Rao Anita G, Kim Tae Kyun, Chronopoulos Efstathios, McFarland Edward G
Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland 21093, USA.
J Bone Joint Surg Am. 2003 Apr;85(4):653-9. doi: 10.2106/00004623-200304000-00011.
Anterosuperior labral variations of the glenohumeral joint have been previously described and are thought to represent normal anatomical variants without any known clinical importance. The goals of this study were to characterize anterosuperior labral anatomical variations and to determine their prevalence and clinical importance.
A total of 546 patients who had an arthroscopic procedure in the shoulder were prospectively evaluated for variations of the anterosuperior aspect of the labrum. Structural characteristics of the anatomical variants were noted and recorded intraoperatively. The relationships of these anterosuperior labral variations to demographic data, preoperative symptoms, findings on physical examination, and associated intra-articular abnormalities were analyzed statistically and compared with findings in patients with normal anterosuperior labral anatomy.
Three distinct variations of the anterosuperior portion of the labrum were found in seventy-three patients (13.4%): a sublabral foramen only (eighteen patients; 3.3%), a sublabral foramen with a cord-like middle glenohumeral ligament (forty-seven; 8.6%), and an absence of labral tissue at the anterosuperior portion of the labrum with a cord-like middle glenohumeral ligament (eight; 1.5%). In multivariate analysis, the presence of one of these three variations revealed a significant positive association with anterosuperior labral fraying (p = 0.000), an abnormal superior glenohumeral ligament (p = 0.012), and increased passive internal rotation with the arm in 90 degrees of abduction (p = 0.046). These lesions were negatively associated with a painful arc sign and the presence of either a partial or full-thickness supraspinatus tendon tear. Statistical analysis revealed a clinical difference between the cord-like middle glenohumeral ligament variants and the sublabral foramen variant.
Anterosuperior labral variants may influence glenohumeral biomechanics and may predispose the shoulder to other abnormalities. These variants are associated with increased internal rotation, which may predispose the shoulder to lesions of the superior glenohumeral ligament and anterosuperior portion of the labrum. These variations themselves do not appear to contribute to instability.
此前已描述过盂肱关节前上盂唇的变异情况，认为其代表正常解剖变异，无任何已知临床意义。本研究的目的是描述前上盂唇的解剖变异特征，确定其发生率及临床意义。
对总共546例行肩关节镜手术的患者进行前瞻性评估，以观察盂唇前上部分的变异情况。术中记录解剖变异的结构特征。对这些前上盂唇变异与人口统计学数据、术前症状、体格检查结果及相关关节内异常之间的关系进行统计学分析，并与前上盂唇解剖正常的患者的结果进行比较。
在73例患者（13.4%）中发现了三种不同的前上盂唇部分变异：仅存在盂唇下孔（18例患者；3.3%）、盂唇下孔伴有条索状肱二头肌长头腱盂肱中韧带（47例；8.6%）、前上盂唇部分无盂唇组织且伴有条索状肱二头肌长头腱盂肱中韧带（8例；1.5%）。多因素分析显示，这三种变异中的任何一种的存在与前上盂唇磨损（p = 0.000）、肱二头肌长头腱盂肱中韧带异常（p = 0.012）以及手臂外展90度时被动内旋增加（p = 0.046）呈显著正相关。这些病变与疼痛弧征以及部分或全层冈上肌腱撕裂的存在呈负相关。统计学分析显示，条索状肱二头肌长头腱盂肱中韧带变异与盂唇下孔变异之间存在临床差异。
前上盂唇变异可能影响盂肱关节生物力学，可能使肩关节易发生其他异常。这些变异与内旋增加有关，这可能使肩关节易发生肱二头肌长头腱盂肱中韧带和前上盂唇部分的病变。这些变异本身似乎不会导致不稳定。
