Wilkinson Eric B, Williams Johnathan F, Paul Kyle D, He Jun Kit, Hutto Justin R, Narducci Carl A, McGwin Gerald, Brabston Eugene W, Ponce Brent A
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
JSES Int. 2021 Jan 9;5(2):205-211. doi: 10.1016/j.jseint.2020.11.002. eCollection 2021 Mar.
Percutaneous fixation of proximal humeral fractures places the axillary nerve and posterior humeral circumflex artery at risk for injury. Safe operative zones for the axillary nerve are described based on external measurements from anatomic landmarks, but no study to date has incorporated advanced imaging to help guide surgical procedures in the region of the axillary neurovascular bundle (ANVB). We sought to define the location and trajectory of the ANVB in relation to osseous landmarks using magnetic resonance imaging (MRI) measurements.
Retrospective review of 750 consecutive MRI studies was performed with 55 imaging studies meeting inclusion criteria for patient positioning, image alignment, and quality. Five measurements were performed including the distance from mid-lateral acromion to lateral ANVB, mid-lateral acromion to medial ANVB, greater tuberosity to lateral ANVB, vertical distance between inferior anatomic neck and lateral ANVB, and angle the ANVB crosses the humerus. Height, gender, and age were recorded. Analysis was performed using ANOVA and Pearson correlation tests.
The lateral ANVB was below the inferior articular margin of the humeral head by an average of 12.9 ± 3.9 mm and within a 22 mm window. It was an average of 57.4 ± 5.1 mm from the lateral mid-acromion, and 34.7 ± 4.3 mm below the greater tuberosity. The angle formed by the ANVB crossing the humerus averaged 19.5 ± 3.9 degrees upward from medial to lateral. Height and gender directly impacted measurements.
The use of the inferior humeral head articular margin provides a radiographic landmark to aid intraoperative lateral ANVB assessment which may be helpful during percutaneous fracture fixation.
肱骨近端骨折的经皮固定会使腋神经和旋肱后动脉有受伤风险。基于从解剖标志进行的外部测量描述了腋神经的安全手术区域，但迄今为止尚无研究纳入先进成像技术来辅助指导腋神经血管束（ANVB）区域的手术操作。我们试图利用磁共振成像（MRI）测量来确定ANVB相对于骨性标志的位置和走行。
对750例连续的MRI研究进行回顾性分析，其中55项成像研究符合患者体位、图像对齐和质量的纳入标准。进行了五项测量，包括从肩峰中外侧到ANVB外侧的距离、从肩峰中外侧到ANVB内侧的距离、大结节到ANVB外侧的距离、解剖颈下与ANVB外侧之间的垂直距离以及ANVB与肱骨交叉的角度。记录身高、性别和年龄。使用方差分析和Pearson相关检验进行分析。
ANVB外侧平均位于肱骨头下关节缘下方12.9±3.9mm，且在22mm的范围内。它距肩峰中外侧平均57.4±5.1mm，在大结节下方平均34.7±4.3mm。ANVB与肱骨交叉形成的角度平均从内侧到外侧向上19.5±3.9度。身高和性别直接影响测量结果。
使用肱骨头下关节缘可提供一个影像学标志，以辅助术中对ANVB外侧进行评估，这在经皮骨折固定过程中可能会有帮助。
