Royal Devon and Exeter Hospital, Exeter, Devon, UK.
Lister Hospital, Stevenage, Hertfordshire, UK.
Bone Joint J. 2016 Oct;98-B(10):1395-1398. doi: 10.1302/0301-620X.98B10.38011.
Despite the expansion of arthroscopic surgery of the shoulder, the open deltopectoral approach is increasingly used for the fixation of fractures and arthroplasty of the shoulder. The anatomy of the terminal branches of the posterior circumflex humeral artery (PCHA) has not been described before. We undertook an investigation to correct this omission.
The vascular anatomy encountered during 100 consecutive elective deltopectoral approaches was recorded, and the common variants of the terminal branches of the PCHA are described.
In total, 92 patients (92%) had a terminal branch that crossed the space between the deltoid and the proximal humerus and which was therefore vulnerable to tearing or avulsion during the insertion of the blade of a retractor during the deltopectoral approach to the shoulder. In 75 patients (75%) there was a single vessel, in 16 (16%) a double vessel and in one a triple vessel.
The relationship of these vessels to the landmark of the tendon of the insertion of pectoralis major into the proximal humerus is described. Damage to these previously undocumented branches can cause persistent bleeding leading to prolonged surgery and post-operative haematoma and infection, as well as poor visualisation during the procedure. Cite this article: Bone Joint J 2016;98-B:1395-8.
尽管肩关节镜手术不断发展，但开放性肩胛下入路仍越来越多地用于肩部骨折固定和关节置换。目前尚未对旋肱后动脉终末支的解剖结构进行描述。我们开展了此项研究，旨在对这一遗漏进行纠正。
记录了 100 例连续的肩胛下入路手术中的血管解剖结构，并描述了旋肱后动脉终末支的常见变异。
在总共 92 例（92%）患者中，存在一支终末支穿过三角肌和肱骨近端之间的间隙，因此在肩胛下入路时插入骨牵开器刀片时，该终末支容易撕裂或撕脱。在 75 例（75%）患者中为单支血管，16 例（16%）为双支血管，1 例为三支血管。
描述了这些血管与胸大肌止点插入肱骨近端的标志之间的关系。这些之前未被记录的分支受损可导致持续性出血，从而导致手术时间延长、术后血肿和感染，并影响手术过程中的可视度。
Bone Joint J 2016;98-B:1395-8.
