Cooper D E, O'Brien S J, Warren R F
W. B. Carrell Memorial Clinic, Baylor University, Medical Center, Dallas, Texas.
Clin Orthop Relat Res. 1993 Apr(289):144-55.
Based on anatomic and surgical dissections, the anatomy of the shoulder region is described in terms of four layers that overlie and support the glenohumeral joint. Each layer envelops the glenohumeral joint on its anterior, lateral, and posterior aspects, and between each layer there is a plane for safe and easy dissection. Layer 1 is composed of the deltoid and pectoralis major muscle bellies with their overlying fascia and enveloping epimysium. Anteriorly, Layer 2 consists of the clavipectoral fascia, the conjoined tendon of the short head of the biceps and coracobrachialis, and the coracoacromial ligament. Posteriorly, Layer 2 is the dense posterior scapular fascia that overlies the infraspinatus and teres minor muscle bellies. It is continuous with the clavipectoral fascia around the lateral aspect of the proximal humerus. Deep to Layer 2, the subdeltoid bursa yields a dissection plane that encompasses the anterior, lateral, superior, and variably the posterior aspects of the glenohumeral joint. Layer 3 consists of the deep layer of the subdeltoid bursa and the underlying musculotendinous units of the rotator cuff, including subscapularis, supraspinatus, infraspinatus, and teres minor. Layer 4 is the capsule of the glenohumeral joint. This includes the glenohumeral ligaments and coracohumeral ligament. These four layers were present and consistent in each shoulder dissected. Significant variations were present only within the deepest layer (shoulder joint capsule). This system can serve as a learning tool and will provide a more organized approach to facilitate surgical dissection in the region.
基于解剖学和手术解剖，肩部区域的解剖结构可分为覆盖并支撑盂肱关节的四层。每层在盂肱关节的前、外侧和后方将其包裹，且每层之间都有一个便于安全解剖的平面。第1层由三角肌和胸大肌肌腹及其上方的筋膜和包绕的肌外膜组成。在前方，第2层由锁胸筋膜、肱二头肌短头和喙肱肌的联合肌腱以及喙肩韧带组成。在后方，第2层是覆盖冈下肌和小圆肌肌腹的致密肩胛后筋膜。它在肱骨近端外侧与锁胸筋膜相连。在第2层的深部，肩峰下囊形成一个解剖平面，该平面覆盖盂肱关节的前、外侧、上方以及部分后方。第3层由肩峰下囊的深层和肩袖的深层肌肌腱单元组成，包括肩胛下肌、冈上肌、冈下肌和小圆肌。第4层是盂肱关节的关节囊。这包括盂肱韧带和喙肱韧带。在每例解剖的肩部中，这四层结构均存在且一致。仅在最深层（肩关节囊）存在显著变异。该系统可作为一种学习工具，并将提供一种更有条理的方法来促进该区域的手术解剖。
