Department of Orthopaedic Surgery and Sports Medicine, Federal University of São Paulo, Brazil.
Arthroscopy. 2013 Jan;29(1):25-30. doi: 10.1016/j.arthro.2012.06.022. Epub 2012 Nov 23.
The aim of this study was to define a safety margin for coracoid process osteotomy that does not compromise the coracoclavicular ligaments and that can be used in the coracoid transfer procedures.
Thirty shoulders from 15 cadavers were dissected, exposing the coracoid process and attached anatomic structures. The distance of the insertion of these structures to the coracoid process apex was measured.
The average length of the coracoid process was 4.26 ± 0.26 cm. The average width and height at the tip were 2.11 ± 0.2 and 1.49 ± 0.12 cm, respectively. The average distance from the tip to the anterior and posterior margin of the pectoralis minor was 0.1 ± 1.17 and 1.59 ± 0.27 cm, respectively. The average distance from the tip to the posterior margin of the coracoacromial ligament was 2.79 ± 0.33 cm. The average distance from the apex to the most anterior part of the trapezoid ligament was 3.33 ± 0.38 cm. We obtained a constant value of 0.85 cm for this measure, and the value increased with each 1.0-cm increase in the distance from the tip to the posterior margin of the pectoralis minor. The safety margin for osteotomy (i.e., available bone distance for the coracoid process transfer) was 2.64 cm.
This study established a safety margin of 2.64 cm for the osteotomy of the coracoid process and its relation with the posterior margin of the pectoralis minor. The anatomic descriptions of bone and soft tissue, as well as a measure of correlation for the safety margin of the coracoid, provide tools for surgeons performing anatomic surgical procedures to correct glenohumeral instability with significant bone loss.
Knowing the safety margin allows the surgeon to perform a safe osteotomy without direct visualization of the coracoclavicular ligaments attachments, thereby making procedures more anatomic.
本研究旨在定义一种不影响喙锁韧带的喙突骨切开术安全边界，并可用于喙突转移术。
从 15 具尸体解剖的 30 个肩部，暴露喙突和附着的解剖结构。测量这些结构到喙突尖端的插入距离。
喙突的平均长度为 4.26 ± 0.26cm。尖端的平均宽度和高度分别为 2.11 ± 0.2cm 和 1.49 ± 0.12cm。尖端到胸小肌前、后缘的平均距离分别为 0.1 ± 1.17cm 和 1.59 ± 0.27cm。尖端到喙肩韧带后缘的平均距离为 2.79 ± 0.33cm。尖端到梯形韧带最前缘的平均距离为 3.33 ± 0.38cm。我们得到了一个恒定值 0.85cm，这个值随着距离胸小肌后缘每增加 1.0cm 而增加。骨切开术（即喙突转移的可用骨距离）的安全边界为 2.64cm。
本研究确定了喙突骨切开术的 2.64cm 安全边界及其与胸小肌后缘的关系。骨和软组织的解剖描述，以及喙突安全边界的相关测量，为外科医生进行解剖手术提供了工具，以纠正有明显骨丢失的肩锁关节不稳定。
了解安全边界可使外科医生在不直接观察喙锁韧带附着的情况下进行安全的骨切开术，从而使手术更具解剖学意义。
