Department of Angiology, Medical University of Łódź, Poland.
Ann Anat. 2013 Jan;195(1):77-81. doi: 10.1016/j.aanat.2012.06.003. Epub 2012 Aug 9.
The suprascapular region is the most common site of compression and injury to the suprascapular nerve. This often results in suprascapular nerve entrapment, a possible risk factor being the anterior coracoscapular ligament (ACSL), a structure that runs in the suprascapular notch, below the superior transverse scapular ligament. The aim of the present study is to determine morphological variation of the ACSL and to measure the reduction in size of the suprascapular opening of specimens exhibiting it.
A total of 84 human shoulders were included in the study. The following measurements were defined and performed for every ACSL: maximal length (ML), maximal proximal width (MPW) and maximal distal width (MPW). Additionally, two measurements of the suprascapular opening were collected: the area (aSSO) and the middle width (mwSSO). All of these measurements were taken using two independent methods: classical osteometry, and a new procedure based on the analysis of digital photographic documentation of the SSN taken using MultiScanBase v.14.02 software.
The anterior coracoscapular ligaments were present in 43 shoulders (51.2%). The analysis allowed the determination of four types of ACSL: first - fan-shaped (7%), second - band-shaped (62.8%), third - bifid (11.6%) and fourth - vestigial (18.6%). The mean area as well as the middle width of the suprascapular opening in the specimens with the anterior coracoscapular ligament was smaller than in those without this structure, however, no statistically significant differences were observed. The suprascapular nerve passed inferior to the ACSL in 2 specimens, and superior to it in 41.
The study presents a classification of the anterior coracoscapular ligament that has not been described in the literature and can be helpful in arthroscopic and open procedures of the suprascapular region. Knowledge of such anatomical variations confirms the safety of operative decompression to relieve entrapment of the suprascapular nerve.
肩胛上区域是肩胛上神经受压和损伤最常见的部位。这通常会导致肩胛上神经卡压，一个可能的危险因素是前肩胛上喙突韧带（ACSL），它是一种在肩胛上切迹内运行的结构，位于上横肩胛韧带下方。本研究的目的是确定 ACSL 的形态变异，并测量显示该韧带的标本的肩胛上孔缩小的尺寸。
共有 84 个人体肩部被纳入研究。对每一条 ACSL 进行了以下测量：最大长度（ML）、最大近端宽度（MPW）和最大远端宽度（MPW）。此外，还收集了两个肩胛上孔的测量值：面积（aSSO）和中间宽度（mwSSO）。所有这些测量值均使用两种独立的方法进行：经典骨测量法和基于使用 MultiScanBase v.14.02 软件对肩胛上神经数字摄影记录进行分析的新方法。
前肩胛上喙突韧带存在于 43 个肩部（51.2%）中。分析确定了四种类型的 ACSL：第一型为扇形（7%），第二型为带状（62.8%），第三型为分叉型（11.6%），第四型为遗迹型（18.6%）。在有前肩胛上喙突韧带的标本中，肩胛上孔的平均面积和中间宽度小于没有该结构的标本，但无统计学意义。在 2 个标本中，肩胛上神经位于 ACSL 下方，在 41 个标本中位于其上方。
本研究提出了一种前肩胛上喙突韧带的分类方法，尚未在文献中描述，可有助于肩胛上区域的关节镜和开放手术。对这种解剖变异的认识证实了手术减压以缓解肩胛上神经卡压的安全性。
