Department of Shoulder Surgery, Institut de la Main, Clinique Jouvenet, 6 Square Jouvenet, 75016, Paris, France.
Knee Surg Sports Traumatol Arthrosc. 2017 Oct;25(10):3289-3295. doi: 10.1007/s00167-016-4224-9. Epub 2016 Jun 24.
The first purpose of this study is to measure the distance between the axillary nerve and the exit point of K-wires placed retrograde through the glenoid in the setting of an arthroscopic Latarjet procedure. The second objective is to evaluate whether manual external rotation of the scapula alters that distance.
In seven fresh-frozen specimens, two 2.0-mm K-wires were drilled through the glenoid using an arthroscopic Latarjet retrograde glenoid guide. These were drilled into the glenoid at the 7- and 8-o'clock positions (right shoulders) and at the 4- and 5-o'clock positions (left). K-wires were oriented parallel to the glenoid articular surface and perpendicular to the long superoinferior axis of the glenoid, 7 mm medial to the joint surface. Two independent evaluators measured the distances between the axillary nerve and the exit point of the K-wires in the horizontal plane (AKHS for the superior K-wire and AKHI for the inferior K-wire) and in the vertical plane (AKV). Measurements were taken with the scapula left free and were repeated with the scapula placed at 15° and 30° of external rotation.
With the scapula left free, scapular external rotation was 34° ± 2.3°. In this position, the AKHS was 2.5 ± 1.6, 6.3 ± 1.2 mm at 15° of external rotation (ER) and 11.4 ± 1.4 mm at 30° ER. The AKHI distance was 0.37 ± 1.6, 3.4 ± 1.4 and 10.6 ± 2.1 mm, respectively, for the scapula left free, at 15° ER and 30° of ER. The AKV distances were, respectively, 0.12 ± 0.2, 4.9 ± 1.6 and 9.9 ± 1.7 mm. The increase in all distances was statistically significant (p < 0.001).
Increasing scapular external rotation significantly increases the distance between the axillary nerve and the exit point of the K-wires, increasing the margin of safety during this procedure. Therefore, increased external rotation of the scapula could be an effective tool to decrease the risk of iatrogenic axillary nerve injury.
Cadaveric study, Level V.
本研究的首要目的是测量关节镜下 Latarjet 手术中经关节盂逆行置入克氏针时，腋神经与克氏针出口点之间的距离。第二个目的是评估肩胛骨的手动外旋是否会改变该距离。
在七个新鲜冷冻标本中，使用关节镜下 Latarjet 逆行盂肱关节引导器，经盂肱关节钻入两根 2.0mm 的克氏针。这些克氏针在右肩的 7 点和 8 点位置以及左肩的 4 点和 5 点位置钻入盂肱关节。克氏针与盂肱关节表面平行，与盂肱关节长轴垂直，距离关节面内侧 7mm。两名独立评估者在水平平面（上克氏针的 AKHS 和下克氏针的 AKHI）和垂直平面（AKV）测量腋神经与克氏针出口点之间的距离。测量时肩胛骨保持自由，然后在肩胛骨外旋 15°和 30°时重复测量。
肩胛骨自由时，肩胛骨外旋 34°±2.3°。在这个位置，AKHS 在肩胛骨外旋 15°时为 6.3±1.2mm，在肩胛骨外旋 30°时为 11.4±1.4mm，而 AKHI 距离分别为 0.37±1.6、3.4±1.4 和 10.6±2.1mm。AKV 距离分别为 0.12±0.2、4.9±1.6 和 9.9±1.7mm。所有距离的增加均具有统计学意义（p<0.001）。
增加肩胛骨外旋显著增加了腋神经与克氏针出口点之间的距离，增加了该手术过程中的安全边际。因此，增加肩胛骨外旋可能是降低医源性腋神经损伤风险的有效工具。
尸体研究，5 级。
