McFarland E G, Caicedo J C, Guitterez M I, Sherbondy P S, Kim T K
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
Am J Sports Med. 2001 Nov-Dec;29(6):729-33. doi: 10.1177/03635465010290061001.
Iatrogenic brachial plexus injury is an uncommon but potentially severe complication of shoulder reconstruction for instability that involves dissection near the subscapularis muscle and potentially near the brachial plexus. We examined the relationship of the brachial plexus to the glenoid and the subscapularis muscle and evaluated the proximity of retractors used in anterior shoulder surgical procedures to the brachial plexus. Eight fresh-frozen cadaveric shoulders were exposed by a deltopectoral approach. The subscapularis muscle was split in the middle and dissected to reveal the capsule beneath it. The capsule was split at midline, and a Steinmann pin was placed in the equator of the glenoid rim under direct visualization. The distance from the glenoid rim to the brachial plexus was measured with calipers with the arm in 0 degrees, 60 degrees, and 90 degrees of abduction. The brachial plexus and axillary artery were within 2 cm of the glenoid rim, with the brachial plexus as close as 5 mm in some cases. There was no statistically significant change in the distance from the glenoid rim to the musculocutaneous nerve, axillary artery, medial cord, or posterior cord with the arm in various degrees of abduction. Retractors placed superficial to the subscapularis muscle or used along the scapular neck make contact with the brachial plexus in all positions tested.
医源性臂丛神经损伤是肩部不稳定重建手术中一种罕见但可能严重的并发症，该手术涉及肩胛下肌附近以及可能在臂丛神经附近的解剖操作。我们研究了臂丛神经与肩胛盂和肩胛下肌的关系，并评估了前肩手术中使用的牵开器与臂丛神经的接近程度。通过三角肌胸大肌入路暴露8个新鲜冷冻尸体肩部。将肩胛下肌在中间劈开并进行解剖，以显露其下方的关节囊。在关节囊中线处劈开，在直视下将一根斯氏针置于肩胛盂边缘的赤道处。使用卡尺测量在手臂外展0度、60度和90度时肩胛盂边缘到臂丛神经的距离。臂丛神经和腋动脉距肩胛盂边缘在2厘米以内，在某些情况下臂丛神经距离仅5毫米。在手臂处于不同外展角度时，肩胛盂边缘到肌皮神经、腋动脉、内侧束或后束的距离没有统计学上的显著变化。放置在肩胛下肌表面或沿肩胛颈使用的牵开器在所有测试位置均与臂丛神经接触。
