Department of Surgery and Radiology, University of Basque Country, lejona, Spain.
Department of Traumatology and Orthopaedic Surgery, Galdakao Hospital, University of Basque Country, c./Labeaga, s/n, 48960, Usansolo, Vizcaya, Spain.
Knee Surg Sports Traumatol Arthrosc. 2017 Oct;25(10):3279-3284. doi: 10.1007/s00167-016-4193-z. Epub 2016 Jun 14.
To evaluate the risk of injuring the axillary nerve during an inferior glenohumeral ligament (IGHL) plication and finding out whether shoulder position (either beach chair position or lateral decubitus position) has any effect in this risk.
The axillary nerve (AN) was identified through a 3-cm posterior incision in 12 cadaveric shoulders. Under arthroscopic visualization, a curved indirect suture-passing device was placed through the posterior and anterior bands of the IGHL. The distances between the device and the AN were measured with the shoulder specimen placed at simulated lateral decubitus position and beach chair position.
There were no cases of nerve injury nor the suture-passing device came closer than 10 mm to the nerve. There was an increase in the injury risk to the AN when inserting the device at the posterior band of the IGHL in the beach chair position [median 13 mm (range 10-21 mm)] compared to the risk in the lateral decubitus position [22.5 mm (20-26 mm), significant differences, p < 0.001]. When the device was inserted at the anterior band of the IGHL, there were no significant differences (n.s.) [lateral decubitus position: 18 mm (14-24 mm) vs. 16 mm (13-18 mm)]. When comparing differences between bands, there were no differences in the beach chair position, but the risk was lower for the posterior band in the lateral decubitus position (p < 0.001).
During plication of the posterior band of the IGHL, the risk is higher if the procedure is performed in the beach chair position. The posterior plication is safer than the anterior plication in lateral decubitus position.
This study helps the surgeon to better understand the proximity of the nerve to the IGHL and to highlight that the risk of nerve injury during capsular plication might be reduced in the lateral decubitus position.
评估在进行下盂肱韧带（IGHL）紧缩术时损伤腋神经的风险，并探讨肩部位置（沙滩椅位或侧卧位）对此风险的影响。
在 12 具尸体肩关节上，通过 3cm 后方切口识别腋神经（AN）。在关节镜可视化下，将一个弯形间接缝线传递装置穿过 IGHL 的后、前束。在模拟侧卧位和沙滩椅位时，测量装置与 AN 之间的距离。
无神经损伤病例，缝线传递装置也未靠近神经 10mm 以内。在沙滩椅位时，从前束插入装置时，AN 损伤风险增加[中位数 13mm（范围 10-21mm）]，与侧卧位相比差异有统计学意义（p<0.001）。从前束插入装置时，差异无统计学意义（n.s.）[侧卧位：18mm（14-24mm）vs. 16mm（13-18mm）]。比较前后束差异时，沙滩椅位无差异，但侧卧位时后束风险较低（p<0.001）。
在进行 IGHL 后束紧缩术时，如果在沙滩椅位进行，风险更高。在侧卧位时，后束紧缩比前束紧缩更安全。
本研究有助于外科医生更好地了解神经与 IGHL 的接近程度，并强调在侧卧位进行囊袋紧缩术时，神经损伤的风险可能降低。
