Ebraheim N A, Mekhail A O, Padanilum T G, Yeasting R A
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699-0008, USA.
Clin Orthop Relat Res. 1997 Jan(334):136-43.
A modified posterior approach to the scapula was tested on 20 cadavers. The approach also was used in 2 cases with fractures involving the scapular neck and glenoid fossa. The incision is C shaped, with the convexity directed toward the lateral angle of the scapula. The posterior muscle fibers of the deltoid are reflected laterally after detaching them from their origin. The infraspinatus is mobilized without division to expose the posterior surface of the scapular neck and glenoid. Access to the rest of the posterior and the superior surfaces of the glenoid can be achieved by osteotomizing the acromion. The suprascapular neurovascular bundle is identified and protected at an average of 1.4 +/- 0.1 cm from the glenoid rim, where it is adherent to the spinoglenoid angle of the scapula. The circumflex scapular artery is protected at the lateral border of the scapula at an average of 2.8 +/- 0.5 cm from the inferior glenoid margin. The axillary nerve is protected inferior to the teres minor. However, care should be taken not to excessively retract the teres minor because the nerve lies in close proximity to the shoulder joint capsule.
在20具尸体上测试了一种改良的肩胛骨后入路。该入路还用于2例累及肩胛颈和肩胛盂窝的骨折病例。切口呈C形，凸面朝肩胛骨外侧角。三角肌后份肌纤维从起点处离断后向外侧牵开。不切断冈下肌，将其游离以暴露肩胛颈和肩胛盂的后表面。通过切断肩峰可显露肩胛盂后表面和上表面的其余部分。肩胛上神经血管束在距肩胛盂边缘平均1.4±0.1 cm处被识别并保护，此处它附着于肩胛骨的肩胛冈盂角。旋肩胛动脉在肩胛骨外侧缘距肩胛盂下边缘平均2.8±0.5 cm处得到保护。腋神经在小圆肌下方得到保护。然而，应注意不要过度牵开小圆肌，因为该神经紧邻肩关节囊。
