Burkhead W Z, Scheinberg R R, Box G
From the University of Texas Health Science Center, Dallas, Texas.
J Shoulder Elbow Surg. 1992 Jan;1(1):31-6. doi: 10.1016/S1058-2746(09)80014-1. Epub 2009 Feb 2.
Any surgical approach that splits the deltoid puts the axillary nerve at risk secondary to extension from traction or sharp dissection. Standard texts an anatomy and chapters on surgical approaches frequently state the axillary nerve comes to lie approximately 2 inches from the acromion. However, a large series of cadavers of varying sex and size on which these measurements had been obtained could not be found in an extensive literature search. Fifty-one embalmed cadaveric specimens representing 102 shoulders were dissected in the static portion of this study. In nearly 20% of cadavers the nerve at some point along its course around the humerus in the deltoid muscle was less than 5 cm from the palpable edge of the acromion. This was especially true of female cadavers with short arm spans; in one cadaver the nerve was 3.1 cm from the acromial edge. Abducting the shoulder to 9cr decreases the distance from the nerve to the palpable edge of the acromion nearly 30%. Five centimeters does not describe an absolute safe zone for the axillary nerve. Furthermore, abduction of the arm brings the nerve even closer to commonly used bony landmarks.
任何劈开三角肌的手术入路都会因牵拉或锐性解剖的延伸而使腋神经处于危险之中。标准的解剖学教材和关于手术入路的章节经常指出，腋神经位于距肩峰约2英寸处。然而，在广泛的文献检索中，未能找到一系列获取了这些测量数据的不同性别和大小的尸体。在本研究的静态部分，解剖了51个经过防腐处理的尸体标本，代表102个肩部。在近20%的尸体中，腋神经在三角肌中围绕肱骨走行的某个点距肩峰可触及边缘不到5厘米。臂展短的女性尸体尤其如此；在一具尸体中，神经距肩峰边缘3.1厘米。将肩部外展至90°可使神经到肩峰可触及边缘的距离减少近30%。5厘米并不能描述腋神经的绝对安全区。此外，手臂外展会使神经更靠近常用的骨性标志。
