Cetik Ozgur, Uslu Murad, Acar Halil Ibrahim, Comert Ayhan, Tekdemir Ibrahim, Cift Hakan
Kirikkale Universitesi Tip Fakultesi Ortopedi ve Travmatoloji Anabilim Dali, 71100 Kirikkale, Turkey.
J Bone Joint Surg Am. 2006 Nov;88(11):2395-9. doi: 10.2106/JBJS.E.01375.
Several authors have defined a variety of so-called safe zones for deltoid-splitting incisions. The first aim of the present study was to investigate the distance of the axillary nerve from the acromion and its relation to arm length. The second aim was to identify a safe area for the axillary nerve during surgical dissection of the deltoid muscle.
Twenty-four shoulders of embalmed adult cadavers were included in the study. The distance from the anterior edge of the acromion to the course of the axillary nerve was measured and was recorded as the anterior distance. The same measurement from the posterior edge of the acromion to the course of the axillary nerve was made and was recorded as the posterior distance for each limb. Correlation analysis was performed between the arm length and the anterior distance and the posterior distance for each limb. The ratios between arm length and the anterior and posterior distances were calculated for each case and were recorded as an anterior index and a posterior index.
The average arm length was 30.40 cm. The average anterior distance was 6.08 cm, and the average posterior distance was 4.87 cm. There was a significant correlation between arm length and both anterior distance (r = 0.79, p < 0.001) and posterior distance (r = 0.61, p = 0.001). The axillary nerve was not found to lie at a constant distance from the acromion at every point along its course. The average anterior index was 0.20, and the average posterior index was 0.16.
The present study describes a safe area above the axillary nerve that is quadrangular in shape, with the length of the lateral edges being dependent on the individual's arm length. Using this safe area should provide a safe exposure for the axillary nerve during shoulder operations.
多位作者已定义了多种所谓的三角肌劈开切口安全区。本研究的首要目的是探究腋神经与肩峰的距离及其与臂长的关系。第二个目的是在三角肌手术解剖过程中确定腋神经的安全区域。
本研究纳入了24具经防腐处理的成年尸体的肩部。测量从肩峰前缘到腋神经走行的距离，并记录为前距离。对每个肢体从肩峰后缘到腋神经走行进行相同测量，并记录为后距离。对每个肢体的臂长与前距离和后距离进行相关性分析。计算每个病例臂长与前后距离的比值，并记录为前指数和后指数。
平均臂长为30.40厘米。平均前距离为6.08厘米，平均后距离为4.87厘米。臂长与前距离（r = 0.79，p < 0.001）和后距离（r = 0.61，p = 0.001）均存在显著相关性。未发现腋神经在其走行的每个点与肩峰的距离恒定。平均前指数为0.20，平均后指数为0.16。
本研究描述了一个腋神经上方的安全区域，其形状为四边形，外侧边缘的长度取决于个体的臂长。在肩部手术中使用该安全区域应为腋神经提供安全暴露。
