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首页> 外文期刊>Patient Safety in Surgery >Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report
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Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report

机译：腋神经异常解剖学变体挑战肩部肩ector部入路：一例报告

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摘要

The deltopectoral approach is a well-described surgical approach to the proximal humerus and glenohumeral joint. One of the structures at risk during this approach is the axillary nerve. Typically, the axillary nerve arises off the posterior cord of the brachial plexus and courses lateral to the proximal humerus and inferior to the glenohumeral joint, exiting the axilla through the quadrangular space. We describe a case of an aberrant axillary nerve, coursing anteriorly across the glenohumeral joint within the deltopectoral groove encountered during a reverse total shoulder arthroplasty. A 73-year-old female presented complaining of atraumatic progressive right shoulder pain of several months duration. Clinical and radiographic findings were consistent with advanced rotator cuff arthropathy. After failing appropriate non-operative treatment, the patient elected to undergo reverse total shoulder arthroplasty. During the deltopectoral approach to the glenohumeral joint, the axillary nerve was found to be coursing deep to the cephalic vein within the deltopectoral interval. The nerve was isolated and protected, and the glenohumeral joint was accessed via a small window in the anterior deltoid muscle. The remainder of the procedure was performed without complication. The patient was found to be healing well and with normal axillary nerve function at 4-month follow-up. Neurologic lesions are well-documented complications of reverse total shoulder arthroplasty. The integrity of the axillary nerve is of particular importance to reverse total shoulder arthroplasty as it innervates the deltoid and post-operative function of the extremity is dependent upon a functioning deltoid muscle. Extreme care must be taken to avoid insult to the axillary nerve and any aberrant paths it may course around the glenohumeral joint.
机译：三角肌入路是一种针对肱骨近端和盂肱关节的手术方法。在这种方法中存在风险的结构之一是腋神经。通常，腋神经出现在臂丛神经的后部，并在肱骨近端外侧和盂肱关节下方行进，通过四角形空间离开腋窝。我们描述了一种异常的腋神经，在整个全肩关节置换术过程中遇到的肩groove沟内横过盂肱关节向前移动。一名73岁的女性抱怨外伤性进行性几个月的进行性右肩痛。临床和影像学检查结果与晚期肩袖关节炎一致。经过适当的非手术治疗失败后，该患者选择进行反向全肩关节置换术。在对肱肱关节的三角肌入路过程中，发现腋神经在三角肌间隔内向头静脉深处移动。分离并保护了神经，通过三角肌前肌中的一个小窗口进入了肱肱关节。该过程的其余部分无并发症。在4个月的随访中发现该患者康复良好，腋神经功能正常。神经系统病变是有记录的全肩关节置换术后并发症。腋神经的完整性对于扭转全肩关节置换术特别重要，因为它支配了三角肌，而四肢的术后功能取决于三角肌的功能。必须格外小心，以免侮辱腋神经及其在盂肱关节周围可能出现的任何异常路径。

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