Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Orthopaedic Surgeon, Mediclinic Kloof Hospital, Pretoria, South Africa.
Surg Radiol Anat. 2023 Jul;45(7):865-873. doi: 10.1007/s00276-023-03168-x. Epub 2023 May 22.
The exact relational anatomy for the anterior axillary approach, targeting the axillary nerve for nerve transfers/grafts, has not been fully investigated. Therefore, this study aimed to dissect and document the gross anatomy surrounding this approach, specifically regarding the axillary nerve and its branches.
Fifty-one formalin-fixed cadavers (98 axilla) were bilaterally dissected simulating the axillary approach. Measurements were taken to quantify distances between identifiable anatomical landmarks and relevant neurovascular structures encountered during this approach. The musculo-arterial triangle, described by Bertelli et al., to aid in identification on localization of the axillary nerve, was also assessed.
From the origin of the axillary nerve till (1) latissimus dorsi was 62.3 ± 10.7 mm and till (2) its division into anterior and posterior branches was 38.8 ± 9.6 mm. The origin of the teres minor branch along the posterior division of the axillary nerve was recorded as 6.4 ± 2.9 mm in females and 7.4 ± 2.8 mm in males. The musculo-arterial triangle reliably identified the axillary nerve in only 60.2% of the sample.
The results clearly demonstrate that the axillary nerve and its divisions can be easily identified with this approach. The proximal axillary nerve, however, was situated deep and therefore challenging to expose. The musculo-arterial triangle was relatively successful in localising the axillary nerve, however, more consistent landmarks such as the latissimus dorsi, subscapularis, and quadrangular space have been suggested. The axillary approach may serve as a reliable and safe method to reach the axillary nerve and its divisions, allowing for adequate exposure when considering a nerve transfer or graft.
对于腋路神经转移/移植术，其腋神经的精确解剖关系尚未得到充分研究。因此，本研究旨在解剖并记录该入路周围的大体解剖结构，特别是腋神经及其分支。
对 51 具福尔马林固定的尸体（98 侧腋窝）进行双侧解剖，模拟腋路入路。测量了在该入路中遇到的可识别解剖标志和相关神经血管结构之间的距离。还评估了 Bertelli 等人描述的肌动脉三角，以帮助识别和定位腋神经。
从腋神经起点到（1）背阔肌止点为 62.3±10.7mm，到（2）其分为前、后支处为 38.8±9.6mm。小圆肌分支在腋神经后支的起点记录为女性 6.4±2.9mm，男性 7.4±2.8mm。肌动脉三角仅在 60.2%的样本中可靠地识别出腋神经。
结果清楚地表明，该入路可以很容易地识别腋神经及其分支。然而，近端腋神经位置较深，因此暴露困难。肌动脉三角在定位腋神经方面相对成功，但是已经提出了更一致的标志，如背阔肌、肩胛下肌和四方区。腋路入路可作为一种可靠且安全的方法到达腋神经及其分支，在考虑神经转移或移植时可提供充分的暴露。
