Riemer B L, D'Ambrosia R
Department of Orthopedic Surgery, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburgh.
Orthopedics. 1992 Jun;15(6):697-9. doi: 10.3928/0147-7447-19920601-05.
An elderly female cadaver fore-quarter amputation was dissected, and a custom straight intramedullary nail with a 55 degrees oblique downward lateral to medial proximal screw was inserted with a trocar protruding beyond the medial cortex of the humeral surgical neck. The main trunk of the axillary nerve was found to be at risk with any penetration from anterior to posterior and any screw penetration beyond the medial cortex with internal rotation. The axillary artery and vein were at risk with penetration of over 3 cm by a drill point or screw tip whether a transverse or oblique downward screw was used. Transverse screws inserted through the humeral neck from lateral to medial have the potential for damaging a small branch of the axillary nerve laterally, and care must be taken of the lateral humerus while inserting these screws. Screws inserted in a downward direction near the greater tuberosity, if originating above the equator of the humeral head, may cause impingement.
对一具老年女性尸体的上肢近端截肢标本进行解剖，将一枚定制的直型髓内钉插入，该髓内钉带有一枚向内侧近端呈55度斜向下的螺钉，其套管针突出于肱骨外科颈的内侧皮质之外。发现腋神经主干在从前向后的任何穿破以及在内旋时任何螺钉穿破内侧皮质的情况下均有风险。无论使用横向螺钉还是斜向下螺钉，当钻头尖端或螺钉尖端穿破超过3厘米时，腋动脉和腋静脉均有风险。从外侧向内侧穿过肱骨颈插入的横向螺钉有可能损伤腋神经外侧的一个小分支，在插入这些螺钉时必须注意肱骨外侧。在大结节附近向下方向插入的螺钉，如果起始于肱骨头赤道上方，可能会造成撞击。
