Steadman Philippon Research Institute, Vail, CO, USA.
Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
J Shoulder Elbow Surg. 2022 Oct;31(10):e465-e472. doi: 10.1016/j.jse.2022.03.029. Epub 2022 May 9.
Neurovascular anatomy has not been previously quantified for the arthroscopic snapping scapula approach with the patient in the most frequent patient position ("chicken-wing" position). The purposes of this study were (1) to determine anatomic relationships of the superomedial scapula and neurovascular structures at risk during arthroscopic surgical treatment of snapping scapula syndrome (SSS), (2) to compare these measurements between the arm in the neutral position and the arm in the chicken-wing position, and (3) to establish safe zones for arthroscopic treatment of SSS.
Eight fresh-frozen cadaveric hemi-torsos (mean age, 55.8 years; range, 52-66 years) were dissected to ascertain relevant anatomic structure locations including the (1) spinal accessory nerve, (2) dorsal scapular nerve, and (3) suprascapular nerve. A coordinate measuring device was used to collect data on the relationships of anatomic landmarks and at-risk structures during the surgical approach.
The dorsal scapular nerve was a mean of 24.4 mm medial to the superomedial scapula in the neutral position and 33.1 mm medial in the chicken-wing position (P < .001); the dorsal scapular nerve was 21.7 mm medial to the medial border of the scapular spine in the neutral position and 35.5 mm medial in the chicken-wing position (P < .001). The mean distance from the superomedial angle to the spinal accessory nerve intersection at the superior scapular border was 16.5 mm in the neutral position and 15.0 mm in the chicken-wing position (P = .031). The average distance from the superomedial angle to the closest point of the spinal accessory nerve was 11.6 mm and 10.4 mm in the neutral position and chicken-wing position, respectively (P = .039).
Neurologic structures around the scapula vary significantly between the neutral arm position and the chicken-wing position commonly used in the arthroscopic treatment of SSS. The chicken-wing position improves safe distances for the dorsal scapular nerve during medial-portal placement and should be considered as a primary position for arthroscopic management of SSS.
神经血管解剖结构以前从未针对关节镜下弹响肩胛入路进行量化，而该入路最常采用的患者体位是“鸡翅位”。本研究的目的为：（1）确定关节镜下治疗弹响肩胛综合征（SSS）时，肩胛上内侧部的解剖关系和相关神经血管结构的位置；（2）比较中立位和“鸡翅位”时的这些测量值；（3）为 SSS 的关节镜治疗建立安全区。
8 具新鲜冷冻的半尸骸（平均年龄，55.8 岁；范围，52-66 岁）进行解剖，以确定相关解剖结构的位置，包括：（1）副神经；（2）肩胛上神经；和（3）肩胛上神经。使用坐标测量装置收集手术入路过程中解剖标志和高危结构的关系数据。
在中立位时，肩胛上神经距肩胛上内侧缘的平均距离为 24.4mm，而在“鸡翅位”时为 33.1mm（P<.001）；在中立位时，肩胛上神经距肩胛脊柱内侧缘的平均距离为 21.7mm，而在“鸡翅位”时为 35.5mm（P<.001）。在中立位时，肩胛上内角到肩胛上缘上副神经交点的平均距离为 16.5mm，而在“鸡翅位”时为 15.0mm（P=.031）。在中立位和“鸡翅位”时，肩胛上内角到最近的副神经点的平均距离分别为 11.6mm 和 10.4mm（P=.039）。
在中立位和 SSS 关节镜治疗中常用的“鸡翅位”之间，肩胛周围的神经结构有明显差异。“鸡翅位”可改善内侧入路时肩胛上神经的安全距离，应作为 SSS 关节镜治疗的主要体位。
