著者

植木 博子 吉村 英哉 日山 鐘浩 望月 智之 二村 昭元 秋田 恵一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.38, no.2, pp.369-371, 2014 (Released:2014-10-01)

参考文献数

7

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小胸筋腱の停止が烏口突起をこえて延長する解剖学的破格は以前から知られている.過去に我々が調査した屍体解剖実習体では小胸筋延長腱の発現率は34.6%(81肩中21肩)であり,延長腱は烏口突起を越えて関節包の方に広がっていた.今回,肩腱板断裂症例において鏡視下修復術時に小胸筋延長腱の有無を確認し形態について観察した. 対象は2012年6月から12月までに当院で鏡視下腱板修復術を施行した腱板断裂症例25例(男性13例,女性12例)であった.術中にまず烏口突起基部を同定し小胸筋延長腱の存在を確認した. 延長腱は25例中10例(40%)に認められた.烏口突起に停止せずに上面を滑動し棘上筋の方向に向かい,烏口上腕靭帯とは明瞭に区別がついた. 臨床でも延長腱の発現頻度は比較的高く,その走行および付着の形態より肩甲上腕関節機能に影響を与えることが示唆された.鏡視下手術では延長腱の存在を留意する必要があると考えられた.

著者

吉村 英哉 望月 智之 宗田 大 菅谷 啓之 前田 和彦 秋田 恵一 松木 圭介 中川 照彦

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.217-219, 2007 (Released:2008-01-30)

参考文献数

10

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Previous studies reported a presumably unusual bony attachment of the pectoralis minor muscle. However, less attention has been given to the insertion of the continuation to the glenohumeral joint. The purpose of this study was to evaluate the frequency of this abnormal insertion of the pectoralis minor muscle, and also to investigate the relation between this continuation and the capsule. 81 anatomic specimen shoulders from 41 cadavers were dissected. The insertion of the pectoralis minor tendon to the glenohumeral joint was carefully investigated. The pectoralis minor tendon ran beyond the coracoid process and extended to the superior portion of the glenohumeral joint in 28 out of 81 specimens (34.6%). The continuing insertion divided the coracoacrominal ligaments into two limbs. The continuation was more variable, and consisted of the whole tendon in 6, the middle part in 5, the lateral part in 15, and the medial part in 2 specimens. Furthermore, the pectoralis minor tendon inserted to the posterosuperior border of the glenoid in 6, to the greater tuberosity in 7, and both to the glenoid and the greater tuberosity in 15 specimens. The prevalence of the anomalous insertion of the pectoralis minor tendon revealed to be as high as 34.6% in the present study. This may suggest that the pectoralis minor tendon plays an important role in the stability of the glenohumeral joint.

著者

吉村 英哉 望月 智之 秋田 恵一 加藤 敦夫 山口 久美子 新井 隆三 菅谷 啓之 浜田 純一郎

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.35, no.3, pp.707-710, 2011 (Released:2011-12-21)

参考文献数

18

被引用文献数

1

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Our previous study revealed that the most proximal portion of the subscapularis tendon extended a thin tendinous slip to the fovea capitis of the humerus, and that the coracohumeral ligament (CHL) together with the SGHL was shaped like a spiral sling, supporting the long head of biceps and attached to the tendinous slip. Little information is available, however, regarding the relationship between CHL and the insertion of subscapularis on the lesser tuberosity. To clarify the significance of CHL, we examined the morphology of CHL and the subscapularis insertion in 20 cadaveric shoulders. The anterior portion of CHL arises from the base of the coracoid process and fans out laterally and inferiorly on the subscapularis. The fibers envelop the tendinous portion of the subscapularis on either side. As a result, the ligament forms a cable-like anterior leading edge over the rotator interval. The subscapularis tendon can appear in relative anatomic position unless the arm is brought into internal rotation and relaxation is achieved. We also demonstrated that CHL was associated with opening the bicipital sheath along its medial border during shoulder elevation. The coracohumeral ligament might contribute to the stability of the subscapularis tendon and to the morphology of the bicipital groove.

著者

山口 久美子 加藤 敦夫 秋田 恵一 望月 智之

出版者

日本肩関節学会

雑誌

肩関節 = Shoulder joint (ISSN:09104461)

巻号頁・発行日

vol.34, no.3, pp.587-589, 2010-08-04

参考文献数

4

被引用文献数

1

---

Coracohumeral ligament (CHL) is situated in the gap between the supraspinatus and the subscapuralis. There are only a few studies concerning the CHL after Clark and Harryman II (1992) in spite of the important role that fills the rotator interval. In this study, we dissected six shoulders of three cadavers to observe the spatial distribution of the CHL in detail. Four shoulders of two cadavers were processed to analyze the attachment of the rotator cuff and the capsule histologically. For the histological analyses, whole parts of the CHL were removed emblock, and serial sections were made from proximal to distal. In gross anatomy, the CHL attached to the proximal lateral surface of the coracoid process in its most proximal part. It filled the rotator interval between the supraspinatus and the subscapularis. Most distal part of the CHL extended to both the superior and inferior surfaces of supraspinatus, and both the anterior and posterior surfaces of subscapularis. In the rotator interval, CHL connected to the superior glenohumeral ligament (SGHL). There was no clear border between the CHL and the SGHL in either gross anatomy or histologically. Histologically, the CHL contained only fine loose slack collagen fibers without any dense fiber that is normally observed in a ligament. With flexion and the extension, the CHL were stretched to pull the rotator interval. From these observations, the CHL seems to work with the SGHL for the stability of the long head of the biceps during shoulder movement.

著者

松木 圭介 菅谷 啓之 前田 和彦 森石 丈二 望月 智之 秋田 恵一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.213-215, 2007

被引用文献数

7

---

The purpose of this study was to examine the anatomy of the infraspinatus including the orientation of muscle fibers and the insertion to the greater tuberosity. Ninety-three shoulders from 52 cadavers were minutely dissected. After resection of the acromion and removal of the coracohumeral ligament, the infraspinatus muscle was carefully investigated macroscopically. After the orientation of muscle fibers was confirmed, the muscle was peeled from the proximal part to the distal part and the insertion of the infraspinatus tendon was examined. In 4 shoulders, muscle fibers were completely removed in water and the direction and insertion of the tendon were examined. The infraspinatus muscle originated both from the inferior surface of the spine of the scapula and the infraspinatus fossa, and inserted to the greater tuberosity. The muscle fibers originated from the spine were running dorsally and horizontally to the greater tuberosity. On the other hand, the fibers from the fossa were running ventrally and diagonally to the greater tuberosity. These fibers were merged at the insertion. The infraspinatus tendon had vast insertion to the greater tuberosity, and the most anterior part of the tendon was inserted to the most anterior portion of the greater tuberosity, bordering on the most anterior part of the supraspinatus tendon. The supraspinatus tendon is regarded as the most affected tendon in rotator cuff tears. However, the results of this study suggested that the infraspinatus tendon could be involved in the majority of rotator cuff tears. The infraspinatus may act not only in external rotation but also in abduction, because the infraspinatus tendon was inserted to the most anterior part of the greater tuberosity.

著者

植木 博子 吉村 英哉 日山 鐘浩 望月 智之 二村 昭元 秋田 恵一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.38, no.2, pp.369-371, 2014

---

小胸筋腱の停止が烏口突起をこえて延長する解剖学的破格は以前から知られている.過去に我々が調査した屍体解剖実習体では小胸筋延長腱の発現率は34.6%(81肩中21肩)であり,延長腱は烏口突起を越えて関節包の方に広がっていた.今回,肩腱板断裂症例において鏡視下修復術時に小胸筋延長腱の有無を確認し形態について観察した.<BR> 対象は2012年6月から12月までに当院で鏡視下腱板修復術を施行した腱板断裂症例25例(男性13例,女性12例)であった.術中にまず烏口突起基部を同定し小胸筋延長腱の存在を確認した.<BR> 延長腱は25例中10例(40%)に認められた.烏口突起に停止せずに上面を滑動し棘上筋の方向に向かい,烏口上腕靭帯とは明瞭に区別がついた.<BR> 臨床でも延長腱の発現頻度は比較的高く,その走行および付着の形態より肩甲上腕関節機能に影響を与えることが示唆された.鏡視下手術では延長腱の存在を留意する必要があると考えられた.

著者

前田 和彦 菅谷 啓之 新井 隆三 森石 丈二 望月 智之 吉村 英哉 松木 圭介 秋田 恵一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.209-211, 2007

被引用文献数

5

---

It is generally believed that the supraspinatus tendon plays an important role in the shoulder function. However, precise anatomy of the supraspinatus tendon has not been well described. The purpose of this study was to investigate the anatomy of the supraspinatus tendon. 57 cadavers (103 shoulders) were used for this study. The clavicle and humerus were cut off at their proximal parts. After resection of the acromion, the coracohumeral ligament was carefully removed. In some specimens, the infraspinatus was completely removed from the humerus to observe the overlapping portion of the supraspinatus and infraspinatus. The supraspinatus muscle and its origin were carefully investigated macroscopically. In 4 shoulders, muscle fibers were completely removed to examine the direction and insertion of the supraspinatus tendon in detail. The supraspinatus muscle fibers originated from the spine of the scapula and the supraspinatus fossa, and they were running toward and attached to the thickest tendinous portion, which was located at the anterior part of the supraspinatus muscle. This tendinous portion was strongly attached to the most anterior portion of the greater tuberosity adjacent to the bicipital groove or at the lesser tuberosity (21.3%). Another part of the supraspinatus, which was located posteriorly, was attached to the greater tuberosity adjacent to the articular cartilage as a thin membrane. The insertion of the supraspinatus tendon revealed to be the most anterior portion of the greater tuberosity and the lesser tuberosity. These results suggested that the supraspinatus tendon worked more efficiently as an abductor of the shoulder joint with the arm externally rotated than internal rotation.

著者

吉村 英哉 望月 智之 宗田 大 菅谷 啓之 前田 和彦 秋田 恵一 松木 圭介 中川 照彦

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.217-219, 2007

---

Previous studies reported a presumably unusual bony attachment of the pectoralis minor muscle. However, less attention has been given to the insertion of the continuation to the glenohumeral joint. The purpose of this study was to evaluate the frequency of this abnormal insertion of the pectoralis minor muscle, and also to investigate the relation between this continuation and the capsule. 81 anatomic specimen shoulders from 41 cadavers were dissected. The insertion of the pectoralis minor tendon to the glenohumeral joint was carefully investigated. The pectoralis minor tendon ran beyond the coracoid process and extended to the superior portion of the glenohumeral joint in 28 out of 81 specimens (34.6%). The continuing insertion divided the coracoacrominal ligaments into two limbs. The continuation was more variable, and consisted of the whole tendon in 6, the middle part in 5, the lateral part in 15, and the medial part in 2 specimens. Furthermore, the pectoralis minor tendon inserted to the posterosuperior border of the glenoid in 6, to the greater tuberosity in 7, and both to the glenoid and the greater tuberosity in 15 specimens. The prevalence of the anomalous insertion of the pectoralis minor tendon revealed to be as high as 34.6% in the present study. This may suggest that the pectoralis minor tendon plays an important role in the stability of the glenohumeral joint.

著者

田崎 篤 二村 昭元 加藤 敦夫 山口 久美子 秋田 恵一 星川 吉光 望月 智之

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.36, no.3, pp.787-790, 2012

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<B>Background:</B> Anatomical information of the insertion of the capsule around the glenoid is essential to recognize the pathological mechanism of shoulder disorders and perform better surgery.<BR><B>Methods:</B> Twenty five shoulders were dissected to investigated the morphology and size of the insertion of the capsule around the glenoid. We treated superior capsule as capsule-CHL. The location of glenoid rim was expressed as the location of the clock face of the glenoid.<BR><B>Results:</B> In the superior margin of the glenoid, the insertion of the capsule-CHL complex covered broadly to the base of the coracoid process in a triangular shape. Belt-like shape insertion was observed in posterior margin of the glenoid. Whereas as you followed anterior to the anteroinferior part, 4-5 oclock was thicker, then gradually thin down toward inferior. The average maximum width of the anterior and posterior insertion was 8.1mm (6.6-10.1mm)and 8.1mm (6.6-10.1mm), respectively. Although the width of insertion tapered, the capsule sent its fibers and connected to the lateral part of the LHT. Its attachment was observed as a thick portion from inside of the joint. This portion was observed as the posterior inferior gulenohumeral ligament.<BR><B>Conclusion:</B> The fact of thick attachment of the capsule on the glenoid rim should be considered when we perform surgery for shoulder instability. Fibrous connection between the capsule and LHT, which compensates for thin capsular attachment at inferior part, reinforces inferior stability. Since contraction of LHT pulls the inferior capsule inferiorly, this mechanism may have a role to avoid impingement of the inferior capsule.

著者

松木 圭介 菅谷 啓之 前田 和彦 森石 丈二 望月 智之 秋田 恵一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.213-215, 2007 (Released:2008-01-30)

参考文献数

6

被引用文献数

14

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The purpose of this study was to examine the anatomy of the infraspinatus including the orientation of muscle fibers and the insertion to the greater tuberosity. Ninety-three shoulders from 52 cadavers were minutely dissected. After resection of the acromion and removal of the coracohumeral ligament, the infraspinatus muscle was carefully investigated macroscopically. After the orientation of muscle fibers was confirmed, the muscle was peeled from the proximal part to the distal part and the insertion of the infraspinatus tendon was examined. In 4 shoulders, muscle fibers were completely removed in water and the direction and insertion of the tendon were examined. The infraspinatus muscle originated both from the inferior surface of the spine of the scapula and the infraspinatus fossa, and inserted to the greater tuberosity. The muscle fibers originated from the spine were running dorsally and horizontally to the greater tuberosity. On the other hand, the fibers from the fossa were running ventrally and diagonally to the greater tuberosity. These fibers were merged at the insertion. The infraspinatus tendon had vast insertion to the greater tuberosity, and the most anterior part of the tendon was inserted to the most anterior portion of the greater tuberosity, bordering on the most anterior part of the supraspinatus tendon. The supraspinatus tendon is regarded as the most affected tendon in rotator cuff tears. However, the results of this study suggested that the infraspinatus tendon could be involved in the majority of rotator cuff tears. The infraspinatus may act not only in external rotation but also in abduction, because the infraspinatus tendon was inserted to the most anterior part of the greater tuberosity.

著者

望月 智之 関矢 一郎 二村 昭元 宗田 大

出版者

東京医科歯科大学

雑誌

基盤研究(C)

巻号頁・発行日

2015-04-01

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肩腱板断裂の修復部に関節のふくろを裏打ちする組織から採取した細胞を投与することにより、治癒を早めることができるかの研究を行った。ラットを使用し、まず膝と肩のどちらから採取した細胞を比較し、膝からの細胞のほうがすぐれていることを証明した。ラットの両肩に腱板断裂を作成し、片側には膝からの細胞を投与した後に修復を行い、反対側の肩関節は何も投与せず修復のみを行った。修復後2週、4週、8週の時点で修復部位の評価を行うと、細胞を移植したほうがしっかりとした構造をつくっていた。また修復した部位を引っ張ってみると、修復後2週の時点では細胞を移植した方が強く固着されていた。

著者

望月 智之 秋田 恵一 宗田 大 関矢 一郎

出版者

東京医科歯科大学

雑誌

若手研究(スタートアップ)

巻号頁・発行日

2007

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1. 腱板停止部(上腕骨大結節)において、棘上筋が停止していると考えられていた部位に棘下筋が停止していることを明らかにした。2. 腱板断裂には棘上筋が最も含まれていると考えられてきたが、棘下筋が断裂に最も関与している可能性が高いことを示唆した。3. 上記の結果を踏まえて、腱板断裂をより解剖学的に修復する手術方法を発表した。

著者

秋田 恵一 山口 久美子 望月 智之 小泉 政啓

出版者

東京医科歯科大学

雑誌

基盤研究(C)

巻号頁・発行日

2008

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肩関節周囲の構造については、臨床の技術の向上にともない、ますます詳細な理解を必要とするようになった。そこで、本研究では肩関節周囲筋の解剖を見直し、総合的に新たに評価を行い、手術、診断といった臨床応用への基盤を形成する。また、肩関節の成り立ちを比較解剖学的に検討し、ヒトの解剖学的な理解に役立たせる。本研究の結果、非常に多くの解剖学的な新知見が得られ、臨床への応用が期待されることになった。また、比較解剖学的な知見から、ヒト肩関節の構造について、より理解が深まったと考えられる。