Variations in the upper limbs are common and are the main causes for iatrogenic injury during invasive procedures. A rare division of the axillary artery was found on the left side of a Korean cadaver during an educat...Variations in the upper limbs are common and are the main causes for iatrogenic injury during invasive procedures. A rare division of the axillary artery was found on the left side of a Korean cadaver during an educational dissection. The subscapular artery originated from the second part of the axillary artery. And then it gave off an aberrant branch to the pectoralis major muscle, as pectoral branch. The author describes this previously unreported case and discusses its prevalence and the clinical implications.展开更多
Purpose: The approach to resect subscapular and subrhomboid tumors needs elevation of the scapula. This is usually performed by detaching the muscles from the margo medialis of the scapula. We wish to communicate our ...Purpose: The approach to resect subscapular and subrhomboid tumors needs elevation of the scapula. This is usually performed by detaching the muscles from the margo medialis of the scapula. We wish to communicate our technique of a longitudinal osteotomy of the margo medialis for improved refixation of the muscles. Patients and Methods: 5 patients with subscapular and one patient with a subrhomboid benign tumor were operated on using this technique. Results: All patients achieved stable healing and full functional recovery;only in one patient there was slightly reduced elevation of the arm. Conclusion: Elevation of the muscles inserting into the medial scapular margo with a small rim of bone facilitates refixation and allows for excellent restitution of function.展开更多
[目的]探讨基于MRI的肩胛下肌腱形态对冻结肩的诊断价值。[方法]回顾性分析2020年1月-2023年6月因肩痛在本院就诊的患者资料。按冻结肩诊断标准将患者为冻结肩组(48例)和非冻结肩组(50例)。比较两组影像测量结果。并通过受试者工作特性...[目的]探讨基于MRI的肩胛下肌腱形态对冻结肩的诊断价值。[方法]回顾性分析2020年1月-2023年6月因肩痛在本院就诊的患者资料。按冻结肩诊断标准将患者为冻结肩组(48例)和非冻结肩组(50例)。比较两组影像测量结果。并通过受试者工作特性曲线(receiver operating characteristic,ROC)分析影像指标对冻结肩的诊断价值。[结果]冻结肩组的肩胛下肌腱厚度(subscapularis tendon thickness,SScTT)[(4.9±0.6) mm vs (3.8±0.4) mm,P<0.001]、横截面积(the cross sectional area o subscapularis tendon,SScT-CSA)[(69.3±27.8) mm2vs (37.9±12.5) mm2,P<0.001]、SScT-CSA/SSc-CSA[(0.3±0.1) vs (0.1±0.0),P<0.001]显著大于非冻结肩组,肩胛下肌的信号值[(59.5±8.3) vs (74.7±7.4),P=0.040]显著小于非冻结肩组。SScTT(AUC=0.900)和SScT-CSA/SSc-CSA(AUC=0.915)对冻结肩均具有高诊断价值。[结论]肩胛下肌腱的厚度以及腱-肌横截面积比能间接反映肩胛下肌腱的纤维化,可以作为冻结肩MRI诊断的新参考指标。展开更多
Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,adva...Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.展开更多
The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruct...The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruction of the mandible.The subscapular system can serve as an alternative to the fibula free flap in the presence of significant atherosclerotic disease or other contraindications.The flexibility and abundance of its soft tissue components make this system particularly advantageous for complex composite defects.Avoiding a fibula free flap for osseous reconstruction of the mandible permits early patient mobilization and may prevent adverse postoperative complications.A long pedicle can be harvested with subscapular flaps,which may prove useful in the face of limited available recipient vessels.Critics of the subscapular system cite longer operative times due to the need for patient repositioning and concerns over the integrity of the bone stock.Positioning modifications may permit a two-team approach to subscapular reconstruction,thus limiting operative times.Subscapular harvest does incur shoulder morbidity;however,this does not appear to affect the quality of life significantly.The flap is reliable and can support endosseous implants if properly planned,though it may be more susceptible to bone resorption when compared to the fibula.Overall,the subscapular system remains a versatile donor that can achieve ideal reconstructive outcomes with minimal morbidity.展开更多
目的探究关节镜下采用单排与双排缝合桥固定技术治疗肩胛下肌腱损伤的疗效。方法回顾性分析自2018年1月至2020年6月沧州市中心医院采用全关节镜修复治疗的40例肩胛下肌腱损伤患者资料。其中,男23例,女17例;年龄39~70岁,平均(55.25±...目的探究关节镜下采用单排与双排缝合桥固定技术治疗肩胛下肌腱损伤的疗效。方法回顾性分析自2018年1月至2020年6月沧州市中心医院采用全关节镜修复治疗的40例肩胛下肌腱损伤患者资料。其中,男23例,女17例;年龄39~70岁,平均(55.25±6.82)岁。依据术中肩胛下肌腱的固定方式分为双排缝合桥固定组(双排组,20例)和单排缝合固定组(单排组,20例)。记录缝合时间、疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩与肘协会评分系统(American Shoulder and Elbow Scoring System,ASES)、洛杉矶加利福尼亚肩关节分级评分(University of California at Los Angeles,UCLA),评估患者术前及术后1年时肩关节功能情况,并应用改良Sugaya分级法评估术后1年肩胛下肌腱愈合和再撕裂情况。结果所有病例获得随访,随访时间12~53个月,平均19.80个月。双排组患者肩胛下肌腱缝合时间多于单排组,差异有统计学意义(P<0.05)。术后1年双排缝合桥固定组的VAS评分[(1.30±0.57)分]、ASES评分[(70.92±5.65)分]、UCLA评分[(26.52±6.88)分]与术前相比明显改善,差异有统计学意义(P<0.05);术后1年单排缝合固定组VAS评分[(1.55±0.69)分]、ASES评分[(70.14±5.46)分]、UCLA评分[(26.89±7.78)分]与术前相比有明显改善,差异有统计学意义(P<0.05)。但术后1年两组间在VAS评分、ASES评分、UCLA评分方面比较,差异均无统计学意义(P>0.05)。根据改良Sugaya分级法,双排组术后1年核磁检查肌腱愈合良好,有1例再撕裂病例,单排组有2例再撕裂病例,两组术后1年肩胛下肌再撕裂情况比较,差异无统计学意义(P>0.05)。结论关节镜下采用单排和双排缝合桥技术修复肩胛下肌腱损伤均可获得满意的临床疗效和较低的再撕裂率。双排缝合固定肩胛下肌腱需要一定的手术技巧,缝合固定时间多于单排缝合方式。展开更多
目的:分析肩胛下动脉(SSA)系统的解剖特点,归纳其分布规律。方法:回顾性分析80例胸部增强CT图像,记录SSA的起源及长度,SSA及其分支——旋肩胛动脉(CSA)、胸背动脉(TDA)的管径及伴随静脉的归属,并进行归类。结果:160支腋动脉(AA)中,88.13...目的:分析肩胛下动脉(SSA)系统的解剖特点,归纳其分布规律。方法:回顾性分析80例胸部增强CT图像,记录SSA的起源及长度,SSA及其分支——旋肩胛动脉(CSA)、胸背动脉(TDA)的管径及伴随静脉的归属,并进行归类。结果:160支腋动脉(AA)中,88.13%(141/160)存在SSA分支,其中75.89%(107/141)起源于AA3,24.11%(34/141)起源于AA2;11.87%(19/160)SSA缺如。男性SSA起源于AA2者多于女性(25/80 vs 9/80),女性SSA缺如者多于男性(16/80 vs 3/80),性别间差异显著(P<0.01)。SSA管径为(4.72±0.76)mm,长度为(29.56±11.9)mm,CSA管径为(3.45±0.69)mm,TDA管径为(2.92±0.56)mm。SSA长度与管径性别间差异较明显(P<0.05)。SSA来源不同,分支不同(P<0.001)。AA2来源的分出胸外侧动脉(LTA)的概率高于AA3,AA3来源的发出旋肱后动脉(PCHA)的概率则高于AA2。SSA来源不同,伴随静脉汇入腋静脉点较恒定,92.52%(99/107)AA3来源、94.12%(32/34)AA2来源,52.63%(10/19)SSA缺如的分支伴随静脉汇合后,均汇入腋静脉偏外侧。结论:SSA系统变异较多,性别差异明显。胸部增强CT能清晰显示SSA系统的解剖细节,能为临床术前提供准确的血管评估。展开更多
文摘Variations in the upper limbs are common and are the main causes for iatrogenic injury during invasive procedures. A rare division of the axillary artery was found on the left side of a Korean cadaver during an educational dissection. The subscapular artery originated from the second part of the axillary artery. And then it gave off an aberrant branch to the pectoralis major muscle, as pectoral branch. The author describes this previously unreported case and discusses its prevalence and the clinical implications.
文摘Purpose: The approach to resect subscapular and subrhomboid tumors needs elevation of the scapula. This is usually performed by detaching the muscles from the margo medialis of the scapula. We wish to communicate our technique of a longitudinal osteotomy of the margo medialis for improved refixation of the muscles. Patients and Methods: 5 patients with subscapular and one patient with a subrhomboid benign tumor were operated on using this technique. Results: All patients achieved stable healing and full functional recovery;only in one patient there was slightly reduced elevation of the arm. Conclusion: Elevation of the muscles inserting into the medial scapular margo with a small rim of bone facilitates refixation and allows for excellent restitution of function.
文摘[目的]探讨基于MRI的肩胛下肌腱形态对冻结肩的诊断价值。[方法]回顾性分析2020年1月-2023年6月因肩痛在本院就诊的患者资料。按冻结肩诊断标准将患者为冻结肩组(48例)和非冻结肩组(50例)。比较两组影像测量结果。并通过受试者工作特性曲线(receiver operating characteristic,ROC)分析影像指标对冻结肩的诊断价值。[结果]冻结肩组的肩胛下肌腱厚度(subscapularis tendon thickness,SScTT)[(4.9±0.6) mm vs (3.8±0.4) mm,P<0.001]、横截面积(the cross sectional area o subscapularis tendon,SScT-CSA)[(69.3±27.8) mm2vs (37.9±12.5) mm2,P<0.001]、SScT-CSA/SSc-CSA[(0.3±0.1) vs (0.1±0.0),P<0.001]显著大于非冻结肩组,肩胛下肌的信号值[(59.5±8.3) vs (74.7±7.4),P=0.040]显著小于非冻结肩组。SScTT(AUC=0.900)和SScT-CSA/SSc-CSA(AUC=0.915)对冻结肩均具有高诊断价值。[结论]肩胛下肌腱的厚度以及腱-肌横截面积比能间接反映肩胛下肌腱的纤维化,可以作为冻结肩MRI诊断的新参考指标。
文摘Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.
文摘The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruction of the mandible.The subscapular system can serve as an alternative to the fibula free flap in the presence of significant atherosclerotic disease or other contraindications.The flexibility and abundance of its soft tissue components make this system particularly advantageous for complex composite defects.Avoiding a fibula free flap for osseous reconstruction of the mandible permits early patient mobilization and may prevent adverse postoperative complications.A long pedicle can be harvested with subscapular flaps,which may prove useful in the face of limited available recipient vessels.Critics of the subscapular system cite longer operative times due to the need for patient repositioning and concerns over the integrity of the bone stock.Positioning modifications may permit a two-team approach to subscapular reconstruction,thus limiting operative times.Subscapular harvest does incur shoulder morbidity;however,this does not appear to affect the quality of life significantly.The flap is reliable and can support endosseous implants if properly planned,though it may be more susceptible to bone resorption when compared to the fibula.Overall,the subscapular system remains a versatile donor that can achieve ideal reconstructive outcomes with minimal morbidity.
文摘目的探究关节镜下采用单排与双排缝合桥固定技术治疗肩胛下肌腱损伤的疗效。方法回顾性分析自2018年1月至2020年6月沧州市中心医院采用全关节镜修复治疗的40例肩胛下肌腱损伤患者资料。其中,男23例,女17例;年龄39~70岁,平均(55.25±6.82)岁。依据术中肩胛下肌腱的固定方式分为双排缝合桥固定组(双排组,20例)和单排缝合固定组(单排组,20例)。记录缝合时间、疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩与肘协会评分系统(American Shoulder and Elbow Scoring System,ASES)、洛杉矶加利福尼亚肩关节分级评分(University of California at Los Angeles,UCLA),评估患者术前及术后1年时肩关节功能情况,并应用改良Sugaya分级法评估术后1年肩胛下肌腱愈合和再撕裂情况。结果所有病例获得随访,随访时间12~53个月,平均19.80个月。双排组患者肩胛下肌腱缝合时间多于单排组,差异有统计学意义(P<0.05)。术后1年双排缝合桥固定组的VAS评分[(1.30±0.57)分]、ASES评分[(70.92±5.65)分]、UCLA评分[(26.52±6.88)分]与术前相比明显改善,差异有统计学意义(P<0.05);术后1年单排缝合固定组VAS评分[(1.55±0.69)分]、ASES评分[(70.14±5.46)分]、UCLA评分[(26.89±7.78)分]与术前相比有明显改善,差异有统计学意义(P<0.05)。但术后1年两组间在VAS评分、ASES评分、UCLA评分方面比较,差异均无统计学意义(P>0.05)。根据改良Sugaya分级法,双排组术后1年核磁检查肌腱愈合良好,有1例再撕裂病例,单排组有2例再撕裂病例,两组术后1年肩胛下肌再撕裂情况比较,差异无统计学意义(P>0.05)。结论关节镜下采用单排和双排缝合桥技术修复肩胛下肌腱损伤均可获得满意的临床疗效和较低的再撕裂率。双排缝合固定肩胛下肌腱需要一定的手术技巧,缝合固定时间多于单排缝合方式。
文摘目的:分析肩胛下动脉(SSA)系统的解剖特点,归纳其分布规律。方法:回顾性分析80例胸部增强CT图像,记录SSA的起源及长度,SSA及其分支——旋肩胛动脉(CSA)、胸背动脉(TDA)的管径及伴随静脉的归属,并进行归类。结果:160支腋动脉(AA)中,88.13%(141/160)存在SSA分支,其中75.89%(107/141)起源于AA3,24.11%(34/141)起源于AA2;11.87%(19/160)SSA缺如。男性SSA起源于AA2者多于女性(25/80 vs 9/80),女性SSA缺如者多于男性(16/80 vs 3/80),性别间差异显著(P<0.01)。SSA管径为(4.72±0.76)mm,长度为(29.56±11.9)mm,CSA管径为(3.45±0.69)mm,TDA管径为(2.92±0.56)mm。SSA长度与管径性别间差异较明显(P<0.05)。SSA来源不同,分支不同(P<0.001)。AA2来源的分出胸外侧动脉(LTA)的概率高于AA3,AA3来源的发出旋肱后动脉(PCHA)的概率则高于AA2。SSA来源不同,伴随静脉汇入腋静脉点较恒定,92.52%(99/107)AA3来源、94.12%(32/34)AA2来源,52.63%(10/19)SSA缺如的分支伴随静脉汇合后,均汇入腋静脉偏外侧。结论:SSA系统变异较多,性别差异明显。胸部增强CT能清晰显示SSA系统的解剖细节,能为临床术前提供准确的血管评估。
