Crutcher Clifford L, Kline David G, Tender Gabriel C
Department of Neurosurgery, Louisiana State University, New Orleans, Louisiana.
Neurosurg Focus. 2017 Mar;42(3):E7. doi: 10.3171/2016.12.FOCUS16470.
The traditional posterior subscapular approach offers excellent exposure of the lower brachial plexus and has been successfully used in patients with recurrent thoracic outlet syndrome after an anterior operation, brachial plexus tumors involving the proximal roots, and postirradiation brachial plexopathy, among others. However, this approach also carries some morbidity, mostly related to the extensive muscle dissection of the trapezius, rhomboids, and levator scapulae. In this article, the authors present the surgical technique and video illustration of a modified, less invasive posterior subscapular approach, using a small, self-retaining retractor and only a partial trapezius and rhomboid minor muscle dissection. This approach is likely to result in decreased postoperative morbidity and a shorter hospital stay.
传统的肩胛下后入路能很好地暴露臂丛神经下部，已成功应用于前路手术后复发性胸廓出口综合征、累及近端神经根的臂丛神经肿瘤以及放疗后臂丛神经病变等患者。然而，这种入路也有一些并发症，主要与斜方肌、菱形肌和肩胛提肌的广泛肌肉解剖有关。在本文中，作者介绍了一种改良的、侵入性较小的肩胛下后入路的手术技术和视频演示，该入路使用小型自固定牵开器，仅部分解剖斜方肌和小菱形肌。这种入路可能会降低术后并发症发生率并缩短住院时间。
