Arai Ryuzo, Kobayashi Masahiko, Harada Hideto, Tsukiyama Hiroyuki, Saji Takahiko, Toda Yoshinobu, Hagiwara Yoshihiro, Miura Takashi, Matsuda Shuichi
Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan,
Knee Surg Sports Traumatol Arthrosc. 2014 Feb;22(2):435-41. doi: 10.1007/s00167-013-2385-3. Epub 2013 Jan 18.
The purpose of this study was to meticulously observe the structures around the origin of the long head of the biceps tendon (LHB) in order to propose a method of anatomical superior labrum anterior and posterior repair.
Twenty-eight shoulders of 16 cadavers with intact LHB origin were macroscopically investigated. Among them, 20 shoulders with an intact superior labrum were additionally observed, to determine whether the anterior edge of LHB on the labrum (point 'A') was anterior to the supraglenoid tubercle. Serial sections vertical to LHB were observed using ordinary light and polarized microscopy in three glenoids and scanning acoustic microscopy in one.
The labrum had a meniscal appearance, and no LHB fibre was sent anterior to the anterior edge of the supraglenoid tubercle. 'A' was not located more posterior than the supraglenoid tubercle. All specimens had the so-called 'the sheet-like structure', in which the portion closer to the LHB origin tends to be stiffer. Fibres of the sheet-like structure ran vertically to LHB.
Fibre orientation and the stiffness of the sheet-like structure suggest its support of LHB. As LHB fibres do not anteriorly cross over 'A', 'A' could be a landmark for the anterior border of LHB, independent from the sheet-like structure. Considering a previous report mentioning that the horizontal mattress suture maintains the meniscus-like structure which might be sufficient for proper motion of the normal superior labrum, the horizontal mattress suture not crossing over 'A' should be recommended from the viewpoint of functional anatomy.
本研究旨在细致观察肱二头肌长头肌腱（LHB）起点周围的结构，以提出一种解剖学上修复上盂唇前后部的方法。
对16具尸体的28个LHB起点完整的肩部进行宏观研究。其中，额外观察了20个上盂唇完整的肩部，以确定盂唇上LHB的前缘（“A”点）是否在关节盂上结节前方。在三个关节盂中使用普通光镜和偏振光显微镜观察垂直于LHB的连续切片，在一个关节盂中使用扫描声学显微镜观察。
盂唇呈半月板样外观，且没有LHB纤维延伸至关节盂上结节前缘前方。“A”点的位置不比关节盂上结节更靠后。所有标本都有所谓的“片状结构”，其中更靠近LHB起点的部分往往更硬。片状结构的纤维垂直于LHB走行。
片状结构的纤维方向和硬度表明其对LHB的支撑作用。由于LHB纤维不会在“A”点前方交叉，“A”点可作为LHB前缘的一个标志，独立于片状结构。考虑到之前有报告提到水平褥式缝合可维持半月板样结构，这可能足以保证正常上盂唇的正常运动，从功能解剖学角度建议采用不穿过“A”点的水平褥式缝合。
