Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
Knee Surg Sports Traumatol Arthrosc. 2019 Dec;27(12):3771-3778. doi: 10.1007/s00167-019-05351-3. Epub 2019 Jan 31.
The purpose of this study was to provide arthroscopic measurements and orientations of the axillary and musculocutaneous nerves medial to the coracoid.
A retrospective chart review of 29 patients undergoing arthroscopic subscapularis repair and arthroscopic cadaveric dissection of 23 shoulders was used to analyze neuroanatomical distances to arthroscopic landmarks and to document the orientations of the axillary and musculocutaneous nerves using a clock face analogy. The clock face data was analyzed by separating the clock face into four quadrants and the frequency of any crossing nerve within each of the four quadrants was then determined.
In vivo, the axillary nerve was found 1.5 ± 0.5 cm medial to the coracoid tip and the musculocutaneous nerve was found 1.6 ± 0.6 cm medial to the coracoid tip. In cadavera, the axillary nerve was found 2.0 ± 0.6 cm medial to the coracoid tip and the musculocutaneous nerve was found 1.5 ± 0.5 cm medial to the coracoid tip. The posterosuperior quadrant of the subcoracoid space contained a crossing nerve in 4 of 29 (13.8%) patients undergoing arthroscopic rotator cuff repair medial to the coracoid, compared to 9 of 23 (39.1%) cadavera undergoing arthroscopic dissection medial to the coracoid. The posteroinferior quadrant contained a crossing nerve in 16 of 29 (55.2%) patients compared to 17 of 23 (73.9%) cadavera.
The axillary and musculocutaneous nerves run in close proximity to the coracoid tip and coracoid arch, most consistently within 1-2 cm medial to these structures, which is closer than has been previously documented in the literature. Crossing nerves are least frequently encountered within the posterosuperior quadrant of the subcoracoid space medial to the coracoid, followed by the posteroinferior quadrant. Arthroscopic dissection of this space should begin in the posterosuperior quadrant and carefully progress to the posteroinferior quadrant to decrease the risk of intraoperative nerve injury. Given the close proximity and frequently encountered nerves in this area, extreme caution must be exercised when working arthroscopically within the subcoracoid space.
本研究的目的是提供喙突内侧腋神经和肌皮神经的关节镜测量和定位。
回顾性分析 29 例接受关节镜下肩胛下肌修复和 23 例肩关节关节镜尸体解剖的患者的图表，以分析神经解剖距离到关节镜标志，并使用时钟面分析记录腋神经和肌皮神经的方向。通过将时钟面分为四个象限来分析时钟面数据，并确定每个象限内任何交叉神经的频率。
在体内，腋神经位于喙突尖端内侧 1.5±0.5cm，肌皮神经位于喙突尖端内侧 1.6±0.6cm。在尸体中，腋神经位于喙突尖端内侧 2.0±0.6cm，肌皮神经位于喙突尖端内侧 1.5±0.5cm。喙突下窝的后上象限在 29 例（13.8%）经喙突内侧行关节镜肩袖修复的患者中，有 4 例（13.8%）存在交叉神经，而在 23 例（39.1%）经喙突内侧行关节镜解剖的尸体中，有 9 例（39.1%）存在交叉神经。后下象限在 29 例（55.2%）患者中有 16 例（55.2%）存在交叉神经，而在 23 例（73.9%）尸体中有 17 例（73.9%）存在交叉神经。
腋神经和肌皮神经与喙突尖端和喙突弓紧密相邻，最常位于这些结构内侧 1-2cm 内，比文献中以前记录的距离更近。在喙突内侧的喙突下窝后上象限中，交叉神经最不容易遇到，其次是后下象限。关节镜下解剖这个空间应该从后上象限开始，并小心地向向后下象限进展，以降低术中神经损伤的风险。鉴于该区域的接近度和经常遇到的神经，在喙突下间隙进行关节镜手术时必须格外小心。
