Yung S W, Lazarus M D, Harryman D T
Department of Orthopaedic Surgery, Singapore General Hospital, Republic of Singapore.
J Shoulder Elbow Surg. 1996 Nov-Dec;5(6):467-70. doi: 10.1016/s1058-2746(96)80019-x.
Surgical mobilization of an adherent or retracted subscapularis tendon is often necessary whenever an attempt is made to restore function to the glenohumeral joint subsequent to failed anterior reconstructive surgery. Surgical guidelines drawn from this study emphasize how a surgeon might accomplish this task effectively and avoid denervating the subscapularis, a muscle that is essential to anterior glenohumeral stability and strength. In this study we examined subscapularis innervation in 11 fresh-frozen cadaveric shoulders. The position of the subscapular nerve insertion points were recorded relative to easily identified surgical landmarks such as the axillary nerve, the conjoined tendon, and the anterior glenoid rim. The palpable anterior border of the glenoid rim deep to the subscapularis along with the medical border of the conjoined tendon can serve as guides to the subscapularis nerve insertion points, because all the nerves are no closer than 1.5 cm medial to these landmarks for all positions of humeral rotation in the unelevated arm. The lower subscapular nerve was found immediately posterior or just lateral to the axillary nerve. During a standard deltopectoral approach potential injury to the subscapularis innervation can be minimized by locating and protecting the axillary nerve, because it serves as a guide to the insertion point of the lower subscapularis nerve, the nerve closet to the surgical field.
每当在前路重建手术失败后试图恢复盂肱关节功能时，通常都需要对粘连或回缩的肩胛下肌腱进行手术松解。本研究得出的手术指南强调了外科医生如何有效地完成这项任务，并避免使肩胛下肌失神经支配，肩胛下肌对盂肱关节前方的稳定性和力量至关重要。在本研究中，我们检查了11个新鲜冷冻尸体肩部的肩胛下肌神经支配情况。记录肩胛下神经插入点相对于易于识别的手术标志的位置，如腋神经、联合肌腱和肩胛盂前缘。肩胛下肌深面肩胛盂边缘的可触及前缘以及联合肌腱的内侧边缘可作为肩胛下神经插入点的引导，因为在未抬高手臂的肱骨旋转的所有位置，所有神经与这些标志内侧的距离均不小于1.5厘米。发现肩胛下神经低位支紧邻腋神经后方或刚好在其外侧。在标准的胸大肌三角肌入路中，通过定位和保护腋神经可将对肩胛下肌神经支配的潜在损伤降至最低，因为腋神经可作为肩胛下神经低位支插入点的引导，该神经最靠近手术区域。
