Orlando Health Jewett Orthopedic Institute, Orlando, Florida, USA.
Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA.
Am J Sports Med. 2024 Jul;52(9):2340-2347. doi: 10.1177/03635465241254535.
The Latarjet procedure is increasingly being utilized for the treatment of glenoid bone loss and has a relatively high neurological complication rate. Understanding the position-dependent anatomy of the axillary nerve (AN) is crucial to preventing injuries.
To quantify the effects of changes in the shoulder position and degree of glenoid bone loss during the Latarjet procedure on the position of the AN.
Controlled laboratory study.
A total of 10 cadaveric shoulders were dissected, leaving the tendons of the rotator cuff and deltoid for muscle loading. The 3-dimensional position of the AN was quantified relative to the inferior glenoid under 3 conditions: (1) intact shoulder, (2) Latarjet procedure with 15% bone loss, and (3) Latarjet procedure with 30% bone loss. Measurements were obtained at 0°, 30°, and 60° of glenohumeral abduction (equivalent to 0°, 45°, and 90° of shoulder abduction) and at 0°, 45°, and 90° of humeral external rotation (ER).
Abduction of the shoulder to 60° resulted in a posterior (9.5 ± 1.1 mm; < .001), superior (3.0 ± 1.2 mm; = .013), and lateral (19.1 ± 2.3 mm; < .001) shift of the AN, and ER to 90° resulted in anterior translation (10.0 ± 1.2 mm; < .001). Overall, ER increased the minimum AN-glenoid distance at 30° of abduction (14.9 ± 1.3 mm [0° of ER] vs 17.3 ± 1.5 mm [90° of ER]; = .045). The Latarjet procedure with both 15 and 30% glenoid bone loss resulted in a superior and medial shift of the AN relative to the intact state. A decreased minimum AN-glenoid distance was seen after the Latarjet procedure with 30% bone loss at 60° abduction and 90° ER (17.7 ± 1.6 mm [intact] vs 13.9 ± 1.6 mm [30% bone loss]; = .007), but no significant differences were seen after the Latarjet procedure with 15% bone loss.
Abduction of the shoulder induced a superior, lateral, and posterior shift of the AN, and ER caused anterior translation. Interestingly, the Latarjet procedure, when performed on shoulders with extensive glenoid bone loss, significantly reduced the minimum AN-glenoid distance during shoulder abduction and ER. These novel findings imply that patients with substantial glenoid bone loss may be at a higher risk of AN injuries during critical portions of the procedure. Consequently, it is imperative that surgeons account for alterations in nerve anatomy during revision procedures.
This study attempts to improve understanding of the position-dependent effect of shoulder position and glenoid bone loss after the Latarjet procedure on AN anatomy. Improved knowledge of AN anatomy is crucial to preventing potentially devastating AN injuries during the Latarjet procedure.
Latarjet 手术越来越多地用于治疗肩盂骨缺损，并且具有相对较高的神经并发症发生率。了解腋神经（AN）的位置依赖性解剖结构对于预防损伤至关重要。
定量研究肩盂骨缺损 Latarjet 手术过程中肩的位置和程度的变化对 AN 位置的影响。
对照实验室研究。
共解剖了 10 具尸体标本，保留肩袖和三角肌的肌腱用于肌肉加载。在 3 种情况下，相对于下肩盂定量测量 AN 的 3 维位置：（1）完整的肩部，（2）Latarjet 手术 15%骨丢失，和（3）Latarjet 手术 30%骨丢失。在 0°、30°和 60°肩外展（相当于 0°、45°和 90°肩外展）和 0°、45°和 90°外展时测量肱骨（ER）。
肩部外展至 60°时，AN 向后（9.5 ± 1.1mm；<.001）、向上（3.0 ± 1.2mm； =.013）和向外（19.1 ± 2.3mm；<.001）移位，ER 至 90°时导致前向移位（10.0 ± 1.2mm；<.001）。总体而言，ER 增加了 30°外展时的最小 AN-肩盂距离（14.9 ± 1.3mm[0°ER]比 17.3 ± 1.5mm[90°ER]；=.045）。Latarjet 手术中 15%和 30%的肩盂骨丢失都会导致 AN 相对于完整状态向上和向内侧移位。Latarjet 手术中 30%骨丢失时，60°外展和 90°ER 后最小 AN-肩盂距离减小（17.7 ± 1.6mm[完整]比 13.9 ± 1.6mm[30%骨丢失]；=.007），但 Latarjet 手术中 15%骨丢失时未见明显差异。
肩部外展导致 AN 向上、向外和向后移位，ER 导致前向移位。有趣的是，当在广泛肩盂骨丢失的肩部上进行 Latarjet 手术时，肩外展和 ER 会显著减小最小 AN-肩盂距离。这些新发现表明，大量肩盂骨丢失的患者在手术的关键部位可能面临更高的 AN 损伤风险。因此，外科医生在进行翻修手术时必须考虑神经解剖结构的变化。
本研究试图提高对 Latarjet 手术后肩的位置和肩盂骨丢失对 AN 解剖结构的位置依赖性影响的理解。更好地了解 AN 解剖结构对于预防 Latarjet 手术中潜在的灾难性 AN 损伤至关重要。
