反向肩关节置换术后腋神经损伤：解剖学研究。
Injury to the axillary nerve after reverse shoulder arthroplasty: an anatomical study.
机构信息
Division of Orthopedics and Trauma Surgery, La Tour Hospital, 3, rue J.-D.-Maillard, 1217 Meyrin, Switzerland; Faculty of Medicine, University of Geneva, 1, rue Michel-Servet, 1211 Geneva 4, Switzerland; Division of Orthopedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 21, Switzerland.
Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, 1, rue Michel-Servet, 1211 Geneva 4, Switzerland.
出版信息
Orthop Traumatol Surg Res. 2014 Feb;100(1):105-8. doi: 10.1016/j.otsr.2013.09.006. Epub 2013 Dec 4.
BACKGROUND
Subclinical neurological lesions after reverse shoulder arthroplasty are frequent, mainly those involving the axillary nerve. One of the major reported risk factors is postoperative lengthening of the arm. The purpose of this study was to evaluate the anatomical relationship between the axillary nerve and prosthetic components after reverse shoulder arthroplasty. The study hypothesis was that inferior overhang of the glenosphere relative to glenoid could put this nerve at risk.
MATERIAL AND METHODS
Eleven fresh frozen shoulder specimens were dissected after having undergone reverse shoulder arthroplasty using a classic deltopectoral approach.
RESULTS
The mean distance from the inferior border of the glenoid to the inferior edge of the glenosphere was 6.0±4.3mm (range, 1.0 to 16.2mm). The axillary nerve was never closer than 15mm to the glenosphere. The main anterior branch of the axillary nerve was in close contact with the posterior metaphysis or humeral prosthetic implant. The mean distance between the nerve and the humeral implants was 5.2±2.1mm (range, 2.0 to 8.1mm).
CONCLUSIONS
The proximity of the axillary nerve to the posterior metaphysis or humeral implants may be a risk factor for axillary nerve injury after reverse shoulder arthroplasty.
CLINICAL RELEVANCE
This study quantifies the proximity of the axillary nerve to the implant after reverse shoulder arthroplasty.
LEVEL OF EVIDENCE
Basic science study, cadaver study.
背景
反向肩关节置换术后常出现亚临床神经损伤，主要涉及腋神经。报道的主要危险因素之一是术后手臂延长。本研究旨在评估反向肩关节置换术后腋神经与假体组件的解剖关系。研究假设是相对于关节盂，肩胛下窝的下悬垂会使神经处于危险之中。
材料和方法
通过经典的三角肌入路对 11 个接受反向肩关节置换的新鲜冷冻肩部标本进行解剖。
结果
肩胛下窝下缘至关节盂下缘的平均距离为 6.0±4.3mm（范围，1.0 至 16.2mm）。腋神经从未距肩胛下窝小于 15mm。腋神经的主要前支与肱骨假体的后干骺端或骨干紧密接触。神经与肱骨植入物之间的平均距离为 5.2±2.1mm（范围，2.0 至 8.1mm）。
结论
腋神经与肱骨假体后干骺端或骨干的接近程度可能是反向肩关节置换术后腋神经损伤的危险因素。
临床相关性
本研究定量评估了反向肩关节置换术后腋神经与植入物的接近程度。
证据水平
基础科学研究，尸体研究。
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