Curtis Alan S, Burbank Kelton M, Tierney John J, Scheller Arnold D, Curran Andrew R
Division of Sports Medicine, New England Baptist Hospital, Boston, USA.
Arthroscopy. 2006 Jun;22(6):609.e1. doi: 10.1016/j.arthro.2006.04.001.
The purpose of this study was to define the entire rotator cuff footprint and relate it to known, easily identifiable landmarks as a guide for both open and arthroscopic rotator cuff repair. Anatomic: Gross and microscopic.
The myotendinous units of the rotator cuff and their insertions onto the humerus were dissected in 20 fresh-frozen cadavers. The separate tendon insertions were identified, and their length and width measured. The character and exact anatomy of the tendons were also noted. The entire insertion was measured and referenced to the articular surface, biceps groove, and bare area of the humerus. In a separate part of the study, 6 cadavers were decalcified and thin-sliced through the supraspinatus tendon insertion. This insertion was evaluated via scanning electron microscopy (SEM).
Our findings demonstrated a consistent pattern at the insertion of the rotator cuff. The horseshoe-shaped insertion tapers away from the articular surface in a superior-to-inferior direction. Interdigitation of the muscle units may be noted, particularly between the supraspinatus and the infraspinatus. Average maximum insertional lengths and widths were as follows: subscapularis (SC): 40 x 20 mm; infraspinatus (IS): 29 x 19 mm; supraspinatus (SS): 23 x 16 mm; and teres minor (TM): 29 x 21 mm. The SC inserted on the lesser tuberosity adjacent to the biceps groove at the edge of the articular surface. It tapered away 18 mm at its inferior border. The SS inserted at the articular surface along its entire insertion from the bicipital groove to the top of the bare area. The IS wrapped the posterior border of the SS superiorly at the articular surface and tapered away inferiorly, framing the bare area. SEM microscopy showed the SS to be adherent to the edge of the articular surface medially. As it filled the sulcus, its lateral edge extended over the edge of the greater tuberosity.
A consistent pattern was noted at the insertional anatomy of the rotator cuff. This anatomy was related to known, easily identifiable landmarks and may serve as a guide for evaluation of size, location, and propagation patterns of rotator cuff tears, as well as for their repair.
Knowledge of the insertional anatomy of the rotator cuff can facilitate grading and repair of rotator cuff tears.
本研究旨在明确整个肩袖止点，并将其与已知的、易于识别的标志相关联，以此作为开放和关节镜下肩袖修复的指导。解剖学研究：大体解剖和显微镜解剖。
在20具新鲜冷冻尸体上解剖肩袖的肌-腱单位及其在肱骨上的附着点。识别各个肌腱附着点，并测量其长度和宽度。还记录肌腱的特征和确切解剖结构。测量整个附着点，并以肱骨的关节面、二头肌沟和裸区为参照。在研究的另一部分，对6具尸体进行脱钙处理，并沿冈上肌腱附着点进行薄片切片。通过扫描电子显微镜（SEM）评估该附着点。
我们的研究结果显示肩袖附着点呈现出一致的模式。马蹄形附着点从关节面向上至下逐渐变细。可以注意到肌肉单位的相互交错，尤其是在冈上肌和冈下肌之间。平均最大附着长度和宽度如下：肩胛下肌（SC）：40×20毫米；冈下肌（IS）：29×19毫米；冈上肌（SS）：23×16毫米；小圆肌（TM）：29×21毫米。肩胛下肌附着于关节面边缘靠近二头肌沟的小结节上。其下缘逐渐变细18毫米。冈上肌沿着从二头肌沟到裸区顶部的整个附着点附着于关节面。冈下肌在关节面处向上包裹冈上肌的后缘，并向下逐渐变细，环绕裸区。扫描电子显微镜显示冈上肌在内侧附着于关节面边缘。当它填充沟时，其外侧边缘延伸到大结节边缘上方。
在肩袖附着解剖结构中发现了一致的模式。这种解剖结构与已知的、易于识别的标志相关，可作为评估肩袖撕裂的大小、位置和扩展模式及其修复的指导。
了解肩袖的附着解剖结构有助于对肩袖撕裂进行分级和修复。
