Maldonado Andrés A, Howe Benjamin M, Lawton Rich, Bishop Allen T, Shin Alexander Y, Spinner Robert J
Rochester, Minn.; and Durango, Colo.
From the Departments of Neurologic Surgery and Orthopedics Radiology, Mayo Clinic; and the Department of Orthopedics, Mercy Regional Medical Center.
Plast Reconstr Surg. 2016 Aug;138(2):419-426. doi: 10.1097/PRS.0000000000002398.
The aim of this study was to quantify the length of the axillary nerve that is able to be dissected through a standard anterior (deltopectoral) and posterior approach. The authors hypothesize that a segment of the axillary nerve cannot be reached using both approaches simultaneously.
Axillary nerves of five frozen cadavers were dissected using an anterior and posterior approach. A first surgical clip marked the most visible distal part of the nerve from the deltopectoral approach; a second surgical clip marked the most proximal part from the posterior approach. The two surgical clips were localized with a shoulder radiograph. The authors performed measurements of the different axillary nerve segments.
In all specimens, there were three zones of the axillary nerve: zone A (anterior), the nerve segment from the origin of the axillary nerve to the first surgical clip, located at the level of the triangle formed by the subscapularis muscle (medial), conjoined tendon (lateral), and axillary fat (inferior); zone B (blind), the nerve segment not reachable through both approaches, from the first to the second surgical clip; and zone C (circumflex), the nerve segment from the second surgical clip (located at the level of the quadrilateral space) to entry into the deltoid muscle. The mean length of the blind zone was 1.6 cm. This blind zone was found 1 to 2 cm from the glenohumeral joint.
The authors have described a segment of the axillary nerve that cannot be evaluated through anterior and posterior combined approaches.
本研究的目的是量化通过标准的前路（三角肌胸大肌间沟）和后路能够解剖出的腋神经长度。作者推测，腋神经的某一段无法通过两种方法同时触及。
使用前路和后路解剖五具冷冻尸体的腋神经。第一个手术夹标记了三角肌胸大肌间沟入路中神经最明显的远端部分；第二个手术夹标记了后入路中神经的最近端部分。通过肩部X线片确定两个手术夹的位置。作者对不同的腋神经节段进行了测量。
在所有标本中，腋神经有三个区域：A区（前路），从腋神经起点到第一个手术夹的神经节段，位于由肩胛下肌（内侧）、联合肌腱（外侧）和腋脂肪（下方）形成的三角水平；B区（盲区），从第一个手术夹到第二个手术夹，无法通过两种入路触及的神经节段；C区（旋肱后动脉），从第二个手术夹（位于四边孔水平）到进入三角肌的神经节段。盲区的平均长度为1.6厘米。该盲区距肩肱关节1至2厘米。
作者描述了腋神经中无法通过前后联合入路评估的一段神经。
