Abstract：
OBJECTIVE: The open Trillat Procedure described to treat recurrent shoulder instability, has a renewed interest with the advent of arthroscopy. The suprascapular nerve (SSN) is theoretically at risk during the drilling of the scapula near the spinoglenoid notch. The purpose of this study was to assess the relationship between the screw securing the coracoid transfer and the SSN during open Trillat Procedure and define a safe zone for the SSN.
METHODS: In this anatomical study, an open Trillat Procedure was performed on ten shoulders specimens. The coracoid was fixed by a screw after partial osteotomy and antero-posterior drilling of the scapular neck. The SSN was dissected with identification of the screw. We measured the distances SSN-screw (distance 1) and SSN-glenoid rim (distance 2). In axial plane, we measured the angles between the glenoid plane and the screw (α angle) and between the glenoid plane and the SSN (β angle).
RESULTS: The mean distance SSN-screw was 8.8 mm +/-5.4 (0-15). Mean α angle was 11°+/-2.4 (8-15). Mean β angle was 22°+/-6.7 (12-30). No macroscopic lesion of the SSN was recorded but in 20% (2 cases), the screw was in contact with the nerve. In both cases, the β angle was measured at 12°.
CONCLUSIONS: During the open Trillat Procedure, the SSN can be injured due to its anatomical location. Placement of the screw should be within 10° of the glenoid plane to minimize the risk of SSN injury and could require the use of a specific guide or arthroscopic-assisted surgery.
METHODS: In this anatomical study, an open Trillat Procedure was performed on ten shoulders specimens. The coracoid was fixed by a screw after partial osteotomy and antero-posterior drilling of the scapular neck. The SSN was dissected with identification of the screw. We measured the distances SSN-screw (distance 1) and SSN-glenoid rim (distance 2). In axial plane, we measured the angles between the glenoid plane and the screw (α angle) and between the glenoid plane and the SSN (β angle).
RESULTS: The mean distance SSN-screw was 8.8 mm +/-5.4 (0-15). Mean α angle was 11°+/-2.4 (8-15). Mean β angle was 22°+/-6.7 (12-30). No macroscopic lesion of the SSN was recorded but in 20% (2 cases), the screw was in contact with the nerve. In both cases, the β angle was measured at 12°.
CONCLUSIONS: During the open Trillat Procedure, the SSN can be injured due to its anatomical location. Placement of the screw should be within 10° of the glenoid plane to minimize the risk of SSN injury and could require the use of a specific guide or arthroscopic-assisted surgery.
摘要：
目的：描述的开放性Trillat手术治疗复发性肩关节不稳定，随着关节镜的出现，人们重新产生了兴趣。理论上，肩胛骨上神经（SSN）在肩胛骨附近钻孔时处于危险之中。这项研究的目的是评估开放Trilat手术期间固定喙突转移的螺钉与SSN之间的关系，并为SSN定义安全区域。
方法：在这项解剖学研究中，在十个肩膀标本上进行了开放式Trillat程序。在部分截骨和肩胛骨颈前后钻孔后，用螺钉固定喙突。用螺钉的标识解剖SSN。我们测量了SSN-螺钉（距离1）和SSN-关节盂边缘（距离2）的距离。在轴向平面中，我们测量了关节盂平面与螺钉之间的角度（α角）以及关节盂平面与SSN之间的角度（β角）。
结果：SSN螺钉的平均距离为8.8mm/-5.4（0-15）。平均α角为11°+/-2.4(8-15)。平均β角为22°+/-6.7(12-30)。没有记录到SSN的宏观病变，但在20％（2例），螺钉与神经接触。在这两种情况下，β角测量为12°。
结论：在开放式Trillat程序中，SSN可能由于其解剖位置而受伤。螺钉的放置应在关节盂平面的10°范围内，以最大程度地减少SSN损伤的风险，并且可能需要使用特定的指南或关节镜辅助手术。
方法：在这项解剖学研究中，在十个肩膀标本上进行了开放式Trillat程序。在部分截骨和肩胛骨颈前后钻孔后，用螺钉固定喙突。用螺钉的标识解剖SSN。我们测量了SSN-螺钉（距离1）和SSN-关节盂边缘（距离2）的距离。在轴向平面中，我们测量了关节盂平面与螺钉之间的角度（α角）以及关节盂平面与SSN之间的角度（β角）。
结果：SSN螺钉的平均距离为8.8mm/-5.4（0-15）。平均α角为11°+/-2.4(8-15)。平均β角为22°+/-6.7(12-30)。没有记录到SSN的宏观病变，但在20％（2例），螺钉与神经接触。在这两种情况下，β角测量为12°。
结论：在开放式Trillat程序中，SSN可能由于其解剖位置而受伤。螺钉的放置应在关节盂平面的10°范围内，以最大程度地减少SSN损伤的风险，并且可能需要使用特定的指南或关节镜辅助手术。
