Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Anatomy, Ultrastructural Cell Biology, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, Japan.
BMC Musculoskelet Disord. 2023 Mar 3;24(1):160. doi: 10.1186/s12891-023-06266-4.
Clavicle fractures are common injuries, especially in young, active individuals. Operative treatment is recommended for completely displaced clavicle shaft fractures, and plate fixation is stronger than the use of intramedullary nails. Few studies have reported on iatrogenic injuries to the muscle attached to the clavicle during fracture surgery. The aim of this study was to clarify the area of the insertion sites of muscles attached to the clavicle in Japanese cadavers using gross anatomy and three-dimensional (3D) analysis. We also aimed to compare the effects of anterior plate templating and superior plate templating on clavicle shaft fractures using 3D images.
Thirty-eight clavicles from Japanese cadavers were analyzed. We removed all clavicles to identify the insertion sites and measured the size of the insertion area of each muscle. Three-dimensional templating was performed on both the superior and anterior plates of the clavicle using data obtained from computed tomography. The areas covered by these plates on the muscles attached to the clavicle were compared. Histological examination was performed on four randomly selected specimens.
The sternocleidomastoid muscle was attached proximally and superiorly; the trapezius muscle was attached posteriorly and partly superiorly; and the pectoralis major muscle and deltoid muscles were attached anteriorly and partially superiorly. The non-attachment area was located mainly in the posterosuperior part of the clavicle. It was difficult to distinguish the borders of the periosteum and pectoralis major muscles. The anterior plate covered a significantly broader area (mean 6.94 ± 1.36 cm) of the muscles attached to the clavicle than did the superior plate (mean 4.11 ± 1.52 cm) (p < 0.0001). On microscopy, these muscles were inserted directly into the periosteum.
Most of the pectoralis major and deltoid muscles were attached anteriorly. The non-attachment area was located mainly from the superior to posterior part of the clavicle midshaft. Both macroscopically and microscopically, the boundaries between the periosteum and these muscles were difficult to demarcate. The anterior plate covered a significantly broader area of the muscles attached to the clavicle than that by the superior plate.
锁骨骨折是一种常见的损伤，尤其是在年轻、活跃的人群中。对于完全移位的锁骨骨干骨折，建议采用手术治疗，钢板固定比髓内钉更强。很少有研究报告锁骨骨折手术中对附着于锁骨的肌肉造成医源性损伤。本研究的目的是通过大体解剖和三维（3D）分析，明确日本尸体中附着于锁骨的肌肉插入点的区域。我们还旨在通过 3D 图像比较前板和上板模板对锁骨骨干骨折的影响。
分析了 38 例来自日本尸体的锁骨。我们切除所有锁骨以确定插入点，并测量每个肌肉的插入面积。使用来自 CT 获得的数据，对锁骨的前板和上板进行 3D 模板制作。比较这些板覆盖附着于锁骨的肌肉的区域。对随机选择的 4 个标本进行组织学检查。
胸锁乳突肌附着于近侧和上侧；斜方肌附着于后侧和部分上侧；胸大肌和三角肌附着于前侧和部分上侧。非附着区主要位于锁骨后上部。很难区分骨膜和胸大肌的边界。前板覆盖附着于锁骨的肌肉的面积明显较宽（平均 6.94±1.36 cm），而上板覆盖的面积较窄（平均 4.11±1.52 cm）（p<0.0001）。显微镜下，这些肌肉直接插入骨膜。
大部分胸大肌和三角肌附着于前侧。非附着区主要位于锁骨中轴的上后部分。无论是宏观还是微观，骨膜和这些肌肉之间的边界都很难划定。前板覆盖附着于锁骨的肌肉的面积明显大于上板。
