Begum Musammad Rashida, Cuthbert Rory, Dott Cameron Andrew Joseph, O'Neill Owen, Tahir Mohammed, Carlos Adrian, Mascio Livio Di
Department of Trauma and Orthopaedic, The Royal London Hospital, London, UK.
Clin Shoulder Elb. 2025 Feb;28(1):3-8. doi: 10.5397/cise.2024.00465. Epub 2024 Dec 24.
Iatrogenic suprascapular nerve injury secondary to posterior drilling or screw penetration is a recognized complication of bone block or coracoid process transfers for anterior glenohumeral instability. We present the first cadaveric study that assesses the safety of posteroanterior reference guides and quantifies the relationship of the suprascapular nerve to posterior glenoid fixation with suture buttons.
Anterior glenoid bone block reconstruction with suture buttons utilizing a posteroanterior reference guide was performed in 10 fresh frozen cadavers via a posterior portal. Bullets were inserted in predefined superior and inferior guide holes via percutaneous incisions to facilitate posteroanterior drilling. Looped guide wires were used to deliver suture buttons from anterior to posterior positions. The shoulder joint was disarticulated and the infraspinatus sharply elevated until the suprascapular nerve was visualized. Four independent static measures of the shortest distance from the superior drill sleeve to the lateral aspect of the suprascapular nerve were recorded.
The suprascapular nerve was not compromised utilizing the posteroanterior guide and suture button fixation technique in any specimen. The mean distance from superior sleeve tunnel to the suprascapular nerve was 5.00 mm (range, 3.25-8.00 mm) in females and 6.80 mm (range, 5.50-8.75 mm) in males. The shortest distance was 3.25 mm and the longest was 8.75 mm.
The use of posteroanterior reference guides for suture button fixation was not associated with iatrogenic suprascapular nerve injury in the specimens examined. However, the proximity of the suprascapular nerve underscores the need for caution. Comparative analysis with anteroposterior bone block techniques is required to establish the potential benefits of this procedure. Level of evidence: V.
继发于后侧钻孔或螺钉穿透的医源性肩胛上神经损伤是用于治疗前侧盂肱关节不稳的骨块移植或喙突转移术的一种公认并发症。我们开展了首例尸体研究，评估前后位参考导向器的安全性，并量化肩胛上神经与使用缝合纽扣进行后侧关节盂固定之间的关系。
通过后侧入路，在10具新鲜冷冻尸体上使用前后位参考导向器，采用缝合纽扣进行前侧关节盂骨块重建。经皮切口将子弹插入预先定义的上、下导向孔，以便进行前后位钻孔。使用环形导丝从前向后输送缝合纽扣。将肩关节离断，将冈下肌急剧抬起，直至可见肩胛上神经。记录从上方钻套到肩胛上神经外侧的最短距离的四项独立静态测量值。
在任何标本中，使用前后位导向器和缝合纽扣固定技术均未损伤肩胛上神经。女性中，从上方套筒隧道到肩胛上神经的平均距离为5.00毫米（范围为3.25 - 8.00毫米），男性为6.80毫米（范围为5.50 - 8.75毫米）。最短距离为3.25毫米，最长为8.75毫米。
在所检查的标本中，使用前后位参考导向器进行缝合纽扣固定与医源性肩胛上神经损伤无关。然而，肩胛上神经位置较近强调了操作时需要谨慎。需要与前后位骨块技术进行对比分析，以确定该手术的潜在益处。证据级别：V级。
