Wang Hanbin, Huddleston Hailey P, Kurtzman Joey S, Gedailovich Samuel, Deegan Liam, Aibinder William R
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA.
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Shoulder Elbow. 2023 Dec;15(6):647-652. doi: 10.1177/17585732231159392. Epub 2023 Feb 23.
Biceps tenodesis is used for a variety of shoulder and biceps pathologies. Humeral fracture is a significant complication of this procedure. This cadaveric anatomy study sought to determine the cortical thickness of the humeral proximal shaft to identify the optimal technique to decrease unicortical drilling and reduce the risk of fracture.
A computed tomography (CT) of eight cadaveric humeral specimens was obtained with a metallic marker placed at the site of subpectoral tenodesis. These scans were examined to define the cortical thickness of the subpectoral region of the humerus and determine angular safe zones for reaming.
At the standard point of a subpectoral tenodesis, a mean angle relative to the coronal plane of 29.2° medially and 21.6° laterally from the deepest portion of the bicipital groove avoided unicortical drilling with a 7 mm reamer. These values varied slightly 1 cm proximal and distal to this level. The thickest regions of cortex in the subpectoral humerus correspond to the ridges of the bicipital groove.
To avoid unicortical tunnels, surgeons should limit deviation from the perpendicular approach to no more than 23° relative to the coronal plane medially and 11° relative to the coronal plane laterally.
肱二头肌固定术用于多种肩部和肱二头肌病变。肱骨骨折是该手术的一种严重并发症。这项尸体解剖学研究旨在确定肱骨近端骨干的皮质厚度，以确定减少单皮质钻孔并降低骨折风险的最佳技术。
对8个尸体肱骨标本进行计算机断层扫描（CT），在胸大肌下固定术部位放置金属标记物。检查这些扫描图像，以确定肱骨胸大肌下区域的皮质厚度，并确定扩孔的角度安全区。
在胸大肌下固定术的标准点，相对于冠状面，从肱二头肌沟最深部向内平均角度为29.2°，向外为21.6°，可避免使用7毫米扩孔钻进行单皮质钻孔。在该水平近端和远端1厘米处，这些值略有变化。胸大肌下肱骨皮质最厚的区域对应于肱二头肌沟的嵴。
为避免单皮质隧道，外科医生应将相对于冠状面的垂直入路偏差限制在内侧不超过23°，外侧不超过11°。
