小针刀治疗肩胛上神经嵌压症的应用解剖

目的为小针刀减压治疗肩胛上神经嵌压症提供形态学基础.方法在34侧常规固定的成人尸体标本上解剖出冈上孔、冈下孔和肩胛上神经及血管,观察冈上孔、冈下孔及其与肩胛上神经、血管的走行位置关系,测量有关数据.结果冈上孔位于锁骨锥状结节的后端深面,由肩胛切迹和横架于其上方的肩胛上横韧带围成,距体表(4.75±0.79)cm.冈下孔位于肩胛冈中外1/3交界处下方2cm处的深面,由冈盂切迹和连于肩峰根部及肩胛骨背面的肩胛下横韧带围成,距体表(3.93±0.95)cm.肩胛上神经起自臂丛上干,行向后外下,穿冈上孔人冈下窝,再向后穿冈下孔入冈下窝,沿途发支至冈上肌、冈下肌和肩关节.肩胛上血管经肩胛上横韧带的外上方入冈上窝与神经伴行.结论本文提出同时扩大或开放两孔进行治疗的新思路,提供的有关数据和定位方法,可提高小针刀治疗肩胛上神经嵌压症的准确性和安全性.     

肩胛上神经阻滞治疗肩周炎的应用解剖

目的：为肩胛上神经阻滞治疗肩周炎提供形态学依据。方法：在34例经常规固定的成人尸体标本上部剖观测了肩胛上神经及其分支的走行及分布,拟定了穿刺点及其体表定位方法,并进行募拟穿刺。结果：肩胛上神经起于臂上干,斜向后外下径斜方肌深面及肩胛切迹至网上窝。起干臂丛上干处的外径为1.86±0.25mm,干长为43.0±6.0mm。主要分支有冈上肌支,冈下肌支及较为细小的肩关节支。冈上肌支外径为0.08±0.12mm,干长为26.6±3.9mm;冈下肌支的外径为1.07±0.13mm,干长为41.5±5.7mm。结论：根据肩胛上神经恒定的走行和分支分布,对其定位阻滞可作为治疗肩周炎的一种有效方法。     

肩胛上神经及其冈上肌干支入肌点的应用解剖

目的探讨肩胛上神经的行程和冈上肌干支入肌点,为肩部疾病的诊治提供解剖形态学基础。方法对15具(30侧)成人上肢标本,观察肩胛上神经及其分支冈上肌支的走行、分段、体表定位和冈上肌支入肌点进行研究。结果肩胛上横韧带前段的肩胛上神经主干长4.03～5.23(4.36±0.60)cm,外径2.21～4.45(4.22±0.63)mm;骨纤维管内肩胛上神经外径与入管前一样;出管后肩胛上神经的分支冈上肌干支长1.24～0.90(3.78±0.23)cm,外径为0.54～2.01(1.82±0.20)mm。冈上肌干支入肌点距孔后为1.15～2.01(8.22±5.20)mm。结论①肩胛上神经行程较长,穿越骨纤维管位置恒定,易发生卡压,其体表定位位于距离肩峰最外端约6 cm处。②冈上肌干支伴血管行走,距孔后约1 cm入肌体,位置相对恒定,其体表定位相当于锁骨锥状结节的后方约3 cm处,入肌内分有前、中、后三支。     

肩胛上神经损伤原因的解剖学分析

目的:探讨肩胛上神经损伤的解剖学原因。方法:观察人肩胛切迹的形态,肩胛上神经和肌肉的关系,同时测量肩胛上神经在肩胛下孔处的转折角、肩胛上、下孔的横径、肩胛上、下横韧带的长度。结果:肩胛切迹U型58.82%,弧形17.65%,V型19.12%,半封闭型2.94%,全封闭型1.47%;肩胛上神经经过肩胛上孔进入冈上窝,之后经冈盂切迹进入冈下窝,此处有1个51.18°±6.93°的转折角,即肩胛上神经转折角;肩胛上孔由肩胛切迹和肩胛上横韧带围成,肩胛上孔横径(7.81±3.29)mm,韧带长(12.23±4.89)mm;肩胛下孔是由冈盂切迹和外侧的肩胛下横韧带(冈盂韧带)围成,其横径(8.79±3.96)mm,韧带长(21.26±5.45)mm。同时肩胛上神经主干主要在肌肉和肩胛骨面之间。结论:肩胛上神经自身走行的路径是其损伤的基础,肩关节反复活动对神经的牵拉是损伤的直接原因。     

肩胛上神经和腋神经联合阻滞治疗肩周炎的应用解剖

目的：为神经阻滞治疗肩周炎提供解剖学基础。方法：在３４侧经常规防腐处理的成人尸体标本上解剖出肩胛上神经和腋神经,观察其走行位置及分支分布,拟定穿刺点及体表定位。结果：①肩胛上神经主要分支有冈上肌支和冈下肌支。肩胛上神经在肩胛横韧带处距皮肤的距离和冈上肌支起始段距皮肤的距离均为４．０～４．５ｃｍ,冈下肌支起始段距皮肤的距离为４．０ｃｍ。②腋神经主要分支有前支和后支。腋神经穿四边孔处距皮肤的距离为５．     

肩胛上神经冈下肌支卡压1例

1临床资料 患者,男,25岁,喜欢打篮球。右肩胛部疼痛3月,理疗无效,右肩部肌肉萎缩、活动乏力而就诊。查体：右肩胛部冈下肌明显萎缩,肩胛冈中外1／3交界下方压痛,压痛范围1cm×1cm。皮肤感觉正常,右肩关节各向活动范围正常,外旋肌力减弱。肌电图表现为传导速度减慢,潜伏期延长。行手术治疗,沿肩胛冈中点向外侧切开至肩峰,切断部分斜方肌、三角肌在肩胛冈上的附着部,分别将冈上、下肌自肩胛冈两侧剥离并牵开,于外侧见肩胛上神经冈下支神经血管束穿行于冈盂切迹与肩胛下韧带构成的骨纤维孔道,肩胛上神经冈下支水肿及瘢痕增生。切除肩胛下韧带及冈盂切迹内侧部分骨质,骨蜡涂抹切骨处,神经外膜松解。术后肩胛部疼痛消失。术后半年两侧肩部肌肉对称。     

肩胛上神经卡压机制的临床解剖学研究

目的　探讨肩胛上神经卡压症的解剖学机制,为临床诊断和治疗提供解剖学依据。 方法　22具(男13具,女9具)44侧成尸标本,解剖观测肩胛上切迹,冈盂切迹的形态特点以及肩胛上神经走行、分支及分布的解剖学特点,所测数据统计学处理。 结果　肩胛上切迹类型：U型占40.91%（18侧）,浅U型占22.73%（10侧）,大弧型占27.27%（12侧）,方形占9.01%（4侧）四种。肩胛上切迹的厚度为（1.55±0.36）mm。肩胛上神经主干与冈上肌支所成角为(86.04±1.28)°。冈下肌支的入肌点,有22.73%在该肌的起点处,77.27%在中或外1/3处。冈盂切迹的厚度在（6.82±1.21）mm 。肩胛上神经自肩胛上孔穿出点至肩胛冈基底部的高度为（11.13±0.21）mm;至冈盂切迹的水平距离为（14.03±0.64）mm 。肩胛上神经转折角为（49.65±1.63）°。 结论　肩胛上切迹的类型、肩胛上切迹和冈盂切迹的厚度,肩胛上神经转折角的大小、神经主干与冈上肌支的角度以及冈下肌支的入肌点等均是肩胛上神经卡压的危险因素。     

肩胛上神经卡压症针刀手术入路研究

目的提供肩胛上神经卡压症针刀手术入路的解剖学基础。方法在30侧经10％福尔马林固定及灌注红色乳胶的成人上肢标本上行局部层次解剖。①观察肩胛上神经位置，行程和分布，以及与周围结构的相互毗邻关系。②测量肩胛上下孔；肩胛上下横韧带的相关数据。③设定肩胛上神经的体表测量标志，并测量相关数据。结果：①肩胛上神经由臂丛C5、6形成后，越过颈后三角向外，经肩胛上孔入冈上窝，分出冈上肌支、上关节支，其主干改名为冈下肌支穿肩胛下孔入冈下窝，分出冈下肌支、下关节支。②肩胛上孔横径7．90±3．0mm；纵径6．2±1．2mm；肩胛下孔横径9．81±1．53mm纵径7．81±2．40mm；肩胛上横韧带长13．4±0．5mm；肩胛下横韧带长25．3～3．9mm。③引用黄德清所测数值：设定肩胛上孔为A点，肩胛下孔为B点，肩胛上角为C点，肩峰外侧端为D点。肩胛冈内侧端与肩胛骨内侧缘相交处为E点。AD／AC相对值为1．26±0．47；BD／BE相对值为0．60±0．08。结论肩胛上神经卡压症的解剖学研究数据能为肩胛上神经卡压症针刀手术提供较安全的入路及定位标志。     

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.     

Morphological study of the inferior transverse scapular ligament

The suprascapular nerve can be compressed by the inferior transverse scapular ligament (ITSL), also known as the spinoglenoid ligament, and this entrapment results in dysfunction of the external rotation of the upper arm owing to isolated weakness of the infraspinatus muscle. The morphology of the ITSL has not been adequately characterized. The aim of this study was to clarify the morphological characteristics of the ITSL. In total, 110 shoulders from 72 cadavers were dissected in this study. The ITSL was present in 73 (66.4%) of the 110 specimens, and comprised membrane in 40 (36.4%), ligament in 25 (22.7%), and both membrane and ligament in eight (7.3%). This structure could be classified into three types on the basis of its shape: band‐like (33.6%, type I), triangular (15.5%, type II), or irregular (17.3%, type III). In the spinoglenoid notch, the suprascapular nerve was always close to the lateral margin of the scapular spine. The length of the ligament between its origin and insertion sites ranged from 8.7 to 23.4 mm at its superior margin and from 8.9 to 17.5 mm at its inferior margin. The ligament width and thickness at its midportion ranged from 1.6 to 10.0 mm and from 0.1 to 1.2 mm, respectively. The results of this study improve understanding of the ITSL and will be helpful for successful diagnoses and treatments for selective suprascapular nerve entrapment. Clin. Anat. 27:707–711, 2014. © 2013 Wiley Periodicals, Inc.     

Proposed surgical technique to facilitate targeted reinnervation of the infraspinatus: A cadaveric feasibility study

Restoration of shoulder lateral rotation remains a significant challenge following brachial plexus injury. Transfer of the accessory nerve to suprascapular nerve (SSN) has been widely performed, although with generally poor outcomes for lateral rotation. A recent report suggested a selective infraspinatus reinnervation technique using a radial nerve branch for SSN transfer. This cadaveric study was performed in 7 specimens (14 shoulders). We present technical modifications to achieve additional length to the recipient nerve (suprascapular) that would facilitate direct repair. Key elements of the technique are (1) isolation of the SSN immediately distal to its motor branch to supraspinatus near the superior transverse scapular ligament; and (2) delivery of the transected SSN through the spinoglenoid notch and deep to the infraspinatus for emergence in the infraspinatus‐teres minor interval. Nerve overlap of at least 21 mm was observed in all 14 dissected shoulders between the harvested SSN and radial nerve branches. The mean nerve overlap between harvested branches was 26 mm (range 21–32 mm). The mean harvested SSN length was 59 mm (range 46–80 mm). The mean length of the harvested radial nerve branch was 72 mm (range 65–85 mm). No measurements were significantly different between left and right shoulders or between males and females (smallest P value = 0.1249). Nerve diameter of the two harvested branches was judged to be appropriately compatible for surgical coaptation in all 14 dissected shoulders. We present a variation on a described technique to increase recipient suprascapular nerve length. Additional length of the recipient nerve is achieved through utilization of a more proximal dissection of the suprascapular nerve near the level of the superior transverse scapular ligament and delivering the nerve through the teres minor‐infraspinatus interval. These surgical modifications are of clinical interest when selective reinnervation of the infraspinatus muscle is considered. We believe such a targeted approach can potentially increase shoulder lateral rotation function. Clin. Anat. 32:131–136, 2019. © 2018 Wiley Periodicals, Inc.     

肩胛上神经阻滞穿刺点的研究及其临床意义

目的为肩胛上神经阻滞麻醉提供解剖学基础。方法解剖观察102例成人尸体肩胛区,在肩胛冈中部上方切除一长宽约8 cm的区域,显露和观察肩胛上神经、血管及肩胛上横韧带的位置及其毗邻关系;测量肩胛上神经与肩峰内侧的距离和肩胛冈上方的距离及其深度;在肩胛骨上角与肩峰的连线上,测量肩胛上神经与肩峰内侧的距离。结果肩胛上神经距离肩峰内侧（6.29±0.71）cm、上方（1.93±0.59）cm、肩胛上神经在此点距皮肤的深度为（3.63±0.55）cm。在肩胛骨上角与肩峰连线上,肩胛上神经距离肩峰内侧（6.37±0.87）cm。结论肩胛上神经阻滞麻醉穿刺点位于肩峰内侧6.29 cm、正上方1.93 cm、此点深度3.63 cm,或在肩胛骨上角与肩峰连线上,肩胛上神经距离肩峰内侧6.37 cm。     

Topographical anatomy of the suprascapular nerve and vessels at the suprascapular notch

Suprascapular nerve entrapment caused by the superior transverse scapular ligament (STSL) causes pain, and limitation of motion in the shoulder. To relieve these symptoms, suprascapular nerve decompression is performed through the resection of STSL. To describe and classify the topographic anatomy of the suprascapular notch, 103 cadaveric shoulders were dissected. The mean length and width of STSLs were 11.2 and 3.4 mm, respectively. The bony bridges replacing STSL in four shoulders were 8.2 mm long and 3.5 mm wide on average. The suprascapular nerve always ran through the notch under the STSL. All shoulders had a single suprascapular artery, while multiple suprascapular veins appeared in 21.3%. The arrangement of the suprascapular vessels was classified into three types: in Type I (59.4%), all suprascapular vessels ran over the STSL; in Type II (29.7%), the vessels ran over and under the STSL simultaneously; in Type III (10.9%), all vessels ran under the STSL. In 48.9% of cadavers, these types were bilaterally matched. The omohyoid muscle originated distantly from the STSL in 38.0%, was adjacent to it in 44.0%, and was partially over the STSL in 18.0%. The number of suprascapular vessels running under the STSL was positively correlated with the size of the STSL and the middle diameter of the suprascapular notch. Age was inversely correlated with the length of STSL. The STSL was wider in males than in females. This study provides details of the structural variations in the region of the suprascapular notch.     

Coexistence of the suprascapular notch and the suprascapular foramen—a rare anatomical variation and a new hypothesis on its formation based on anatomical and radiological studies

The suprascapular notch is the most common site of suprascapular nerve entrapment, which can manifest in disability and pain of the upper limb. Here, we present three cases of a very rare anatomical variation in the suprascapular region: the coexistence of the suprascapular notch and the suprascapular foramen. The variation was found during radiological and anatomical investigations. The suprascapular foramen was situated inferior to the suprascapular notch. A bony bridge lay between them, likely created by an ossified anterior coracoscapular ligament (ACSL). This anatomical variation probably increased the risk of suprascapular nerve entrapment by nerve irritation of the bony margins during passsage through the foramen and by a lack of the elasticity that the ACSL normally demonstrates. Also, a bony bridge passing through the middle part of the suprascapular notch reduces the space available for nerve passage (bony bridge decreases the space by about 36.5–38.6 %). One patient who underwent the radiological study had typical symptoms of suprascapular nerve entrapment. Based on his medical history and the presence of this rare variation of the suprascapular notch at the suprascapular region we suspect this neuropathy.     

Ultrasonographic evaluation and morphometric measurements of the suprascapular notch

Background:  The aim of this study was to define the sonographic evaluation and morphometric measurements of the suprascapular notch. Methods  The suprascapular notch was evaluated by ultrasound on both sides in 50 volunteers (25 males, 25 females). By means of ultrasound, the notch width, the notch depth and the distance between the skin and the notch base (skin–notch base interval) were measured and imaging of the superior transverse scapular ligament was attempted. Furthermore, imaging of the suprascapular artery and vein was performed by Doppler ultrasound. Results  On the measurements performed, the notch was found to be deeper in men than in women on both the right (P = 0.022) and the left (P = 0.011) sides. Taking all volunteers into account without grouping sex, no differences were detected between the two sides with respect to the measurements of the notch width, notch depth and distance between the skin and the notch base. The superior transverse scapular ligament was demonstrated in 48 (96%) of 50 volunteers. On color Doppler ultrasound, the artery–vein complex was visualized in a total of 43 (86%) volunteers. Conclusions  Suprascapular notch measurements and the visualization of the anatomical neighborhood, which may be beneficial for the suprascapular nerve blockade procedure, can be successfully performed by the use of high-frequency ultrasound imaging.     

Bilateral suprascapular nerve entrapment

Bilateral suprascapular nerve entrapment syndrome is very rare. It presents with shoulder pain, weakness and atrophy of the supraspinatus and infraspinatus muscles. We present a twenty-year old man having a history of bilateral shoulder pain associated with weakness. Electromyographic studies revealed signs of a lesion that caused a neupraxic state of the left suprascapular nerve, moderate axonal loss of the right suprascapular nerve and denervation of the right suprascapular muscle. The patient was treated with physical and medical therapy. Due to worsening of the symptoms, a surgical operation was performed by the excision of the transverse scapular ligaments bilaterally. His pain, weakness and atrophy had diminished on examination six weeks later. Suprascapular nerve entrapment should be considered in patients with shoulder pain, particularly those with weakness and atrophy of the supraspinatus and infraspinatus muscles.     

Anatomical considerations for safe scapular resection in snapping scapula syndrome

Background  

The resection of the superomedial angle of the scapula in snapping scapula syndrome is associated with potential risk of injury to the suprascapular nerve. The aim of the present study was to determine the distance of site of resection on the upper border of the scapula from the suprascapular notch during arthroscopic resection of the superomedial angle using standard superior Bell’s and medial portals at the middle of medial border.     

Sexual dimorphism of the suprascapular notch – morphometric study

Introduction

The concept of the study was to compare the morphometry of the suprascapular notch (SSN) in females and males because its size and shape may be a factor in suprascapular nerve entrapment.

Material and methods

The measurements of 81 scapulae included morphological length and width, maximal width and length projection of the scapular spine, and width and length of the glenoid cavity. The width-length scapular and glenoid cavity indices were calculated. In addition to standard anthropometric measurements three other dimensions were defined and collected for every SSN: maximal depth (MD), superior (STD) and middle (MTD) transverse diameters.

Results

The analysis of the measurements allowed us to distinguish five types of SSN. Type I (26%) had longer maximal depth than superior transverse diameter. Type II (3%) had equal MD, STD and MTD. In type III (57.6%) superior transverse diameter was longer than maximal depth. In type IV (7.4%) a bony foramen was present. Type V (6%) was without a discrete notch. Types I and III were divided into two subtypes: A (MTD was longer than STD) and B (MTD < STD). Distribution of the suprascapular notch types in both sexes was similar. However, MD, STD and MTD were significantly higher in males. The superior transverse suprascapular ligament was completely and partially ossified in 7.4% and 24.7% respectively.

Conclusions

The presented classification of the suprascapular notch is simple, easy to use, and based on specific geometric parameters which allow one to clearly distinguish five types of these structures. All dimensions of SSN were significantly higher in males than in females.