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[关节镜下改良Latarjet劈开肩胛下肌:基于腋神经、肩胛盂和肩胛下肌的解剖学研究]

[Modified Latarjet splitting subscapularis muscle under arthroscopy: an anatomical study based on axillary nerve, glenoid, and subscapularis muscle].

作者信息

Liang Xinzhi, Liang Daqiang, Qiu Zhihe, Li Sheng, Wu Bing, Li Hao, Huang Gang, Lu Wei, Xie Denghui, Liu Haifeng

机构信息

Department of Sports Medicine, Shenzhen University First Affiliated Hospital (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518035, P. R. China.

Department of Orthopedic Medical Center, Joint Surgery and Sports Medicine, the Third Affiliated Hospital of Southern Medical University, Guangzhou Guangdong, 510630, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 May 15;37(5):556-560. doi: 10.7507/1002-1892.202302059.

Abstract

OBJECTIVE

To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting.

METHODS

A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively.

RESULTS

In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane.

CONCLUSION

In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.

摘要

目的

验证改良关节镜下Latarjet手术中肩胛下肌劈开窗口与腋神经的空间关系,为肩胛下肌劈开改良提供解剖学依据。

方法

对29例成人尸体肩部标本进行逐层解剖,最终确认腋神经走行于肩胛下肌的前方。保持肩关节处于中立位,将克氏针从右肩胛盂环4:00位置(左肩胛盂环7:00位置)由后向前穿过肩胛下肌,记录前方出口点(点A,Latarjet手术中肩胛下肌劈开点)。分别测量点A与腋神经之间的垂直和水平距离。

结果

在肩关节中立位时,点A与腋神经在水平面的距离为27.37(19.80,34.55)mm,在垂直面的距离为16.67(12.85,20.35)mm。

结论

在肩关节中立位时,从右肩胛盂4:00位置(左肩胛盂环7:00位置)进针,经肩胛下肌后方穿向前方并向外劈开,腋神经损伤的可能性相对降低。

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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 May 15;37(5):556-560. doi: 10.7507/1002-1892.202302059.
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本文引用的文献

1
Low rates of serious complications after open Latarjet procedure at short-term follow-up.
J Shoulder Elbow Surg. 2023 Jan;32(1):41-49. doi: 10.1016/j.jse.2022.06.004. Epub 2022 Jul 21.
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Burns Trauma. 2022 May 28;10:tkac021. doi: 10.1093/burnst/tkac021. eCollection 2022.
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Modified Arthroscopic Latarjet Procedure: Suture-Button Fixation Achieves Excellent Remodeling at 3-Year Follow-up.
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Open Versus Arthroscopic Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review and Meta-analysis.
Am J Sports Med. 2019 Apr;47(5):1248-1253. doi: 10.1177/0363546518759540. Epub 2018 Mar 20.
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Contraindications and complications of the Latarjet procedure.
Shoulder Elbow. 2018 Jan;10(1):15-24. doi: 10.1177/1758573217728716. Epub 2017 Sep 11.

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