Spiegelberg Ben G I, Riley Nicholas D, Taylor Geoffrey J
Buckinghamshire Healthcare NHS Trust, Wycombe General Hospital, Queen Alexandra Road, High Wycombe, Buckinghamshire, United Kingdom.
Buckinghamshire Healthcare NHS Trust, Wycombe General Hospital, Queen Alexandra Road, High Wycombe, Buckinghamshire, United Kingdom.
Injury. 2014 Aug;45(8):1185-9. doi: 10.1016/j.injury.2014.05.006. Epub 2014 May 17.
The antegrade intramedullary Locking Blade Nail (Marquardt, Germany) is a device aimed at improving purchase in the humeral head and reducing varus displacement by providing medial buttress support and triangular stability within the humeral head. The aim of this study is to measure the relationship of the proximal fixation screws to the axillary nerve.
13 whole cadavers underwent insertion of an antegrade proximal humeral blade nail via a deltoid split approach to both shoulders. The anatomic proximity of the anterior branch of the axillary nerve to the screws was measured following soft tissue dissection and inspection of the nerve.
The mean distance of the nerve from the anterolateral acromion was 62 mm (range 45-81 mm). The nerve lay closest to the distal blade fixation screw 4.9 mm (range 0-19 mm). In three cases the nerve lay directly underneath the washer and in all three cases there was macroscopic evidence of damage to the nerve. In 5 cases the nerve travelled obliquely in a cranial direction to lie 1.8 mm (range 0-3 mm) from the distal blade fixation screw, in 2 of these cases the nerve lay beneath the washer.
The anterior branch of the axillary nerve is placed at risk during insertion of the locking screws despite use of protection sleeves and trocars. We advocate that when using antegrade intramedullary nails that incorporate an inferomedial calcar screw an extended anterolateral acromial approach is undertaken.
顺行髓内锁定刀片式钉（德国马夸特公司）是一种旨在通过提供内侧支撑和肱骨头内的三角稳定性来改善肱骨头固定并减少内翻移位的器械。本研究的目的是测量近端固定螺钉与腋神经的关系。
13具完整尸体经三角肌劈开入路在双侧肩部插入顺行肱骨近端刀片式钉。在软组织解剖和神经检查后，测量腋神经前支与螺钉的解剖学距离。
神经距肩峰前外侧的平均距离为62毫米（范围45 - 81毫米）。神经最靠近远端刀片固定螺钉，距离为4.9毫米（范围0 - 19毫米）。在3例中，神经直接位于垫圈下方，且在所有3例中均有神经损伤的宏观证据。在5例中，神经向头侧斜行，距远端刀片固定螺钉1.8毫米（范围0 - 3毫米），其中2例神经位于垫圈下方。
尽管使用了保护套筒和套管针，但在插入锁定螺钉时腋神经前支仍有风险。我们主张，在使用带有内下骨距螺钉的顺行髓内钉时，应采用扩大的肩峰前外侧入路。
