Beals T C, Harryman D T, Lazarus M D
Department of Orthopaedic Surgery, the University of Utah, Salt Lake City, USA.
Arthroscopy. 1998 Jul-Aug;14(5):465-70. doi: 10.1016/s0749-8063(98)70073-8.
The anatomic boundaries the subacromial bursa may serve as a useful guide for surgical orientation and safety. The goals of this study were to measure the minimum distance between the subdeltoid reflection of the subacromial bursa and the circumflex branch of the axillary nerve and to identify relationships between the margins of the subacromial bursa and the acromion, rotator cuff, and acromioclavicular joint. Seventeen fresh-frozen cadavers (mean age, 69 years), were included. Eleven cadavera were dissected only after the subacromial bursa was injected with a latex solution to define the peripheral boundaries of the bursa. The bursal margins were always 2 cm or more from the anterolateral corner of the bursal acromial surface and the bursa lined the anterior half of the anteroposterior distance of the acromion. The mean distances from all points of the acromion to the axillary nerve averaged approximately 5 cm. The mean minimum distance from the subdeltoid bursal reflection to the axillary nerve was 0.8 +/- 0.5 cm with a range of 0.0 to 1.4 cm. In the unelevated extremity, the inferior bursal reflection was always cephalad to the axillary nerve even when the two structures were apposed. Surgeons should exercise caution when approaching the inferior boundary of the subdeltoid bursal reflection because of the proximity to the axillary nerve. We recommend coupling previously reported "safe deltoid-split" distances to this useful anatomic landmark to prevent nerve injury. Furthermore, the central location of the anterolateral corner of the acromion within the bursal space can be applied to needle placement for injection, arthroscopic diagnosis or treatment and mini-open rotator cuff repairs.
肩峰下囊的解剖边界可为手术定位和安全提供有用的指导。本研究的目的是测量肩峰下囊的三角肌下反折与腋神经旋支之间的最小距离，并确定肩峰下囊边缘与肩峰、肩袖和肩锁关节之间的关系。纳入了17具新鲜冷冻尸体（平均年龄69岁）。11具尸体仅在向肩峰下囊注入乳胶溶液以确定囊的周边边界后进行解剖。囊边缘距囊肩峰面外侧角总是2 cm或更远，且囊覆盖肩峰前后距离的前半部分。从肩峰所有点到腋神经的平均距离约为5 cm。从三角肌下囊反折到腋神经的平均最小距离为0.8±0.5 cm，范围为0.0至1.4 cm。在未抬高的肢体中，即使两个结构相邻，囊的下反折也总是位于腋神经的头侧。由于靠近腋神经，外科医生在接近三角肌下囊反折的下边界时应谨慎操作。我们建议将先前报道的“安全三角肌劈开”距离与这个有用的解剖标志相结合，以防止神经损伤。此外，肩峰外侧角在囊间隙内的中心位置可应用于注射、关节镜诊断或治疗以及小切口肩袖修复的进针定位。
