Nord Keith D, Brady Paul C, Yazdani Rehan S, Burkhart Stephen S
Sports, Orthopedics & Spine, Jackson, Tennessee 38301, USA.
Arthroscopy. 2007 Sep;23(9):999-1005. doi: 10.1016/j.arthro.2007.04.011.
A standard posterior portal allows excellent visualization of the glenohumeral joint but is inadequate for anchor placement because of its parallelism to the glenoid surface. The purpose of this study was to describe the low posterolateral portal for glenohumeral arthroscopy, describe the anatomy of the portal and surrounding structures, and discuss the portal's usefulness in addressing posterior and inferior shoulder pathology.
Five cadaveric shoulders were dissected after placement of a spear through the low posterolateral portal. The location was identified via a spinal needle, 2 to 4 cm lateral and 4 to 5 cm inferior to the posterolateral corner of the acromion. Measurements from the spear to the anatomic structures were recorded with a caliper. Seventeen patients with posterior labral pathology were included in this study. The low posterolateral portal was established while visualizing through the anterosuperolateral or posterior portal. The spear and anchor were inserted through the low posterolateral portal.
Five shoulders were dissected, and the neurovascular structures relative to the low posterolateral portal were identified. The portal was 13.8 +/- 1.6 mm from the axillary nerve and 13.4 +/- 1.2 mm from the posterior humeral circumflex artery. In the retrospective review the low posterolateral portal was created without difficulty or complication in all 17 patients. The portal was extremely helpful for anchor insertion in the posteroinferior glenoid. It was useful in suture passage through the posterior and inferior labrum and in suture management.
The low posterolateral portal provides the optimal angle for insertion of instruments and anchors, resulting in a more anatomic repair.
The standard 3 portals are not optimal for approaching posterior and inferior labral tears, and use of the low posterolateral portal improves access and treatment.
标准后外侧入路可实现对盂肱关节的良好可视化，但由于其与关节盂表面平行，不利于锚钉置入。本研究旨在描述用于盂肱关节镜检查的后外侧低位入路，阐述该入路及周围结构的解剖，并探讨该入路在处理肩关节后方及下方病变中的实用性。
在通过后外侧低位入路插入一根探针后，对五具尸体肩部进行解剖。通过脊柱穿刺针确定位置，位于肩峰后外侧角外侧2至4厘米、下方4至5厘米处。用卡尺记录探针与解剖结构之间的测量值。本研究纳入了17例存在后方盂唇病变的患者。在通过前上外侧或后入路进行可视化的同时建立后外侧低位入路。将探针和锚钉通过后外侧低位入路插入。
解剖了五个肩部，确定了与后外侧低位入路相关的神经血管结构。该入路距腋神经13.8±1.6毫米，距旋肱后动脉13.4±1.2毫米。在回顾性研究中，所有17例患者均顺利建立后外侧低位入路，未出现困难或并发症。该入路对在关节盂后下方置入锚钉极为有用。在缝线穿过后方及下方盂唇以及缝线管理方面也很有用。
后外侧低位入路为器械和锚钉的插入提供了最佳角度，从而实现更符合解剖结构的修复。
标准的三个入路对于处理后方及下方盂唇撕裂并非最佳选择，而后外侧低位入路的使用改善了入路和治疗效果。
