van de Sande Michiel A J, Cosker Tom, McDonnell Stephen M, Gibbons C L M H, Giele Henk
Department of Orthopaedics, LUMC, Albinusdreef 2, 2300 RC Leiden, Netherlands.
The Oxford Bone and Soft Tissue Tumour Service, Nuffield Orthopaedic Centre, Oxford, UK.
Case Rep Orthop. 2014;2014:937342. doi: 10.1155/2014/937342. Epub 2014 Dec 31.
The surgical repair of an extensive anterior glenohumeral soft tissue defect is complicated by glenohumeral instability and subsequent significant functional deficit. This surgical note offers a relatively simple reconstruction of the anterior capsule and subscapularis muscle using a pectoralis minor pedicle flap. This reconstruction is supplemented with functional reconstruction of the anterior glenohumeral joint. A conventional deltopectoral approach is utilized and pectoralis minor is freed from its coracoid insertion, released, and mobilized without compromising the pedicle entering from the dorsum and inferior one-third of the muscle. The mobilized pectoralis minor vascular pedicle has sufficient length for the pectoralis minor to be transferred to provide coverage of the anterior shoulder joint even in full external rotation, providing anterior stability. To further improve glenohumeral stability and shoulder function, the pectoralis major muscle can be split with the clavicular part reinserted lateral to the bicipital groove onto the lesser tuberosity replacing subscapularis function while stabilising the glenohumeral joint.
广泛的肩肱前软组织缺损的手术修复因肩肱关节不稳定及随后出现的明显功能缺陷而变得复杂。本手术记录介绍了一种使用胸小肌带蒂皮瓣对肩前关节囊和肩胛下肌进行相对简单的重建方法。这种重建辅以肩肱前关节的功能重建。采用传统的三角肌胸大肌入路，将胸小肌从其喙突附着处游离、松解并移位，同时不影响从肌肉背侧和下三分之一处进入的蒂部。移位后的胸小肌血管蒂有足够的长度，使胸小肌即使在完全外旋时也能转移以覆盖肩前关节，从而提供前向稳定性。为进一步提高肩肱关节稳定性和肩部功能，可劈开胸大肌，将锁骨部重新附着于肱二头肌沟外侧的小结节上，以替代肩胛下肌的功能，同时稳定肩肱关节。
