Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Shoulder Elbow Surg. 2021 Jun;30(6):1266-1272. doi: 10.1016/j.jse.2020.09.018. Epub 2020 Oct 15.
Axillary artery injury is a devastating complication related to anterior shoulder surgery and can result in significant morbidity and/or mortality. The purpose of our study was to evaluate the course of the axillary artery in relation to bony landmarks of the shoulder and identify variations in artery position with humeral external rotation.
Dissection of 18 shoulders (9 fresh whole-body cadavers) with simulated vessel perfusion using radiopaque dye was performed. The axillary artery position was measured from multiple points including 2 points on the coracoid base (C1 and C2), 3 points on the coracoid tip (C3-C5), 4 points on the glenoid: superior, middle, and inferior glenoid (D1-D4), and 2 points on the lesser tuberosity (L1 and L2). Fluoroscopic measurements were taken and compared at 0° and 90° of external rotation (F1 vs. F1' and F2 vs. F2'). Manual and fluoroscopic measurements were compared with one another using Kendall's τ correlation.
There were 6 male and 3 female cadavers with an average age of 67.2 ± 9.3 years (range: 49-77 years). The mean distance from the axillary artery to the coracoid base (C1 and C2) measured 21.1 ± 7.3 and 22.3 ± 7.4 mm, respectively, whereas the mean distance to the coracoid tip (C3, C4, and C5) measured 30.7 ± 9.3, 52.1 ± 20.2, and 46.5 ± 14.3 mm, respectively. Measurements relative to the glenoid face (D1, D2, and D3) showed a progressive decrease in mean distance from superior to inferior, measuring 31.6 ± 10.3, 16.5 ± 7.5, and 10.3 ± 7.3 mm, respectively, whereas D4 (inferior glenoid to axillary artery) measured 17.8 ± 10.7 mm. The minimum distance from the axillary artery to any point on the glenoid was as close as 4.1 mm (D3). There was a statistically significant difference in F1 (0° external rotation) vs. F1' (90° external rotation) (18.5 vs. 13.4 mm, P = .03). Kendall's τ correlation showed a strong, positive correlation between manual and fluoroscopic measurements (D4: 16.0 ± 12.5 mm vs. F1: 18.5 ± 10.7 mm) (τ = 0.556, P = .037).
The axillary artery travels an average of 1-1.8 cm from the inferior glenoid margin, which puts the artery at significant risk. In addition, the artery is significantly closer to the inferior glenoid with humeral external rotation. Surgeons performing anterior shoulder surgery should have a thorough understanding of the axillary artery course and understand changes in the position of the artery with external rotation of the humerus.
腋动脉损伤是与肩关节前侧手术相关的一种破坏性并发症，可导致严重的发病率和/或死亡率。我们的研究目的是评估腋动脉与肩部骨性标志的关系，并确定在肱骨外旋时动脉位置的变化。
对 18 个肩部（9 个全尸）进行了模拟血管灌注的解剖，并用显影剂进行了研究。从多个点测量腋动脉位置，包括喙突基底部的 2 个点（C1 和 C2）、喙突尖端的 3 个点（C3-C5）、肩胛盂的 4 个点：上、中、下肩胛盂（D1-D4）和小结节的 2 个点（L1 和 L2）。在外旋 0°和 90°时进行透视测量，并分别比较 F1 与 F1'和 F2 与 F2'。使用 Kendall's τ 相关性比较手动和透视测量值。
有 6 名男性和 3 名女性尸体，平均年龄为 67.2±9.3 岁（范围：49-77 岁）。腋动脉与喙突基底部（C1 和 C2）的平均距离分别为 21.1±7.3 和 22.3±7.4mm，而与喙突尖端（C3、C4 和 C5）的平均距离分别为 30.7±9.3、52.1±20.2 和 46.5±14.3mm。相对于肩胛盂面（D1、D2 和 D3）的测量值显示，从上方到下方的平均距离逐渐减小，分别为 31.6±10.3、16.5±7.5 和 10.3±7.3mm，而 D4（肩胛盂下部到腋动脉）的测量值为 17.8±10.7mm。腋动脉与肩胛盂之间的最短距离可达 4.1mm（D3）。F1（外旋 0°）与 F1'（外旋 90°）之间存在统计学显著差异（18.5 与 13.4mm，P=0.03）。Kendall's τ 相关性显示手动和透视测量之间存在很强的正相关（D4：16.0±12.5mm 与 F1：18.5±10.7mm）（τ=0.556，P=0.037）。
腋动脉从肩胛盂下缘平均移动 1-1.8cm，这使动脉面临很大的风险。此外，在肱骨外旋时，动脉与肩胛盂下部的距离更近。进行肩关节前侧手术的外科医生应该充分了解腋动脉的走行，并了解在肱骨外旋时动脉位置的变化。
