Ball Craig M, Steger Thomas, Galatz Leesa M, Yamaguchi Ken
Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
J Bone Joint Surg Am. 2003 Aug;85(8):1497-501. doi: 10.2106/00004623-200308000-00010.
Surgery on the posterior aspect of the shoulder has become accepted practice for a number of pathological conditions affecting the scapula and the glenohumeral joint. Despite this trend, the anatomy of the posterior branch of the axillary nerve has not been well characterized. The purpose of the present study was to determine the innervation pattern and surgical relationships of the posterior branch of the axillary nerve.
Nineteen fresh-frozen human cadaveric forequarter amputation specimens were dissected through a posterior approach. The location of the posterior branch of the axillary nerve and its anatomical relationships with surrounding structures were documented and measured with use of digital calipers.
The posterior branch separated from the main anterior circumflex branch of the axillary nerve immediately anterior to the origin of the long head of the triceps muscle at the six o'clock position on the glenoid. It coursed posteriorly, adjacent to the inferior aspect of the glenoid rim for an average distance of 10 mm (range, 2 to 17 mm) before dividing into the superior-lateral brachial cutaneous nerve and the nerve to the teres minor. The nerve to the teres minor coursed medially along the posterior aspect of the inferior part of the glenoid rim for an average distance of 18 mm (range, 11 to 25 mm) before entering the muscle at its inferior border. The superior-lateral brachial cutaneous nerve coursed inferiorly, deep to the posterior aspect of the deltoid. It became superficial by passing around the medial border of the muscle at an average of 8.7 cm (range, 6.3 to 10.9 cm) inferior to the posterolateral corner of the acromion.
The posterior branch of the axillary nerve has an intimate association with the inferior aspects of the glenoid and shoulder joint capsule, which may place it at particular risk during capsular plication or thermal shrinkage procedures. The superior-lateral brachial cutaneous nerve and the nerve to the teres minor always arise from the posterior branch. Thus, loss of sensation over the deltoid may indicate loss of teres minor function. The posterior aspect of the deltoid has a more consistent supply from the anterior branch of the axillary nerve, necessitating caution when performing a posterior deltoid-splitting approach to the shoulder.
对于影响肩胛骨和盂肱关节的多种病理状况，肩部后方手术已成为公认的治疗方法。尽管有这一趋势，但腋神经后支的解剖结构尚未得到充分描述。本研究的目的是确定腋神经后支的神经支配模式及其手术相关关系。
通过后方入路解剖19个新鲜冷冻的人体上肢截肢标本。使用数字卡尺记录并测量腋神经后支的位置及其与周围结构的解剖关系。
腋神经后支在盂肱关节六点位置，于肱三头肌长头起点前方紧邻腋神经主要的旋肱前支处发出。它向后走行，在盂唇下方平均10毫米（范围2至17毫米）处，然后分为臂外侧上皮神经和小圆肌神经。小圆肌神经沿盂唇下部后方内侧走行，平均距离18毫米（范围11至25毫米），然后在其下缘进入该肌。臂外侧上皮神经向下走行，在三角肌后方深层。它在肩峰后外侧角下方平均8.7厘米（范围6.3至10.9厘米）处绕过三角肌内侧缘后浅出。
腋神经后支与盂和肩关节囊的下部密切相关，这可能使其在关节囊折叠或热缩手术中面临特殊风险。臂外侧上皮神经和小圆肌神经总是发自后支。因此，三角肌区域感觉丧失可能提示小圆肌功能丧失。三角肌后部由腋神经前支供血更为恒定，因此在采用后方劈开三角肌入路至肩部时需谨慎。
