肩锁关节及关节盘的相关解剖学特征

背景：目前临床上多数认为，肩部疾病如肩锁关节脱位、肩峰下撞击综合征等与肩锁关节的解剖形态有很大的关系，但国内外文献很少有关于肩锁关节的形态学数据支持，特别对于肩锁关节关节盘的解剖学研究。同时肩锁关节属于微动关节，参与肩关节的联合运动，现临床上有关肩锁关节脱位的手术方式繁多，较流行的手术方式多为刚性固定，并未保留其微动特点以及锁骨和肩胛骨的运动特点，其中关节盘的取舍目前国内外并无大样本多中心对照研究。

目的：对肩锁关节及关节盘行相关解剖学研究，用于更好地指导肩部疾病的诊治。

方法：对58 具肩锁关节尸体标本(同济大学解剖教研室提供)进行形态学及组织结构研究，共获得58 个肩峰、58 个锁骨和36 个关节盘(包括完全型和不完全型)。采用BIGLIANI 肩峰形态分型、DEPALMA 锁骨形态分型、EMURA 肩锁关节盘分型，获得各肩峰与锁骨组合下关节盘出现的频率并行苏木精-伊红染色(上海市普陀区人民医院提供)。

结果与结论：①在58 个肩锁关节尸体中，肩锁关节盘type1 型共15 例，所占比例最高，为25.9%；type3a型共4 例，所占比例最少，为6.9%。②Ⅰ型肩峰32 个，所占比例最高，为55.2%；Ⅲ型肩峰3 个，所占比例最低，为5.2%。③Ⅰ型锁骨27 个，所占比例最高，为46.6%；Ⅲ型锁骨9 个，所占比例最低，为15.5%。④以Ⅰ型及Ⅱ型肩峰与Ⅰ型锁骨组合所占比例较大，分别为24.1%和22.4%，以Ⅲ型肩峰对Ⅰ型锁骨所占比例最小，为0%。⑤而在Ⅰ型肩峰与Ⅰ型锁骨组合下type1 型和type2b 型关节盘所占比例最大，分别为35.7%和28.6%；Ⅱ型肩峰与Ⅰ型锁骨组合下type2a 型和type1 型关节盘所占比例最大，分别为38.5%和23.1%。⑥苏木精-伊红染色在组织切片中可以发现，关节盘中的细胞外基质清晰可辨，细胞形态饱满，含有丰富的细胞质，提示为软骨细胞，即形成纤维软骨的主要成分。此外，从关节囊顶端和底端两侧可见部分骨膜纤维层移行至关节盘内侧，考虑共同组成关节盘结构，即关节盘由近骨面的软骨细胞及远离骨面的纤维层共同构成。

上海市卫健委面上项目()，课题名称：髋关节置换术后唑来膦酸纳治疗对假体周围股骨骨密度影响研究，项目负责人：叶征

BACKGROUND:At present,most clinicians believed that shoulder diseases such as acromioclavicular joint dislocation and subacromial impact syndrome,have a great relationship with the anatomic shape of the acromioclavicular ,there are few morphological data on acromioclavicular joints in and outside China,especially for the anatomical study of acromioclavicular joint ,the acromioclavicular joint belongs to the micro-movement joint and participates in the joint movement of the shoulder are many clinical methods of acromioclavicular dislocation surgery,the most popular surgical methods are rigid fixation,and do not retain their micro-movement characteristics and the motion characteristics of the clavicle and them,the choice of joint discs is not a large multicenter controlled study in and outside China.

OBJECTIVE:To study the anatomy of the acromioclavicular joint and joint discs in order to diagnose and treat shoulder diseases.

METHODS:The morphology and tissue structure of 58 acromioclavicular joint corpses(provided by the Department of Anatomy,Tongji University) were total of 58 acromion,58 clavicles and 36 joint discs(including complete and incomplete) were acromicular morphology typing,DEPALMA clavicle morphological typing,and EMURA acromioclavicular joint disc typing were used to obtain the frequency of joint discs under each acromion and clavicle combination and hematoxylin-eosin staining(provided by Shanghai Putuo District People’s Hospital).

RESULTS AND CONCLUSION:(1) Among 58 corpses of acromioclavicular joints,there were 15 cases of type 1 acromioclavicular joints,with the highest proportion being 25.9%,and 4 cases of type 3a,with the lowest proportion being 6.9%.(2) There was 32 type I acromion,with the highest proportion of 55.2%,3 type III acromion,with the lowest proportion of 5.2%.(3) There were 27 type I clavicle,with the highest proportion of 46.6%,9 type III clavicle,with the lowest proportion of 15.5 %.(4) Type I and type II acromion combined with type I clavicle accounted for a large proportion,which were 24.1% and 22.4%,respectively,and type III acromion had a minimum proportion of type I clavicle of 0%.(5) Type 1 and type 2b joint discs accounted for the largest proportion under the combination of type I acromion and type I clavicle,which were 35.7% and 28.6% 2a and type 1 joint discs under the combination of type II acromion and type I clavicle presented the largest proportions 38.5% and 23.1%.(6) Hematoxylin-eosin staining could be found in tissue extracellular matrix in the articular disc was clearly cells were full in morphology,and rich in cytoplasm,suggesting chondrocytes,which were the main components of fibrocartilage addition,part of the periosteum fiber layer can be seen from the top and bottom of the joint capsule to the inside of the joint disc.It is considered to form a joint disc structure,that is,the joint disc is composed of chondrocytes near the bone surface and a fiber layer away from the bone surface.

文章来源：《解剖学研究》 网址: http://www.jpxyjzz.cn/qikandaodu/2021/0207/343.html