Department of Orthopaedic Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
J Shoulder Elbow Surg. 2010 Jul;19(5):709-15. doi: 10.1016/j.jse.2009.12.007. Epub 2010 Apr 3.
The purpose of this cadaveric anatomic study was to investigate the risk of iatrogenic suprascapular nerve injury during the standard drilling techniques in arthroscopic superior labrum anterior-posterior (SLAP) repairs.
Cadaveric shoulder girdles were isolated and drilled at the glenoid peripheral rim by use of standard arthroscopic equipment reproducing common drill locations and portal orientations for SLAP repairs. Drill hole depth was determined by the manufacturer's drill stop (20 mm), and any subsequent drill perforations through the medial bony surface of the glenoid were directly confirmed by dissection. The suprascapular nerve was then isolated to note the presence of any observable direct nerve injury from the drilling. The bone tunnel depth, subsequent distance to the suprascapular nerve, scapular height and width, and humeral length were also recorded.
Eighteen drill perforations through the medial glenoid wall occurred in 8 of 21 cadavers (38%). Twelve perforations occurred through anterosuperior drill holes with only one associated nerve injury. Six perforations occurred through low posterosuperior drill holes with four associated nerve injuries. Five of the six shoulders with low posterosuperior perforation also had an associated anterior perforation. No perforations occurred through high posterosuperior drill holes. Of the specimens, 5 had bilateral involvement (4 female and 1 male). Specimens with a perforation had a significantly shorter scapular height (P = .007) and humeral length (P = .01).
The suprascapular nerve is at risk for direct injury during arthroscopic SLAP repairs from penetration of the medial glenoid with arthroscopic drill equipment in cadavers.
本尸体解剖研究的目的是调查在关节镜上盂唇前-后（SLAP）修复的标准钻孔技术中，医源性肩胛上神经损伤的风险。
使用标准关节镜设备，在盂肱关节的关节盂周缘隔离和钻孔，再现 SLAP 修复的常见钻孔位置和入口方向。钻孔深度由制造商的钻头止动器确定（20 毫米），并且任何随后通过关节盂内侧骨面的钻头穿孔都通过解剖直接确认。然后分离出肩胛上神经，以注意到钻孔是否存在任何可观察到的直接神经损伤。还记录了骨隧道深度、随后与肩胛上神经的距离、肩胛的高度和宽度以及肱骨的长度。
在 21 个尸体中的 8 个（38%），有 18 个钻头穿透了关节盂内侧壁。12 个穿孔发生在前上钻孔，只有 1 个与神经损伤有关。6 个穿孔发生在低后上钻孔，有 4 个与神经损伤有关。这 6 个有低后上穿孔的肩膀中有 5 个也有一个相关的前穿孔。没有穿孔发生在高后上钻孔。在标本中，有 5 个有双侧受累（4 个女性和 1 个男性）。有穿孔的标本肩胛高度（P =.007）和肱骨长度（P =.01）明显缩短。
在尸体中，使用关节镜钻具穿透关节盂内侧时，肩胛上神经在关节镜 SLAP 修复中存在直接损伤的风险。
