Shaffer B, Evans B, Ferrero G
Department of Orthopaedics, Georgetown University Medical Center, Washington, DC 20007, USA.
J Shoulder Elbow Surg. 1997 May-Jun;6(3):297-305. doi: 10.1016/s1058-2746(97)90020-3.
The purpose of this study was to examine the anatomy and ability to reattach the coracoacromial ligament (CAL) after acromioplasty. Twenty-eight fresh cadaveric shoulder specimens were dissected, and the CAL dimensions and pattern of attachment were examined. The ability to reattach the CAL to the anterior acromion after acromioplasty was investigated, comparing release along the anterior acromion (traditional anterior acromioplasty) versus subperiosteal elevation from the acromial undersurface. The influence of CAL length, acromial "type," and amount of acromioplasty on reattachment were examined. In 96% of the specimens (27 of 28) confluent medial and lateral bands of the CAL insertion along the acromion precluded "selective" release. The ability to anatomically reattach the CAL was directly related to the method of ligament release (anterior release versus subperiosteal elevation) (p < 0.0001). When directly released from along the anterior acromion, the CAL could not be anatomically reattached in any specimen. Nonanatomic reattachment to a more medial anterior acromial insertion site, however, was possible in 22 (79%) of 28 specimens. Reattachment required an average medial positioning of 60% (range 16% to 88%) along the anterior acromion from the anterolateral tip. Six (21%) specimens could not be reattached despite attempted medial positioning. In contrast, when subperiosteally elevated from the anterior inferior acromion, the CAL was reattachable in all specimens, anatomically in 26 (93%) of 28. The two nonanatomic reattachments required medially reattaching the ligament's normal acromial insertion by an average of 30%. There was no relationship between specimen sex, age, presence of rotator cuff tear, type of acromion, and CAL reattachment. The confluent anatomy of the CAL does not permit "selective" release of discretely identifiable portions of the CAL (i.e., the lateral band). In cases in which CAL restoration is important, careful subperiosteal elevation from the acromial undersurface will facilitate anatomic reattachment. Standard release of the CAL from the anterior acromion precludes anatomic, and in some cases any, reattachment of the CAL.
本研究的目的是检查肩峰成形术后喙肩韧带（CAL）的解剖结构及重新附着的能力。对28个新鲜尸体肩部标本进行解剖，检查CAL的尺寸和附着模式。研究肩峰成形术后将CAL重新附着于前肩峰的能力，比较沿前肩峰松解（传统前肩峰成形术）与从肩峰下表面进行骨膜下剥离。检查CAL长度、肩峰“类型”和肩峰成形量对重新附着的影响。在96%的标本（28个中的27个）中，CAL沿肩峰的内侧和外侧融合带插入，排除了“选择性”松解。CAL解剖学重新附着的能力与韧带松解方法（前松解与骨膜下剥离）直接相关（p < 0.0001）。当从沿前肩峰直接松解时，在任何标本中CAL都无法进行解剖学重新附着。然而，在28个标本中的22个（79%）中，CAL可以非解剖学方式重新附着于更内侧的前肩峰插入部位。重新附着需要从外侧尖端沿前肩峰平均向内侧定位60%（范围为16%至88%）。尽管尝试了向内侧定位，仍有6个（21%）标本无法重新附着。相比之下，当从肩峰前下方进行骨膜下剥离时，在所有标本中CAL均可重新附着，28个中有26个（93%）为解剖学重新附着。两个非解剖学重新附着需要将韧带正常的肩峰插入部位平均向内侧重新附着30%。标本的性别、年龄、肩袖撕裂的存在、肩峰类型和CAL重新附着之间没有关系。CAL的融合解剖结构不允许对CAL离散可识别部分（即外侧带）进行“选择性”松解。在CAL修复很重要的情况下，从肩峰下表面进行仔细的骨膜下剥离将有助于解剖学重新附着。从肩峰前侧对CAL进行标准松解会排除CAL的解剖学重新附着，在某些情况下甚至排除任何重新附着。
