Shaffer B S, Conway J, Jobe F W, Kvitne R S, Tibone J E
Kerlan-Jobe Orthopaedic Clinic, Inglewood, California.
Am J Sports Med. 1994 Jan-Feb;22(1):113-20. doi: 10.1177/036354659402200118.
Standard posterior shoulder surgical approaches include infraspinatus tendon detachment and infraspinatus-teres minor interval development. Cadaveric and clinical investigation of a new infraspinatus-splitting approach to the posterior glenohumeral joint was undertaken to assess efficacy in providing exposure, preserving tendon attachment, and avoiding neurologic compromise. Infraspinatus musculotendinous and neural anatomy was examined in 20 cadavers. Four patients with posterior shoulder instability underwent posterior capsulorrhaphy through this infraspinatus-splitting approach, followed by electrodiagnostic testing. Infraspinatus muscle was bipennate in all specimens, the tendinous interval an average 14 mm inferior to the scapular spine at the glenoid rim. The infraspinatus-splitting interval bisected the posterior glenoid rim at its midpoint, whereas the infraspinatusteres minor interval crossed the glenoid rim's lower quarter. The suprascapular nerve provided sole innervation to the infraspinatus muscle in all specimens, entering the infraspinous fossa at the notch as a single trunk 22 mm medial to the glenoid rim. Minimum branching variability was observed. Electrodiagnostic testing showed no evidence of axonal damage or muscle denervation in either infraspinatus pennate bundle. Limiting infraspinatus-splitting dissection medially to 1.5 cm from the posterior glenoid rim prevents damage to any interval-crossing suprascapular nerve branches. Posterior shoulder surgery through a horizontal, longitudinal infraspinatus tendon-splitting approach provides excellent exposure of posterior capsule, labrum, and glenoid, without requiring tendon detachment or causing neurologic compromise.
标准的后肩部手术入路包括冈下肌腱切断术和冈下肌-小圆肌间隙的分离。对一种新的经冈下肌劈开入路至肱盂后关节进行了尸体和临床研究，以评估其在提供暴露、保留肌腱附着以及避免神经损伤方面的效果。在20具尸体上检查了冈下肌肌腱和神经解剖结构。4例后肩部不稳定患者通过这种冈下肌劈开入路进行了后关节囊缝合术，随后进行了电诊断测试。在所有标本中，冈下肌均为羽状肌，肌腱间隙在肩胛盂边缘处平均位于肩胛冈下方14毫米处。冈下肌劈开间隙在肩胛盂后缘中点将其后缘平分，而冈下肌-小圆肌间隙穿过肩胛盂后缘的下四分之一。在所有标本中，肩胛上神经是冈下肌的唯一神经支配，在肩胛切迹处作为单一主干进入冈下窝，位于肩胛盂边缘内侧22毫米处。观察到最小的分支变异。电诊断测试显示，在任何一个冈下肌羽状束中均未发现轴突损伤或肌肉失神经支配的证据。将冈下肌劈开的内侧解剖限制在距肩胛盂后缘1.5厘米以内，可防止损伤任何穿过间隙的肩胛上神经分支。通过水平、纵向的冈下肌腱劈开入路进行后肩部手术，可提供对后关节囊、盂唇和肩胛盂的良好暴露，而无需切断肌腱或造成神经损伤。
