大圆肌的解剖学研究：一条额外的远端肌束的描述。
Anatomical study of the teres major muscle: description of an additional distal muscle slip.
作者信息
Ernstbrunner Lukas, Jessen Malik, Rohner Marco, Dreu Manuel, Bouaicha Samy, Wieser Karl, Borbas Paul
机构信息
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria.
出版信息
BMC Musculoskelet Disord. 2021 Apr 16;22(1):359. doi: 10.1186/s12891-021-04227-3.
BACKGROUND
Understanding muscle and tendon anatomy is of tremendous importance to achieve optimal surgical execution and results in tendon transfers around the shoulder. The aim of this study was to introduce and describe an additional distal muscle slip of the teres major (TM).
METHODS
Sixteen fresh-frozen cadaver shoulders were dissected with the deltopectoral approach. The ventral latissimus dorsi (LD) tendon was harvested, and the shoulders were analyzed for the presence/absence of a distal teres major slip (dTMs) and its dimensions and relationship with the TM and LD tendons.
RESULTS
The dTMs was identified in 12 shoulders (75%). It was always distal to the TM tendon and visible during the deltopectoral approach. There was a clear separation between the TM proximally and dTMs tendon distally. At the humeral insertion, both tendons had a common epimyseal sheet around the teres major and inserted continuously at the humerus. The mean width of the dTMs tendon at the insertion was 13 ± 4 mm (range, 7-22 mm). The total lengths of the dTMs tendon and LD tendon were 40 ± 7 mm (range, 25-57 mm) and 69 ± 7 mm (range, 57-79 mm), respectively (p < 0.001). The dTMs muscle showed direct adhesions in ten shoulders (83%) with the LD muscle.
CONCLUSIONS
This is the first macroscopic description of an additional distal slip of the teres major muscle. The dTMs has a separate (distal) but continuous (mediolateral) insertion at the humerus within a common epimyseal sheet around the TM. The dTMs tendon is visible during the deltopectoral approach and can therefore provide a lead structure, particularly in ventral LD transfers with the deltopectoral approach.
背景
了解肌肉和肌腱解剖结构对于在肩部周围进行肌腱转移时实现最佳手术操作和效果至关重要。本研究的目的是介绍并描述大圆肌（TM）的一个额外的远端肌束。
方法
采用胸大肌三角肌入路对16个新鲜冷冻尸体肩部进行解剖。采集腹侧背阔肌（LD）肌腱，并分析肩部是否存在远端大圆肌肌束（dTMs）及其尺寸以及与TM和LD肌腱的关系。
结果
在12个肩部（75%）中发现了dTMs。它始终位于TM肌腱的远端，在胸大肌三角肌入路过程中可见。TM在近端与dTMs肌腱在远端有明显的分离。在肱骨止点处，两条肌腱在TM周围有一个共同的肌外膜层，并在肱骨处连续插入。dTMs肌腱在止点处的平均宽度为13±4mm（范围为7 - 22mm）。dTMs肌腱和LD肌腱的总长度分别为40±7mm（范围为25 - 57mm）和69±7mm（范围为57 - 79mm）（p < 0.001）。dTMs肌肉在10个肩部（83%）中与LD肌肉有直接粘连。
结论
这是对大圆肌额外远端肌束的首次宏观描述。dTMs在肱骨处有一个单独的（远端）但连续的（内外侧）止点，位于TM周围的共同肌外膜层内。dTMs肌腱在胸大肌三角肌入路过程中可见，因此可以提供一个引导结构，特别是在采用胸大肌三角肌入路进行腹侧LD转移时。
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