨折的诊疗研究进展[J]. 中华肩肘外科电子杂志, 2018, 6(4): 313-318. DOI: 10.3877/j.issn.2095-5790.2018.04.016.
[20]张斌. 冈上肌的解剖学研究及其临床应用[D]. 济南: 泰山医学院, 2013. DOI: 10.7666/d.Y2507631.
[21]Lee SH, Nam DJ, Kim SJ, et al. Comparison of clinical and structural outcomes by subscapularis tendon status in massive rotator cuff tear[J]. Am J Sports Med, 2017, 45(11): 2555-2562. DOI: 10.1177/0363546517721187.
[22]Mihata T, Gates J, McGarry MH, et al. Effect of rotator cuff muscle imbalance on forceful internal impingement and peel-back of the superior labrum: a cadaveric study[J]. Am J Sports Med, 2009, 37(11): 2222-2227. DOI: 10.1177/0363546509337450.
[23]Minagawa H, Itoi E, Konno N, et al. Humeral attachment of the supraspinatus and infraspinatus tendons: an anatomic study[J]. Arthroscopy, 1998, 14(3): 302-306. DOI: 10.1016/s0749-8063(98)70147-1.
[24]Lake SP, Miller KS, Elliott DM, et al. Effect of fiber distribution and realignment on the nonlinear and inhomogeneous mechanical properties of human supraspinatus tendon under longitudinal tensile loading[J]. J Orthop Res, 2009, 27(12): 1596-1602. DOI: 10.1002/jor.20938.
[25]Moroder P, Schulz E, Mitterer M, et al. Long-term outcome after pectoralis major transfer for irreparable anterosuperior rotator cuff tears[J]. J Bone Joint Surg Am, 2017, 99(3): 239-245. DOI: 10.2106/JBJS.16.00485.