Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia, Bulgaria.
Department of Anatomical Sciences, St. George's University, True Blue, Grenada.
J Anat. 2024 Jul;245(1):197-198. doi: 10.1111/joa.14037. Epub 2024 Mar 6.
We read with great interest the article by Weninger et al. (2023) on the presence of the axillary arch (AA) (of Langer) found during anatomical dissections-"Axillary arch (of Langer): A large-scale dissection and simulation study based on unembalmed cadavers of body donors." The authors performed their study using 400 axillae from 200 unembalmed cadavers; they identified this variant muscle in 27 axillae of 18 cadavers. Weninger et al. (2023) described the muscular AA in 15 cases; AA was composed of connective tissue in six cases, and AA comprised muscular and connective tissue in six cadavers. Moreover, these authors indicated that after passive abduction and lateral rotation of the arm, 17 arches (63%) came into contact with the neurovascular axillary bundle, which is of clinical importance. In our opinion, this is the most precise and detailed AA muscle study in the literature, illustrated with excellent photographs and schemes. Such studies expand the existing data in the literature and are of real help to clinicians. However, we want to present our modest comments about the title of the article and would like to pose the question, "What is the axillary arch (of Langer)?" Weninger et al. (2023) stated that connective or muscular tissue crossing the axilla is termed the AA (of Langer). This structure splits from the latissimus dorsi muscle, crosses the axilla, and joins the anterior part of the upper limb. The first detailed description of this variation was published in 1846 by Karl Langer Ritter von Edenberg (Langer, 1846). Nowadays, a significant number of articles term all muscular and fibromuscular connections between the latissimus dorsi muscle and the anterior part of the upper limb as "Langers AA" (Markou et al., 2023; Sang et al., 2019; Scrimgeour et al., 2020; Taterra et al., 2019). What Langer described in his work "Zur anatomie des musculus latissimus dorsi" was a fibrous thickening of the medial edge of the axillary fascia between the borders of the pectoralis major and the latissimus dorsi muscles, a structure he termed "Achselbogen." In a sequel of this article, Langer investigated muscular fibers inserting at or encircling the connective tissue "Achselbogen" (Langer, 1846). Therefore, in our opinion, in the study of Weninger et al. (2023), the term AA (of Langer) should only be used to describe the cases presenting solely with a connective tissue "arch" or these comprised of both, muscular and connective tissue. Weninger et al. (2023) noted that muscle fibers could not be excluded in these cases. Of course, to answer this question accurately, a histological study of these cases would be necessary.
我们饶有兴趣地阅读了 Weninger 等人(2023 年)关于腋弓(Langer 氏)在解剖学解剖中存在的文章(“腋弓(Langer 氏):基于未防腐尸体供体的大规模解剖和模拟研究”)。作者使用 200 具未防腐尸体的 400 个腋窝进行了他们的研究;他们在 18 具尸体的 27 个腋窝中发现了这种变异肌肉。Weninger 等人(2023 年)描述了 15 例肌肉腋弓;在 6 例中,腋弓由结缔组织组成,在 6 例中,腋弓由肌肉和结缔组织组成。此外,这些作者指出,在手臂被动外展和外侧旋转后,17 个弓(63%)与神经血管腋束接触,这具有临床重要性。在我们看来,这是文献中最精确和详细的腋弓肌肉研究,附有极好的照片和图表。此类研究扩展了文献中的现有数据,对临床医生有真正的帮助。然而,我们想对文章的标题提出我们的一些看法,并想提出一个问题,“腋弓(Langer 氏)是什么?”Weninger 等人(2023 年)指出,穿过腋窝的结缔组织或肌肉组织被称为腋弓(Langer 氏)。该结构起源于背阔肌,穿过腋窝,连接上肢的前部分。这种变异的第一次详细描述是由 Karl Langer Ritter von Edenberg(Langer,1846 年)于 1846 年发表的。如今,大量文章将背阔肌和上肢前部分之间的所有肌肉和纤维肌肉连接都称为“Langer 的腋弓”(Markou 等人,2023 年;Sang 等人,2019 年;Scrimgeour 等人,2020 年;Taterra 等人,2019 年)。Langer 在他的著作“Zur Anatomie des Musculus Latissimus Dorsi”中描述的是胸大肌和背阔肌之间的腋窝筋膜内侧边缘的纤维状增厚,他称之为“腋窝弓”(Langer,1846 年)。在这篇文章的续集中,Langer 研究了插入连接组织“腋窝弓”(Langer,1846 年)或围绕其插入的肌肉纤维(Langer,1846 年)。因此,在我们看来,在 Weninger 等人(2023 年)的研究中,仅应使用术语“腋弓(Langer 氏)”来描述仅存在结缔组织“弓”或由肌肉和结缔组织组成的病例。Weninger 等人(2023 年)指出,在这些情况下不能排除肌肉纤维的存在。当然,要准确回答这个问题,需要对这些病例进行组织学研究。