喙肱韧带的应用解剖_杨会峰VIP免费

CHINESEJOURNALOFANATOMYVol.31No.12008解剖学杂志2008年第31卷第1期喙肱韧带的应用解剖v通讯作者,E-mail:Tangkanglai@hotmail.com收稿日期:2007-09-10;修回日期:2007-11-05杨会峰唐康来v李建福陈伟王健许建中(第三军医大学西南医院骨科,重庆400038)摘要目的:探讨喙肱韧带(coracohumeralligament,CHL)的解剖学特点。方法:观察20侧正常成人肩关节标本的CHL位置、形态、起止点及与盂肱上韧带的关系;CHL在肩关节各种活动中所处的状态;CHL与关节囊融合处、CHL根部组织、关节囊及喙肩韧带组织学特点。结果:20侧CHL全部起于喙突基底部的外侧缘;9侧止于冈上肌腱,7侧止于肩袖间隙,3侧止于冈上肌腱和肩胛下肌腱,1侧止于肩胛下肌腱;其中11侧可见CHL与盂肱上韧带存在纤维组织连接;CHL于肩关节旋外、前屈、后伸、内收、肱骨头前后平动时紧张,于旋内、中立位、外展位时松弛;CHL与关节囊融合处、CHL根部组织与关节囊组织学特点相似,均呈现关节囊组织的典型特点,喙肩韧带呈现出韧带的特有表现。结论:CHL位置与形态相对固定,起点一致,但止点呈多样性;CHL与盂肱上韧带复合体不固定;CHL在不同运动状态其紧张度不一;CHL与关节囊组织形态相似,是关节囊增厚部。关键词喙肱韧带;肩关节;解剖AppliedanatomyofthecoracohumeralligamentYangHuifeng,TangKanglaiv,LiJianfu,ChenWei,WangJian,XuJianzhong(DepartmentofOrthopaedics,SouthwestHospital,ThirdMilitaryMedicalUniversity,Chongqing400038,China)AbstractObjective:Tostudytheanatomicfeaturesofcoracohumeralligament(CHL).Methods:Twentyadultnormalshoulderspecimenswereobservedasfollows:theenthesis,position,morphologyofCHL;therelationshipwithsuperiorgle-nohumeralligament(SGHL);thetensioninvariouskindsofshouldermovements;histologicalfeaturesoftheirconfluenceofCHLandjointcapsule,thebaseofCHL,jointcapsuleandcoracoacromialligament(CAL).Results:TheCHLsinallcasesoriginatedfromlateralaspectofthebaseofcoracoidprocess.Theligamentsofninecasesinsertedintothesupraspinatusten-don,theligamentsofsevencasesinsertedintotherotatorinterval(betweenthesupraspinatusandsubscapularistendons),theligamentsofthreecasesinsertedintothesupraspinatusandsubscapularistendons,andtheligamentofonecaseinsertedintothesubscapularistendon;elevenofthemhadtheconjunctionoftheCHLandSGHL;TheCHLwastautinexternalro-tation,anteriorflexion,backwardextension,adduction,anteriorandposteriortranslationofthehumeralhead,andwasslackinmedialrotation,neutralpostionandabduction;TheconfluenceoftheCHLandthejointcapsule,thebasetissueoftheCHLandthejointcapsulewerehistologicallysimilar,whichshowedthetypicalappearanceofthejointcapsule.TheCALshowedthecharacteristicappearanceoftheligament.Conclusion:TheCHLhastheinvarianceoftheirpositionandmorphous,butithasthesameoriginandvariableinsertions.ThecomplexoftheCHLandSGHLisvariedgreatly.Theten-sionofCHLsisdifferentinvariousmovements.ThemorphousoftheCHLpstissueislikethejointcapsule,anditisthethickeningpartofjointcapsule.Keywordscoracohumeralligament;shoulderjoint;anatomy有研究表明,喙肱韧带(coracohumeralligament,CHL)在冻结肩的发生、发展过程中起着较为关键的作用。1992年,有文献报道CHL限制肩关节的外旋功能,在冻结肩中表现为纤维化挛缩,往往需要松解才能达到治疗目的[1]。近来Ozaki等[2]、Bunker等[3]、Tet-ro等[4]认为CHL在冻结肩的诊断和治疗中起着非常重要的作用。但是,CHL的解剖学描述差异较大。因此,探讨CHL的解剖学特点十分必要。本研究将取肩关节标本解剖观察CHL的位置、形态、起止点及与盂肱上韧带关系,检查CHL在肩关节各种活动中所处的状态以及明确喙肱韧带组织学特点。1材料和方法111材料20侧(男15侧,女5侧)成人肩关节标本,左侧9个,右侧11个,中位年龄4515岁(20~70岁),所有标本肩部无畸形、外伤及手术改变,皮肤表面完...