CT localization on suprascapular nerve and clinical application value in arthroscopic Bristow-Latarjet / 中国组织工程研究

ABSTRACT

BACKGROUND: The Bristow-Lataijet technique is a reliable treatment for recurrent anterior shoulder instability. However, it as been reported 1.6% of patients suffering nerve injury. Thereafter, the all-arthroscopic Latarjet procedure has been gaining popularity, but the surgeon is unable to palpate the nerves, and their localization, so protection is a difficulty. OBJECTIVE: To investigate the CT localization of suprascapular nerve on the posterosuperior scapular neck, and to improve the safety and quality in Bristow-Latarjet surgery. METHODS: This study was carried out on 12 normal formalin fixed adult cadaveric upper limb specimens (8 males and 4 females). The study was in accordance with the ethical requirements of Dongguan Hospital of Traditional Chinese Medicine. The nerve trunk and branches were marked with developing lines to examine the position and course of nerve on the posterosuperior scapular neck. CT localization was used to measure the distance, angle and height ratio to glenoid from the superior pole of scapula, spinoglenoid notch, the entry point of outermost nerve branch to anterior and posterior margin of the glenoid, through internally and externally rotating 45 degrees of should joints. The data were statistically analyzed. RESULTS AND CONCLUSION: (1) Pearson correlation analysis: The height of glenoid was positively correlated with the distance from the spinoglenoid notch and entrance point to the articular surface. (2) Comparison between internal and external rotation 45 degrees: Distance of superior pole of scapula and angles showed no significant difference (all P > 0.05). There were significant differences in the distance and angle in the spinoglenoid notch (all P 0.05). There were significant differences in distance, angle, and height ratio at entrance point (all P < 0.01), suggesting that external rotation had larger angle and safer range of distance than internal rotation. In the position of internal and external rotation 45 degrees, the distance, angle and height ratio of spinoglenoid notch and entrance point showed significant differences (P < 0.01), indicating that compared with spinoglenoid notch, the angle between entrance point and articular surface was smaller, the distance from entrance point to articular surface was shorter, and the height ratio was higher. (4) Therefore, external rotation is recommended in the case of internal fixation of the bony tunnel for the posterior glenoid so as to reduce the incidence of nerve injury.