Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.
Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
J Anat. 2021 Nov;239(5):973-982. doi: 10.1111/joa.13496. Epub 2021 Jun 23.
Trauma, corticosteroid therapy and metabolic diseases are well established aetiologies of humeral head osteonecrosis; however, there is increasing evidence that arthroscopic rotator cuff surgery may be another possible cause. One of the reasons is that there may be inadvertent damage to the arterial blood supply to the humeral head during surgical intervention. The blood supply to the humeral head displays large amounts of variation with regard to origin, course and distribution. Therefore, to shed light on the pathogenesis, the blood supply of the humeral head is reviewed together with a summary of all reported cases of osteonecrosis of the humeral head that occurred following rotator cuff repair. Inconsistencies with regard to terminologies used and contradictions concerning arterial contributions from the anterior circumflex humeral artery and the posterior circumflex humeral artery towards humeral head supply are addressed. Moreover, variations in the course of the anterior circumflex humeral artery and its branches are summarized. The vascular anatomy of the humeral head is clinically relevant due to the close relationship of these blood vessels with the surgical repair sites for rotator cuff surgery and biceps tenotomies or tenodesis procedures. Potential sites of disruption of blood supply following arthroscopic rotator cuff surgery are discussed. Detailed knowledge of the course of the arteries supplying the humeral head may help to minimize the risk of vascular injury and subsequent osteonecrosis. Given the great interindividual variations of vascular anatomy, imaging procedures preceding arthroscopic rotator cuff surgery may be advisable.
创伤、皮质类固醇治疗和代谢性疾病是肱骨头坏死的公认病因；然而，越来越多的证据表明关节镜肩袖手术可能是另一个可能的原因。原因之一是在手术干预过程中可能会无意中损伤肱骨头的动脉血液供应。肱骨头的血液供应在起源、路径和分布方面存在大量变化。因此，为了阐明发病机制，本文综述了肱骨头的血液供应，并总结了所有报道的肩袖修复后发生肱骨头坏死的病例。本文还解决了在使用术语方面的不一致性，以及在前旋肱动脉和后旋肱动脉对肱骨头供应的动脉贡献方面的矛盾。此外，还总结了前旋肱动脉及其分支的走行变化。由于这些血管与肩袖手术和肱二头肌切断术或肌腱固定术的手术修复部位密切相关，因此肱骨头的血管解剖结构在临床上具有重要意义。讨论了关节镜肩袖手术后血液供应中断的潜在部位。详细了解供应肱骨头的动脉的走行可能有助于降低血管损伤和随后发生骨坏死的风险。鉴于血管解剖结构的个体间差异很大，在关节镜肩袖手术前进行影像学检查可能是明智的。
