Lee C-J, Yeh M-L, Chang C-H, Chiang F L, Hong C-K, Su W-R
Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, 704 Tainan, Taiwan.
Orthop Traumatol Surg Res. 2017 Dec;103(8):1265-1269. doi: 10.1016/j.otsr.2017.08.011. Epub 2017 Sep 22.
The purpose of this study was to delineate the anatomic relationship between the anterior articular capsule and the adjacent subscapularis by measuring the dimensions of the anterior articular capsule attachment and the subscapularis footprint on the humerus, as well as investigating the interface between the two structures.
Three shoulder specimens underwent histological analysis; for histological analysis, cross-sections through the subscapularis-capsule complex were harvested at the tendinous and muscular insertion sites. The dimensions of the anterior articular capsule attachment and the subscapularis footprint (including the tendinous and muscular insertions) were measured in thirteen cadaveric shoulder specimens.
Histologically, the articular capsule has thin and loosely arranged collagen fibers with many interspersing fibroblast nuclei, whereas the outer layer of the articular capsule blends into a layer of more loosely spaced and less organized collagen fibers. This interface between the subscapularis and the underlying articular capsule is filled with more loosely spaced and less organized collagen fibers. The macroscopic evaluation showed that the minimum articular capsule width (4.2mm, SD 2.2mm) was located at its initiation 4.9mm (SD, 2.1mm) inferior to the superior margin of the subscapularis; the corresponding subscapularis footprint width measured 10.1mm (SD, 4.9mm). The maximum articular capsule width was11.1 mm (SD, 3.7mm) and was located 5mm distal to the inferior margin of the tendinous footprint. The maximum subscapularis footprint width was 15.8mm (SD, 2.9mm); the corresponding articular capsule attachment measured 5.2mm (SD, 1.8mm).
Our results suggest that the anterior articular capsule attachment of the glenohumeral joint complements the footprint of the subscapularis and occupies a larger area of the lesser tubercle and metaphysis of the humerus than previously documented. The histological study confirms the presence of a demarcation between the subscapularis and articular capsule, specifically more significant at the region medial to the tendon insertion and at the muscular insertion of the subscapularis.
本研究的目的是通过测量前关节囊附着处的尺寸以及肩胛下肌在肱骨上的足迹尺寸，并研究这两个结构之间的界面，来描绘前关节囊与相邻肩胛下肌之间的解剖关系。
对三个肩部标本进行组织学分析；对于组织学分析，在肩胛下肌 - 关节囊复合体的肌腱和肌肉附着部位获取横截面。在13个尸体肩部标本中测量前关节囊附着处和肩胛下肌足迹（包括肌腱和肌肉附着处）的尺寸。
组织学上，关节囊有薄且排列松散的胶原纤维，有许多散在的成纤维细胞核，而关节囊外层融入一层间距更宽且排列更无序的胶原纤维。肩胛下肌与下方关节囊之间的这个界面充满了间距更宽且排列更无序的胶原纤维。宏观评估显示，关节囊最小宽度（4.2毫米，标准差2.2毫米）位于其起始处，在肩胛下肌上缘下方4.9毫米（标准差2.1毫米）处；相应的肩胛下肌足迹宽度为10.1毫米（标准差4.9毫米）。关节囊最大宽度为11.1毫米（标准差3.7毫米），位于肌腱足迹下缘远侧5毫米处。肩胛下肌足迹最大宽度为15.8毫米（标准差2.9毫米）；相应的关节囊附着处为5.2毫米（标准差1.8毫米）。
我们的结果表明，肩肱关节的前关节囊附着补充了肩胛下肌的足迹，并且在肱骨小结节和干骺端占据的面积比先前记录的更大。组织学研究证实了肩胛下肌与关节囊之间存在分界，特别是在肌腱附着内侧区域以及肩胛下肌肌肉附着处更为明显。
