肩关节前上外侧手术入路的应用解剖

Applied Anatomy of Anterior Superolateral Approach for the Shoulder Joint

目的：为肩关节前上外侧手术入路提供解剖学依据．方法：按照手术入路和层次，对２５例成年尸体 ５０侧上肢标本作了解剖观测．结果：三角肌前外侧部起点长度为（８．７３±０．６４）ｃｍ，三角肌肩峰外侧端起点至三角肌粗隆长（１５．４９±１．５７） ｃｍ．腋神经前支于肩峰外侧端与三角肌止点连线相交点位于肩峰下（６． １９± ０．４９）ｃｍ，相当于肩峰与三角儿止点连线问三角风长度的上２／５与下３／５交点．结论：手术横行切口，从肩峰沿锁骨向内侧不超过（８．７３± ０．６４） ｃｍ，否则容易损伤位于三角肌胸大肌间隙内的头静脉、胸肩峰动脉和胸外侧神经．纵行切口，从肩峰向下不超过（６．１９±０．４９）ｃｍ，也就是说此纵切口不超过三角肌中线长度的上２／５．以防损伤腋神经前支及旋肱后动、静脉等．

Objective: In order to provide anatomic proof for anterior superolateral approach for the shoulder joint. Methods: On the basis of operative approach and layer, anatomic observation has been made on 25 adult cadavers (50 upper limbs).Results: The anterolateral length of the origin of the deltoid muscle is (8.73±0.64) cm, the distance between the acromion and the deltoidtuberosity is(15.49±1.57) cm. The point where the anterior branch of axillary nerve crosses the line junction the acromion to the deltoid tuberosity lies below the acromion (6.19±0.49)cm, and it corresponds to the junction of upper 215 and lower 3/5 of the length of the deltoid muscle. Conclusions: the part of transverse incision along the clavicle from acromion to medial end of the incision can't go beyond (8.73±0.64) cm, or easy injure the cephalic vein in the deltopectoral groove,the thoracoacromial artery and the lateral pectoral nerve. The part of vertical incision from acromion to lower end of the incision can't go beyond (6.19±0.49)cm that is to say the vertical operative incision can't go beyond the upper 2/5 of the length of the deltoid muscle. In order to prevent the anterior branch of the axillary nerve and the posterior circumflex humeral artery and vein from injuries.