Akyeampong Daniel, Hoey Alexander, Patel Arjun, Privette Alicia R, Ganske William, Halmark John, Muir Cassidy, Kubalak Steven W, Eriksson Evert A
From the Department of Surgery (D.A., A.H., A.P., A.R.P., W.G., J.H., C.M., E.A.E.) and Department of Anatomy (S.W.K.), Medical University of South Carolina, Charleston, South Carolina.
J Trauma Acute Care Surg. 2024 Dec 1;97(6):869-871. doi: 10.1097/TA.0000000000004430. Epub 2024 Sep 6.
Variations in the anatomy of the anterior rib cage and costal margin have been observed. We sought to evaluate the location of interchondral joints and evaluate their effect on mobility of the rib cage.
Cadaveric dissections were performed to evaluate the anatomy of the anterior ribs and the composition of the costal margin. Experienced chest wall surgeons and anatomists evaluated this anatomy through a standardized dissection and assessment. The presence of interchondral joints, and morphology and mobility of ribs were quantified. In addition, the movement and interactions of the ribs with upward pressure on the costal margin at the tip of the 10th rib were assessed.
Twenty-eight cadavers were evaluated bilaterally. In all patients, the first rib attached to the manubrium, the second rib attached to the sternal/manubrial junction, and ribs 3 to 6 attached directly to the sternum. Interchondral joints were present between ribs 4/5 in 0%, 5/6 in 35%, 6/7 in 96%, and 7/8 in 96%. The eighth/ninth ribs had free tips in 58% and 92%, respectively, and 10th rib was floating in 46%. Upward pressure on the costal margin resulted in compression of the ribs up to, on average, the 5.7 ± 0.6 rib with no compression above this level. This level corresponded to the rib interspace just above the most superior interchondral joint in 98% of evaluation. The transmission of these upward forces demonstrated an articulation of the ribs at the costal cartilage-sternal junction in the lower ribs.
Bridging interchondral joints are common between ribs 5 to 8 and participate in distributing forces from the costal margin across the chest wall. Upward forces at the costal margin are transmitted across the lower rib cage and result in increased mobility of the lower half of the ribs. The eighth/ninth ribs often have mobile tips, and the 10th is often a floating rib.
Prognostic and Epidemiological; Level IV.
已观察到前侧胸廓和肋弓的解剖结构存在变异。我们试图评估软骨间关节的位置，并评估其对胸廓活动度的影响。
进行尸体解剖以评估前侧肋骨的解剖结构和肋弓的组成。经验丰富的胸壁外科医生和解剖学家通过标准化的解剖和评估来研究这种解剖结构。对软骨间关节的存在情况以及肋骨的形态和活动度进行量化。此外，还评估了在第10肋尖端对肋弓施加向上压力时肋骨的运动及相互作用。
对28具尸体进行了双侧评估。在所有受试者中，第一肋附着于胸骨柄，第二肋附着于胸骨/胸骨柄关节，第3至6肋直接附着于胸骨。第4/5肋之间存在软骨间关节的比例为0%，第5/6肋之间为35%，第6/7肋之间为96%，第7/8肋之间为96%。第8/9肋的肋尖分别有58%和92%为游离状态，第10肋有46%为浮肋。对肋弓施加向上压力导致肋骨平均压缩至第5.7±0.6肋，在此水平以上无压缩。在98%的评估中，该水平对应于最上侧软骨间关节上方的肋间隙。这些向上的力的传递表明下侧肋骨在肋软骨 - 胸骨交界处存在关节活动。
第5至8肋之间常见连接性软骨间关节，其参与将肋弓的力量分布于整个胸壁。肋弓处的向上力通过下侧胸廓传递，导致下侧肋骨下半部分的活动度增加。第8/9肋的肋尖通常活动度较大，第10肋通常为浮肋。
预后和流行病学；IV级。
