Simone Juan Pablo, Streubel Philipp N, Sanchez-Sotelo Joaquin, Steinmann Scott P, Adams Julie E
1 Shoulder and Elbow Surgery, Hospital Alemán, Buenos Aires, Argentina.
2 Shoulder, Elbow and Hand Surgery, Department of Orthopedic Surgery, University of Nebraska Medical Center, Omaha, USA.
Hand (N Y). 2017 Jul;12(4):395-400. doi: 10.1177/1558944716668849. Epub 2016 Oct 13.
This study investigated whether axillary nerve (AN) distance to the inferior border of the humeral head and inferior glenoid would change while placing the glenohumeral joint in different degrees of external rotation and abduction.
A standard deltopectoral approach was performed on 10 fresh-frozen cadaveric specimens. The distance between AN and the inferior border of the humeral head and inferior glenoid while placing the shoulder in 0°, 45°, and 90° of external rotation or abduction was measured. Continuous variables for changes in AN position were compared with paired 2-tailed Student t test.
The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of external rotation and 0° of abduction was 13.77 mm (SD 4.31), 13.99 mm (SD 4.12), and 16.28 mm (SD 5.40), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of external rotation was 16.33 mm (SD 3.60), 15.60 mm (SD 4.19), and 16.43 (SD 5.35), respectively. The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of abduction and 0° of external rotation was 13.76 mm (SD 4.31), 10.68 mm (SD 4.19), and 3.81 mm (SD 3.08), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of abduction was 16.33 mm (SD 3.60), 17.66 mm (SD 5.80), and 12.44 mm (SD 5.57), respectively.
The AN position relative to the inferior aspect of the glenohumeral joint does not significantly change despite position of external rotation. Increasing shoulder abduction over 45° decreases the distance from the glenohumeral joint to the AN and should be avoided.
本研究调查了在将盂肱关节置于不同程度的外旋和外展时，腋神经（AN）与肱骨头下缘及肩胛盂下缘的距离是否会发生变化。
对10个新鲜冷冻尸体标本采用标准的三角肌胸大肌入路。测量在将肩部置于外旋或外展0°、45°和90°时，腋神经与肱骨头下缘及肩胛盂下缘之间的距离。使用配对双尾学生t检验比较腋神经位置变化的连续变量。
肩部处于外旋0°、45°和90°且外展0°时，腋神经与肱骨头之间的平均距离分别为13.77毫米（标准差4.31）、13.99毫米（标准差4.12）和16.28毫米（标准差5.40）。肩部处于外旋0°、45°和90°时，腋神经与肩胛盂之间的平均距离分别为16.33毫米（标准差3.60）、15.60毫米（标准差4.19）和16.43（标准差5.35）。肩部处于外展0°、45°和90°且外旋0°时，腋神经与肱骨头之间的平均距离分别为13.76毫米（标准差4.31）、10.68毫米（标准差4.19）和3.81毫米（标准差3.08）。肩部处于外展0°、45°和90°时，腋神经与肩胛盂之间的平均距离分别为16.33毫米（标准差3.60）、17.66毫米（标准差5.80）和12.44毫米（标准差5.57）。
尽管有外旋位置，但腋神经相对于盂肱关节下方的位置并无显著变化。肩部外展超过45°会减小盂肱关节到腋神经的距离，应予以避免。
