Salazar J D, Doty J R, Tseng E E, Marin P C, Girotto J A, Roseborough G S, Yang S C, Heitmiller R F
Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md, USA.
J Thorac Cardiovasc Surg. 1998 Dec;116(6):960-4. doi: 10.1016/S0022-5223(98)70047-9.
The objective was to determine the course of the long thoracic nerve relative to the scapula as an aid to the prevention of proximal long thoracic nerve injuries.
Eighteen fresh cadavers (7 male, 11 female) were studied. Each was sequentially placed in the transaxillary and posterolateral thoracotomy positions, and the distance of the long thoracic nerve from the scapular tip and anterior scapular border was measured. The measurements were made bilaterally; the mean, standard deviation, and 99% confidence interval were calculated for each position by gender.
Distances from the scapular tip to the long thoracic nerve are listed as mean/outer range: transaxillary thoracotomy, male 4.9/7.0 cm left, 5.2/7.5 cm right; female 4.3/5.0 cm left, 4.7/6.0 cm right; posterolateral thoracotomy, male 3.1/6.0 cm left, 4.5/5.1 cm right; female 3.2/4.5 cm left, 3.8/5.5 cm right. In all instances, the long thoracic nerve was furthest from the scapula at its tip.
For patients positioned for a transaxillary thoracotomy, incision sites should be at least 7.5 and 6.0 cm anterior to the scapular tip for male and female patients, respectively. For patients in posterolateral thoracotomy positioning, incisions should be 6.0 and 5.5 cm anterior to the scapular tip for male and female patients, respectively. By using these anatomic guidelines, we believe that the incidence of iatrogenic proximal long thoracic nerve injury can be minimized.
确定胸长神经相对于肩胛骨的走行，以辅助预防胸长神经近端损伤。
对18具新鲜尸体（7例男性，11例女性）进行研究。依次将每具尸体置于经腋窝和后外侧开胸体位，测量胸长神经与肩胛尖和肩胛骨前缘的距离。双侧进行测量；按性别计算每个体位的平均值、标准差和99%置信区间。
肩胛尖至胸长神经的距离列于表中，均值/范围：经腋窝开胸，男性左侧4.9/7.0 cm，右侧5.2/7.5 cm；女性左侧4.3/5.0 cm，右侧4.7/6.0 cm；后外侧开胸，男性左侧3.1/6.0 cm，右侧4.5/5.1 cm；女性左侧3.2/4.5 cm，右侧3.8/5.5 cm。在所有情况下，胸长神经在其尖端处离肩胛骨最远。
对于接受经腋窝开胸手术的患者，男性和女性患者的切口位置应分别在肩胛尖前方至少7.5 cm和6.0 cm处。对于接受后外侧开胸手术的患者，男性和女性患者的切口应分别在肩胛尖前方6.0 cm和5.5 cm处。我们认为，通过遵循这些解剖学指导原则，可以将医源性胸长神经近端损伤的发生率降至最低。
