Ruland L J, Ruland C M, Matthews L S
Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland, USA.
Arthroscopy. 1995 Feb;11(1):52-6. doi: 10.1016/0749-8063(95)90088-8.
Because endoscopic management has recently been introduced as treatment for painful subscapular snapping, we designed a cadaveric study to identify the boundaries of the scapulothoracic spaces and the relationship of important neurovascular structures to safe portal sites for arthroscopic surgery. We studied eight fresh, unembalmed cadaveric shoulders by anatomic dissection alone and eight fresh, unembalmed cadaveric shoulders by dissection after arthroscopy. We noted the following findings: (1) the scapulothoracic articulation has two triangular spaces, the serratus anterior space and the subscapularis space, that are divided obliquely by the serratus anterior muscle; (2) the boundaries of the larger serratus anterior space include the chest wall anteriorly, the serratus anterior muscle posteriorly, and the rhomboids medially; (3) the boundaries of the subscapularis space are the serratus anterior muscle anteriorly, the subscapularis muscle posteriorly, and the axilla laterally; and (4) a well-defined bursa occupies the serratus anterior space. Based on these findings, we recommend that portals for arthroscopic surgery should be inferior to the spine of the scapula and three to four finger-breadths from the vertebral border of the scapula (1) to avoid the neurovascular structures at the superomedial angle of the scapula, (2) to avoid the dorsosacpular nerve and artery, and (3) to prevent perpendicular orientation of the arthroscope to the lateral chest wall.
由于内镜治疗最近已被引入用于治疗疼痛性肩胛下弹响，我们设计了一项尸体研究，以确定肩胛胸壁间隙的边界以及重要神经血管结构与关节镜手术安全入路部位的关系。我们仅通过解剖研究了8个新鲜、未防腐处理的尸体肩部，通过关节镜检查后解剖研究了另外8个新鲜、未防腐处理的尸体肩部。我们发现如下：（1）肩胛胸壁关节有两个三角形间隙，即前锯肌间隙和肩胛下肌间隙，由前锯肌斜向分隔；（2）较大的前锯肌间隙的边界包括前方的胸壁、后方的前锯肌和内侧的菱形肌；（3）肩胛下肌间隙的边界是前方的前锯肌、后方的肩胛下肌和外侧的腋窝；（4）一个界限清晰的滑囊占据前锯肌间隙。基于这些发现，我们建议关节镜手术的入路应位于肩胛冈下方，距肩胛内侧缘三到四个手指宽度处，（1）以避免肩胛上角的神经血管结构，（2）避免背肩胛神经和动脉，（3）防止关节镜与外侧胸壁垂直。
