Meyer Matthieu, Graveleau Nicolas, Hardy Philippe, Landreau Philippe
Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris-Ouest University, Boulogne, France.
Arthroscopy. 2007 May;23(5):529-36. doi: 10.1016/j.arthro.2006.12.022.
The purpose of this anatomic cadaveric study was to determine with trocars in situ the relationships of 12 shoulder arthroscopic portals frequently used with the adjacent musculotendinous and neurovascular structures.
Twelve shoulders of embalmed cadavers installed in a beach-chair position were dissected. Twelve different portals were established by using their authors' description: posterior "soft point," central posterior, anterior central, anterior inferior, anterior superior, 5 o'clock portal, Neviaser, superolateral, transrotator cuff approach, Port of Wilmington, anterolateral, and posterolateral. Six of these portals were placed on each shoulder so that each portal was studied 6 times. Dissections were conduced with trocars in situ to take into account their volume. The distance to the adjacent relevant neurovascular structures at risk (axillar and suprascapular nerves, axillar and suprascapular arteries, and cephalic vein) were measured, arm at side, by using a calliper. Musculotendinous structures crossed by portals were noticed.
The cephalic vein was injured twice by anterior portals. The 5 o'clock portal is at most risk of neurovascular injury. It is located at mean distances to the axillar artery and nerve of 13 and 15 mm, respectively. Other anterior, posterior, superior, and lateral portals are safe with mean distances higher than 20 mm. No musculotendinous rupture nor large injury occurred.
The present study shows that the trocars placement of the studied portals did not create, except for the cephalic vein, any lesion of the neurovascular adjacent structures.
This study suggests, except for the 5 o'clock portal, the safety of the shoulder arthroscopic portals tested regarding to the neurovascular adjacent structures.
本解剖学尸体研究旨在通过原位套管针确定12个常用肩关节镜入路与相邻肌肉肌腱及神经血管结构的关系。
解剖12具处于沙滩椅位的防腐尸体的肩部。按照其作者的描述建立12个不同的入路：后方“软点”、中央后方、前方中央、前下方、前上方、5点入路、内维亚塞尔入路、后外侧、经旋转袖入路、威尔明顿港入路、前外侧和后外侧。每个肩部放置其中6个入路，以便每个入路被研究6次。在原位使用套管针进行解剖以考虑其体积。使用卡尺在手臂处于体侧时测量到相邻有风险的相关神经血管结构（腋神经和肩胛上神经、腋动脉和肩胛上动脉以及头静脉）的距离。记录入路穿过的肌肉肌腱结构。
头静脉被前方入路损伤2次。5点入路发生神经血管损伤的风险最高。它到腋动脉和神经的平均距离分别为13和15毫米。其他前方、后方、上方和外侧入路是安全的，平均距离大于20毫米。未发生肌肉肌腱断裂或严重损伤。
本研究表明，除头静脉外，所研究入路的套管针放置未造成相邻神经血管结构的任何损伤。
本研究表明，除5点入路外，所测试的肩关节镜入路在涉及相邻神经血管结构方面是安全的。
