Pouliart N, Gagey O
Department of Orthopaedics and Traumatology, Academic Hospital Vrije Universiteit Brussel, Brussels, Belgium.
Clin Anat. 2005 Oct;18(7):493-9. doi: 10.1002/ca.20185.
In a cadaveric instability model that leaves all muscles intact initially, we studied anteroinferior glenohumeral dislocation behavior after section of the ligaments on the humeral side of the joint. In this study, the latissimus dorsi seemed to play a role when complete section did not result in a locked anteroinferior dislocation. We therefore initiated a study to test the hypothesis that the latissimus dorsi may, in certain circumstances, depending on variations in its anatomy, influence dislocation behavior. Here, in Part I, we present the results of the anatomic study of latissimus dorsi and its tendons. The anatomy of the latissimus dorsi pertaining to the scapula and humerus was studied in 100 cadaver specimens. The distance between the uppermost part of the tendon of both the latissimus dorsi and the teres major and the edge of the articular cartilage of the humeral head (tendon-cartilage distance, TCD) as well as the width and length of the tendons were measured. Furthermore, the relationship between latissimus dorsi and the inferior angle of the scapula was studied. The tendon of the latissimus dorsi inserted at a variable distance from the cartilage of the humeral head: the TCD ranged from 12.6 to 31.6 mm (mean 21.06 mm+/-5.11 mm). The latissimus dorsi can have muscular fibers arising from the inferior angle of the scapula (type 1 scapular connection, 43%). Alternatively, there may be only a few fibrous strands between the muscle and the scapula or there may be an intervening bursa (type 2 scapular connection, 57%). This variability in the morphology of the latissimus dorsi may be a factor explaining the differences observed in a study of humerus-based sequential cutting of the glenohumeral capsule. This possibility is explored in Part II of the study. The latissimus dorsi may also complete the tendinous protection of the humeral side of the capsule generally provided by the rotator cuff.
在一个最初保留所有肌肉完整的尸体不稳定模型中，我们研究了在关节肱骨侧韧带切断后肩肱关节前下脱位的行为。在本研究中，当完全切断韧带未导致锁定性前下脱位时，背阔肌似乎发挥了作用。因此，我们开展了一项研究来验证以下假设：背阔肌在某些情况下，可能会因其解剖结构的差异而影响脱位行为。在此，在第一部分中，我们展示了背阔肌及其肌腱的解剖学研究结果。在100具尸体标本中研究了背阔肌与肩胛骨和肱骨相关的解剖结构。测量了背阔肌和大圆肌肌腱最上部与肱骨头关节软骨边缘之间的距离（肌腱 - 软骨距离，TCD）以及肌腱的宽度和长度。此外，还研究了背阔肌与肩胛骨下角之间的关系。背阔肌肌腱在距肱骨头软骨不同距离处附着：TCD范围为12.6至31.6毫米（平均21.06毫米±5.11毫米）。背阔肌的肌纤维可能起自肩胛骨下角（1型肩胛连接，占43%）。或者，肌肉与肩胛骨之间可能只有少数纤维束，也可能存在一个中间滑囊（2型肩胛连接，占57%）。背阔肌形态的这种变异性可能是解释在一项基于肱骨的肩肱关节囊序贯切断研究中观察到的差异的一个因素。在本研究的第二部分中探讨了这种可能性。背阔肌还可能完成通常由肩袖提供的关节囊肱骨侧的腱性保护。
