臂丛分支的CT定位研究及在Bristow-Latarjet术式的临床意义

目的　研究臂丛分支在肩胛下肌前方的CT定位，提高Bristow-Latarjet术式临床操作时安全范围的认知。 方法　福尔马林固定的上肢标本16侧（男10，女6）。解剖和使用显影线标记16侧肩的臂丛分支（肌皮神经、腋神经、桡神经）在肩胛下肌前方的位置、行程，CT水平位上测量肩关节内旋45°、中立位、外旋45° 3个体位2~5点位置肌皮神经到关节盂的距离及成角规律，所得数据经统计学处理。 结果　⑴臂丛在肩胛下肌前方，由内往外神经的排列分别是腋神经、桡神经、肌皮神经。⑵CT水平位上测量肌皮神经在3个体位的数据，组间比较：角度上比较，2~5点位置的内旋位与中立位、与外旋位比较具有统计学意义（均P<0.05）；距离上比较：2点位置的外旋位与中立位、与内旋位比较具有统计学意义（均P<0.05），中立位与内旋位比较无统计学差异（P=0.15）；3~5点位置的内旋位与中立位、与外旋位比较具有统计学意义（均P<0.05）。5点位置的外旋位与中立位比较无统计学差异（P=0.07）。组内比较：内旋位2点位置的角度分别与3~5点位置比较，均有统计学差异（均P<0.05），3~5点位置的两两比较，均无统计学差异（均为P>0.05）。 Pearson分析：盂的高度HL与内旋位2点位置的角度呈负相关，与3点位置的角度呈正相关，与内旋位2点位置的距离呈负相关，与3~5点位置的距离呈正相关。 结论　肩关节内旋45°时肌皮神经的安全范围显著大于中立位及外旋45°，建议内旋位操作。

CT localization study of brachial plexus branches and its clinical significance in Bristow-Latarjet

Objective　To study the CT localization of the brachial plexus in front of the subscapularis muscle and to improve the knowledge of the safe range of Bristow-Latarjet surgical procedures. Methods　A total of 16 shoulder cadaver specimens were selected from Guangdong Medical University. Sixteen shoulder specimens were dissected and the position and stroke of the brachial plexus (musculocutaneous nerve, axillary nerve, radial nerve) trunk in front of the subscapularis muscle were marked using the development line. The distance between the musculocutaneous nerves to the anterior edge of the scapular glenoid (at the 2~5 o'clock position of the internal rotation 45° position, the neutral position and the external rotation 45° position) as well as its angular regularity with the line connecting the anterior and posterior margin of thescapular glenoid was measured at the CT level. The resulting data was processed and analyzed statistically.　Results 　(1) The brachial plexus was in front of the subscapularis muscle and the arrangement of the nerves from the inside to the outside was: the axillary nerve, the radial nerve and the musculocutaneous nerve. (2)The data of musculocutaneous nerve measured in three positions on CT horizontal position were compared among groups: angle comparison showed that there were significant differences between the internal rotation position and neutral position and external rotation position at 2~5 o'clock (all P<0.05). Distance comparison showed that there were significant differences between the external rotation position and neutral position at 2 o'clock and between the internal rotation position (all P<0.05). There was no statistical difference between the neutral position and the internal rotation position (P=0.15). There was statistical difference between the internal rotation position and the neutral position and the external rotation position at 3~5 o'clock (P<0.05). There was no significant difference between the 5 o'clock position and the neutral position (P=0.07). Intra-group comparison: the angle of 2 o'clock position of internal rotation was significantly different from that of 3~5 o'clock position (all P<0.05), and there was no significant difference between the two positions of 3~5 o'clock (all P>0.05). Pearson's analysis showed that the height of the pelvis HL was negatively correlated with the angle of 2-point position of the internal rotation position, positively correlated with the angle of 3-point position, negatively correlated with the distance of 2 o'clock position of the internal rotation position and positively correlated with the distance of 3~5 o'clock position.　Conclusions　The safe range of the musculocutaneous nerve at the internal rotation 45° position of the shoulder joint is significantly larger than that at the neutral position and the external rotation 45°position. Operation at the internal rotation position is recommended.