Loomer R, Graham B
Royal Columbian Hospital, New Westminster, Canada.
Clin Orthop Relat Res. 1989 Jun(243):100-5.
Axillary nerve injury is a recognized complication of the capsular slide procedure for multidirectional instability of the shoulder. Axillary nerve dissection followed by an anterior or posterior capsular shift procedure was carried out on 12 autopsy subjects to observe: (1) the normal relationships of the nerve; (2) its proximity to structures dissected in the procedure; and (3) the effects upon it of both anterior and posterior capsular shift procedures. The axillary nerve arises immediately posterior to the coracoid process and conjoint tendon. It crosses the inferolateral border of the subscapularis 3 to 5 mm medial to its musculotendinous junction, and it lies in intimate contact with the inferior capsule as it passes through the quadrilateral space. The nerve should be visualized prior to transecting the subscapularis tendon. During detachment of the inferior capsule from the humeral neck, the humerus should be gradually externally rotated, and the nerve should be gently retracted with a small flat instrument. Sutures reattaching the flap should be carefully placed to avoid injuring the nerve. The tendinous insertion of the teres minor is preserved from a posterior approach. The nerve can be visualized and protected during capsular detachment.
腋神经损伤是肩关节多向不稳定的关节囊移位手术中一种公认的并发症。对12例尸体进行了腋神经解剖，随后进行前或后关节囊移位手术，以观察：（1）神经的正常关系；（2）其与手术中解剖结构的接近程度；（3）前、后关节囊移位手术对其的影响。腋神经在喙突和联合腱后方立即发出。它在肩胛下肌肌腱结合部内侧3至5毫米处穿过肩胛下肌的下外侧缘，在穿过四边形间隙时与下关节囊紧密接触。在切断肩胛下肌肌腱之前应显露该神经。在将下关节囊从肱骨头颈部分离时，应逐渐将肱骨向外旋转，并用一个小的扁平器械轻轻牵拉神经。重新缝合皮瓣时应小心放置缝线，以免损伤神经。从后方入路时保留小圆肌的腱性止点。在关节囊分离过程中可显露并保护神经。
