Corrêa Mário Chaves, Naves Érica Antunes, Vaz Gilvan Ferreira, Machado Thalles Abreu, de Andrade Marco A P
Hospital Madre Teresa, Belo Horizonte, Brazil.
Hospital Governador Israel Pinheiro, Instituto de Previdência do Servidores do Estado de Minas Gerais, Belo Horizonte, Brazil.
JSES Int. 2020 Jan 14;4(1):77-84. doi: 10.1016/j.jses.2019.11.003. eCollection 2020 Mar.
Shoulder arthroscopy can be performed with the patient in the lateral decubitus or beach-chair position, but in both cases, glenohumeral (GH) joint spaces must be increased to improve visualization and allow access of the optical instrument. The aim of this study was to determine the effects of limb setup and longitudinal traction on the opening of the GH space with patients placed in the beach-chair (dorsal decubitus) position.
GH spaces at 3 test points corresponding to the anatomic locations of Bankart lesions were determined indirectly from radiographic images obtained from 67 patients presenting shoulder pathology with an indication for arthroscopic surgery. Measurements were made with the operative limb in neutral rotation and positioned in relation to the coronal plane in adduction, 45° of abduction, or adduction with an axillary spacer, in each case with and without longitudinal traction.
GH spaces were optimized at 2 of 3 test points when the operative limb was positioned in adduction or neutral rotation and manual longitudinal traction was applied with or without a polystyrene spacer placed under the axilla, but use of the spacer was essential to maximize the GH space at all 3 locations. In contrast, 45° of abduction proved to be the least appropriate position because it afforded the smallest GH space values with or without traction.
Appropriate positioning of the patient on the operating table is a critical aspect of shoulder arthroscopy. Radiographic images revealed that adducted upper-limb traction with the use of an axillary spacer in patients in the beach-chair position generates a significant increase in the GH space in the lower half of the glenoid cavity, thereby facilitating visualization and access of the optical equipment to the GH compartments.
肩关节镜检查可在患者侧卧位或沙滩椅位进行，但在这两种情况下，都必须增加盂肱（GH）关节间隙以改善视野并便于光学器械进入。本研究的目的是确定在沙滩椅（仰卧位）位放置患者时，肢体摆放和纵向牵引对GH间隙开口的影响。
从67例有肩关节镜手术指征的肩部病变患者获得的X线影像中间接确定对应于Bankart损伤解剖位置的3个测试点的GH间隙。测量时手术肢体处于中立旋转位，并相对于冠状面处于内收、外展45°或使用腋窝间隔物内收的位置，每种情况均在有和没有纵向牵引的情况下进行。
当手术肢体处于内收或中立旋转位并应用手动纵向牵引时，无论腋窝下是否放置聚苯乙烯间隔物，在3个测试点中的2个点处GH间隙得到优化，但使用间隔物对于在所有3个位置使GH间隙最大化至关重要。相比之下，45°外展被证明是最不合适的位置，因为无论有无牵引，其GH间隙值最小。
患者在手术台上的适当体位是肩关节镜检查的关键方面。X线影像显示，在沙滩椅位的患者中使用腋窝间隔物进行上肢内收牵引会使肩胛盂下半部的GH间隙显著增加，从而便于光学设备观察和进入GH腔室。
