肩胛上神经卡压机制的临床解剖学研究

A mechanism study of clinical anatomy on suprascapular nerve entrapment

目的探讨肩胛上神经卡压症的解剖学机制,为临床诊断和治疗提供解剖学依据。方法22具(男13具,女9具)44侧成尸标本,解剖观测肩胛上切迹,冈盂切迹的形态特点以及肩胛上神经走行、分支及分布的解剖学特点,所测数据统计学处理。结果肩胛上切迹类型:U型占40.91%(18侧),浅U型占22.73%(10侧),大弧型占27.27%(12侧),方形占9.01%(4侧)四种。肩胛上切迹的厚度为(1.55±0.36)mm。肩胛上神经主干与冈上肌支所成角为(86.04±1.28)°。冈下肌支的入肌点,有22.73%在该肌的起点处,77.27%在中或外1/3处。冈盂切迹的厚度在(6.82±1.21)mm。肩胛上神经自肩胛上孔穿出点至肩胛冈基底部的高度为(11.13±0.21)mm;至冈盂切迹的水平距离为(14.03±0.64)mm。肩胛上神经转折角为(49.65±1.63)°。结论肩胛上切迹的类型、肩胛上切迹和冈盂切迹的厚度,肩胛上神经转折角的大小、神经主干与冈上肌支的角度以及冈下肌支的入肌点等均是肩胛上神经卡压的危险因素。

Objective To study the anatomical mechanism of the suprascapular nerve entrapment, to provide the basis for clinical diagnosis and treatment of this disease. Methods In 22 （male 13, female 9） 44 sides of cadaveric specimens, the anatomic features of the suprascapular notch, spinoglenoid notch, the branches and distribution of supraspinatus were observed. The data were analyzed statistically. Results The suprascapular notch could be divided into four types. U type 40.91%（18 sides）,shallow U type 22.73%（10 sides）, arc type 27.27%（12 sides）, square type 9.01%（4 sides）. The thickness of suprascapular notch was （1.55 ± 0.36） mm; The angle of between the trunk of suprascapular nerve and the branch of the supraspinatus was （ 86.04±1.28）°. The position of the branches of infraspinatus that entered infraspinatus was located near the origin of the infraspinatus in 10 sides. The thickness of the spinoglenoid notch was （6.82 ± 1.21） mm.The heights of suprascapular nerve from the suprascapular hole to the base of scapular averaged （11.13 ± 0.21） mm. And the horizontal distance from the suprascapular hole to the spinoglenoid notch was （14.03 ± 0.64） mm. The angle of the suprascapular nerve was （49.65 ± 1.63）° . Conclusion The risk factors that can lead to suprascapular nerve entrapment include： the types of scapular notch, the thickness of the suprascapular notch and the spinoglenoid notch, the angles of suprascapular nerve, the angles between the trunk of suprascapular nerve and the branches of supraspinatus, the position of the branches of infraspinatus that enter it.