Orthopedics. 2021 Jan 1;44(1):e68-e72. doi: 10.3928/01477447-20200925-04. Epub 2020 Oct 1.
Anatomical reconstruction of the coracoclavicular ligaments involves drilling the base of the coracoid or looping a graft around it, placing the axillary nerve at risk for injury. Rockwood type V acromioclavicular (AC) separation injuries involve disruption of the AC joint capsule and coracoclavicular ligaments, resulting in inferomedial displacement of the scapulohumeral complex and alteration of the normal anatomical relations of the shoulder girdle structures. This study evaluated the effect of Rockwood type V AC separation on the anatomical relation of the axillary nerve to the coracoid base. Ten shoulders of 6 adult human cadavers were dissected to determine the dimensions of the coracoid. A digital caliper was used to measure the coracoclavicular distance and the minimal distance between the coracoid base and the axillary nerve. A Rockwood type V AC separation was created by transecting the AC joint capsule and coracoclavicular ligaments, and applying 15 kg of longitudinal tension to the upper extremity. Changes in the distance between the coracoid base and the axillary nerve were measured. Mean width, length, and thickness of the coracoid was 15.05±0.93 mm, 23.1±1.75 mm, and 11.88±1.33 mm, respectively. Mean distance between the coracoid base and the axillary nerve was 26.0±3.9 mm. After simulated Rockwood type V AC separation, mean distance was 22.0±3.4 mm; this difference was statistically significant (P=.0263; 95% CI, 2.0-5.9 mm). The axillary nerve is closer to the coracoid base during simulated Rockwood type V AC separation than previously reported in the orthopedic literature. Anatomical reconstruction of the coracoclavicular ligaments for Rockwood type V AC separation presents a higher risk for axillary nerve iatrogenic injury than previously reported. [Orthopedics. 2021;44(1):e68-e72.].
喙锁韧带的解剖重建包括在喙突基底钻孔或环扎移植物，这可能会损伤腋神经。Rockwood Ⅴ型肩锁关节（AC）分离损伤涉及 AC 关节囊和喙锁韧带的破坏，导致肩胛肱复合体向内侧下方移位，并改变肩带结构的正常解剖关系。本研究评估了 Rockwood Ⅴ型 AC 分离对腋神经与喙突基底解剖关系的影响。10 个成人尸体的 6 个肩部进行解剖以确定喙突的尺寸。使用数字卡尺测量喙锁间距和喙突基底与腋神经之间的最小距离。通过横断 AC 关节囊和喙锁韧带并对上肢施加 15kg 的纵向张力来创建 Rockwood Ⅴ型 AC 分离。测量喙突基底与腋神经之间的距离变化。喙突的平均宽度、长度和厚度分别为 15.05±0.93mm、23.1±1.75mm 和 11.88±1.33mm。喙突基底与腋神经之间的平均距离为 26.0±3.9mm。模拟 Rockwood Ⅴ型 AC 分离后，平均距离为 22.0±3.4mm；这一差异具有统计学意义（P=.0263；95%CI，2.0-5.9mm）。与之前在骨科文献中报道的相比，在模拟 Rockwood Ⅴ型 AC 分离时，腋神经更靠近喙突基底。与之前报道的相比，为 Rockwood Ⅴ型 AC 分离重建喙锁韧带会增加腋神经医源性损伤的风险。[骨科。2021；44(1):e68-e72.]。
