■Latarjet手术越来越多地用于治疗关节盂骨丢失,并且具有相对较高的神经系统并发症发生率。了解腋下神经(AN)的位置依赖性解剖结构对于预防损伤至关重要。
■量化Latarjet手术过程中肩关节位置和关节盂骨丢失程度的变化对AN位置的影响。
■对照实验室研究。
■共解剖了10具尸体的肩膀,留下肩袖和三角肌的肌腱用于肌肉负荷。在3种情况下,相对于下关节盂,对AN的3维位置进行了量化:(1)完整的肩,(2)Latarjet手术有15%的骨丢失,和(3)Latarjet手术,骨丢失30%。在0°处获得测量结果,30°,肱骨外展60°(相当于0°,45°,和肩部外展90°),在0°,45°,肱骨外旋90°(ER)。
■将肩部外展至60°导致后部(9.5±1.1mm;P<.001),优越(3.0±1.2毫米;P=.013),和AN的横向(19.1±2.3mm;P<.001)位移,和ER至90°导致前平移(10.0±1.2mm;P<.001)。总的来说,外展30°时,ER增加了最小AN-关节盂距离(14.9±1.3mm[ER的0°]与17.3±1.5mm[ER的90°];P=.045)。Latarjet程序具有15%和30%的关节盂骨丢失,导致AN相对于完整状态的上向和内侧移位。Latarjet手术后发现最小AN-关节盂距离减少,在60°外展和90°ER时,骨损失为30%(17.7±1.6mm[完整]vs13.9±1.6mm[30%骨损失];P=.007),但是在Latarjet手术后没有发现明显差异,骨丢失为15%。
■绑架肩膀引起上,横向,和AN的后移,和ER引起前翻译。有趣的是,Latarjet程序,当在广泛的关节盂骨丢失的肩膀上进行时,肩外展和ER期间的最小AN关节盂距离显着减少。这些新发现暗示,在手术的关键部分,关节盂骨大量丢失的患者可能有更高的AN损伤风险。因此,外科医生必须在翻修手术中解释神经解剖结构的改变。
■这项研究试图提高对Latarjet程序对AN解剖结构后肩关节位置和关节盂骨丢失的位置依赖性影响的理解。提高对AN解剖结构的了解对于防止Latarjet手术过程中潜在的破坏性AN伤害至关重要。
UNASSIGNED: The Latarjet procedure is increasingly being utilized for the treatment of glenoid bone loss and has a relatively high neurological complication rate. Understanding the position-dependent anatomy of the axillary nerve (AN) is crucial to preventing injuries.
UNASSIGNED: To quantify the effects of changes in the shoulder position and degree of glenoid bone loss during the Latarjet procedure on the position of the AN.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: A total of 10 cadaveric shoulders were dissected, leaving the tendons of the rotator cuff and deltoid for muscle loading. The 3-dimensional position of the AN was quantified relative to the inferior glenoid under 3 conditions: (1) intact shoulder, (2) Latarjet procedure with 15% bone loss, and (3) Latarjet procedure with 30% bone loss. Measurements were obtained at 0°, 30°, and 60° of glenohumeral abduction (equivalent to 0°, 45°, and 90° of shoulder abduction) and at 0°, 45°, and 90° of humeral external rotation (ER).
UNASSIGNED: Abduction of the shoulder to 60° resulted in a posterior (9.5 ± 1.1 mm; P < .001), superior (3.0 ± 1.2 mm; P = .013), and lateral (19.1 ± 2.3 mm; P < .001) shift of the AN, and ER to 90° resulted in anterior translation (10.0 ± 1.2 mm; P < .001). Overall, ER increased the minimum AN-glenoid distance at 30° of abduction (14.9 ± 1.3 mm [0° of ER] vs 17.3 ± 1.5 mm [90° of ER]; P = .045). The Latarjet procedure with both 15 and 30% glenoid bone loss resulted in a superior and medial shift of the AN relative to the intact state. A decreased minimum AN-glenoid distance was seen after the Latarjet procedure with 30% bone loss at 60° abduction and 90° ER (17.7 ± 1.6 mm [intact] vs 13.9 ± 1.6 mm [30% bone loss]; P = .007), but no significant differences were seen after the Latarjet procedure with 15% bone loss.
UNASSIGNED: Abduction of the shoulder induced a superior, lateral, and posterior shift of the AN, and ER caused anterior translation. Interestingly, the Latarjet procedure, when performed on shoulders with extensive glenoid bone loss, significantly reduced the minimum AN-glenoid distance during shoulder abduction and ER. These novel findings imply that patients with substantial glenoid bone loss may be at a higher risk of AN injuries during critical portions of the procedure. Consequently, it is imperative that surgeons account for alterations in nerve anatomy during revision procedures.
UNASSIGNED: This study attempts to improve understanding of the position-dependent effect of shoulder position and glenoid bone loss after the Latarjet procedure on AN anatomy. Improved knowledge of AN anatomy is crucial to preventing potentially devastating AN injuries during the Latarjet procedure.