Fucentese Sandro F, Jost Bernhard
Departement für Orthopädische Chirurgie, Uniklinik Balgrist, Universität Zürich, Schweiz.
Oper Orthop Traumatol. 2010 May;22(2):188-95. doi: 10.1007/s00064-010-8064-3.
Safe approach to the posterior shoulder and scapula.
Posterior shoulder stabilization. Posterior bony reconstruction of the glenoid. Corrective osteotomies of the glenoid. Treatment of scapular neck fractures. Treatment of posterior glenoid rim fractures. Treatment of fractures of the acromion. Arthrodesis of the shoulder. Biopsy. Tumor resection. Relative: shoulder joint replacement with simultaneous posterior glenoid reconstruction. Relative: treatment of posterior dislocated proximal humerus fractures.
General contraindications.
Landmarks: scapular spine and acromion. Incision depending on goal of surgery: from horizontal to oblique or vertical: - horizontal incision along the scapular spine to the posterior corner of acromion, - oblique incision along the lateral border of scapula. Authors' preference: angle bisector between scapular spine and lateral border of scapula. Detachment of the deltoid with a bony chip from scapular spine beginning laterally (subacromial space). Under the deltoid the infraspinatus is exposed. Approach to glenoid: the internervous plane is between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve). Approach to scapular neck (attention: identify axillary nerve!): more dangerous internervous plane between teres minor (axillary nerve) and teres major (subscapular nerve). If needed, detachment of infraspinatus from tendinous insertion for better visualization of posterior capsule and glenoid.
According to the operated pathology.
Results are according to the operated pathology. As an example, results from the authors' clinic are presented. Between 1982 to 1995, 24 patients (26 shoulders) with posterior instability underwent open posteroinferior capsular shift. Mean follow-up was 7.6 years. The average relative Constant-Murley Score amounted to 91%. Subjective result was good to excellent for 24 and fair for two shoulders. Recurrence occurred in 23% (all cases with surgery before index procedure or new trauma). No approach-related complications (weakness or insufficiency) were noted.
安全进入肩关节后方及肩胛骨。
肩关节后方稳定术。肩胛盂后方骨重建。肩胛盂矫正截骨术。肩胛颈骨折的治疗。肩胛盂后缘骨折的治疗。肩峰骨折的治疗。肩关节融合术。活检。肿瘤切除。相关：同期进行肩胛盂后方重建的肩关节置换术。相关：肱骨近端后脱位骨折的治疗。
一般禁忌证。
标志：肩胛冈和肩峰。根据手术目的选择切口：从水平到斜行或垂直：- 沿肩胛冈的水平切口至肩峰后角，- 沿肩胛骨外侧缘的斜行切口。作者偏好：肩胛冈与肩胛骨外侧缘之间的角平分线。从肩胛冈外侧（肩峰下间隙）开始带骨块剥离三角肌。在三角肌下方暴露冈下肌。进入肩胛盂：神经间平面位于冈下肌（肩胛上神经）和小圆肌（腋神经）之间。进入肩胛颈（注意：识别腋神经！）：更危险的神经间平面位于小圆肌（腋神经）和大圆肌（肩胛下神经）之间。如有必要，从肌腱附着处剥离冈下肌以更好地显露后关节囊和肩胛盂。
根据手术病理情况。
结果根据手术病理情况。作为示例，展示了作者所在诊所的结果。1982年至1995年，24例（26肩）肩关节后方不稳定患者接受了开放性后下关节囊移位术。平均随访7.6年。平均相对Constant-Murley评分为91%。主观结果为24肩良好至优秀，2肩一般。复发率为23%（所有病例均为初次手术前已进行手术或有新创伤）。未发现与手术入路相关的并发症（无力或功能不全）。
