Chernchujit Bancha, Chiarnpattanodom Amolnat, Agrawal Sumit
Thammasat University Hospital, Pathum Thani, Thailand.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2023 Jan 6;31:1-5. doi: 10.1016/j.asmart.2022.12.001. eCollection 2023 Jan.
Biceps tenodesis is an effective procedure performed to treat shoulder pain originating from the long head biceps tendon. In arthroscopic biceps tenodesis unicortical drilling of the humerus is more commonly practiced as it is considered safe to the vital structures lying posterior to the proximal humerus. Many surgeons are wary of the bi-cortical approach as it poses a risk to these vital structures. The aim of this study was to establish whether bi-cortical drilling in proximal humerus is safe or not. Our second purpose was to find a safe zone (if any) for bi-cortical drilling if bi-cortical drilling is safe.
This study is a descriptive study conducted on cadaveric shoulders. Bilateral shoulders and arms of ten fresh-frozen cadavers (mean age 77.7 y) were dissected. Four landmarks in the dissected humerus were identified. They were superior margin of the bicipital groove, center of the bicipital groove, upper and lower border of pectoralis major insertion. Bi-cortical trans-humeral pinning was done in the humerus at all these points so that the pin exited through the posterior cortex of the humerus. The shortest distance between the pin and the nearest vital structure namely axillary nerve, radial nerve, articular surface of the humeral head, and cephalic vein was calculated from each fixed landmark.
We established that bi-cortical drilling in proximal humerus was safe. The safe zone established for bi-cortical biceps tenodesis is at the middle of bicipital groove, which is 18.00 ± 4.02 mm inferior to the groove's upper border. The boundaries of the safe zone lie 9.39 mm superiorly and 9.40 mm inferiorly to the middle of the bicipital groove.
The center of the established safe zone for bi-cortical trans-humeral pinning was 18 mm inferior to the bicipital groove's upper border.
肱二头肌肌腱固定术是治疗源于肱二头肌长头肌腱的肩部疼痛的有效手术。在关节镜下肱二头肌肌腱固定术中，肱骨单皮质钻孔更为常用，因为它被认为对肱骨近端后方的重要结构是安全的。许多外科医生对双皮质入路持谨慎态度，因为它对这些重要结构构成风险。本研究的目的是确定肱骨近端双皮质钻孔是否安全。我们的第二个目的是如果双皮质钻孔是安全的，找到一个双皮质钻孔的安全区域（如果有的话）。
本研究是对尸体肩部进行的描述性研究。解剖了10具新鲜冷冻尸体（平均年龄77.7岁）的双侧肩部和手臂。在解剖的肱骨中确定了四个标志点。它们是肱二头肌沟的上缘、肱二头肌沟的中心、胸大肌止点的上下边界。在所有这些点对肱骨进行双皮质经肱骨穿针，使针从肱骨后皮质穿出。从每个固定标志点计算针与最近的重要结构（即腋神经、桡神经、肱骨头关节面和头静脉）之间的最短距离。
我们确定肱骨近端双皮质钻孔是安全的。为双皮质肱二头肌肌腱固定术建立的安全区域位于肱二头肌沟的中部，比沟的上缘低18.00±4.02毫米。安全区域的边界位于肱二头肌沟中部上方9.39毫米和下方9.40毫米处。
双皮质经肱骨穿针的既定安全区域中心位于肱二头肌沟上缘下方18毫米处。
