Background: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.Purpose: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.Study Design:Controlled laboratory study.Methods: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).Results: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.Conclusion: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.Clinical Relevance: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.

中文翻译：

---

Latarjet 手术期间关节盂骨质流失和肩部位置对腋神经解剖结构的影响


背景：Latarjet 手术越来越多地用于治疗关节盂骨质流失，并且具有相对较高的神经并发症发生率。了解腋神经 (AN) 的位置依赖性解剖结构对于预防损伤至关重要。目的：量化 Latarjet 手术期间肩部位置的变化和关节盂骨质流失程度对 AN 位置的影响。研究设计：对照实验室研究。方法：总共解剖了10具尸体肩部，留下肩袖和三角肌的肌腱用于肌肉负荷。 AN 的 3 维位置在 3 种条件下相对于下关节盂进行量化：（1）完整的肩部，（2）具有 15% 骨丢失的 Latarjet 手术，以及（3）具有 30% 骨丢失的 Latarjet 手术。在盂肱外展 0°、30° 和 60°（相当于肩部外展 0°、45° 和 90°）以及肱骨外旋 (ER) 0°、45° 和 90° 时获得测量值结果：肩部外展至 60° 导致后位 (9.5 ± 1.1 mm; P < .001)、上位 (3.0 ± 1.2 mm; P = .013) 和侧位 (19.1 ± 2.3 mm; P < .013)。 001) AN 和 ER 移动至 90° 导致向前平移 (10.0 ± 1.2 mm; P < .001)。总体而言，ER 增加了外展 30° 处的最小 AN-关节盂距离（14.9 ± 1.3 mm [0° ER​​] vs 17.3 ± 1.5 mm [90° ER​​]；P = .045）。 Latarjet 手术导致关节盂骨质流失 15% 和 30%，导致 AN 相对于完整状态发生上移和内移。 Latarjet 手术后，最小 AN-关节盂距离减小，60° 外展和 90° ER​​ 时骨质流失 30%（17.7 ± 1.6 mm [完整] vs 13.9 ± 1.6 mm [30% 骨质流失]；P = .007），但在 Latarjet 手术后没有观察到显着差异，骨质流失为 15%。结论：肩部外展导致 AN 向上、横向和后移，而 ER 导致前移。有趣的是，当对关节盂广泛骨质流失的肩部进行 Latarjet 手术时，显着缩短了肩部外展和 ER 期间的最小 AN-关节盂距离。这些新发现意味着关节盂骨质大量流失的患者在手术的关键部分可能面临更高的 AN 损伤风险。因此，外科医生在翻修手术期间必须考虑到神经解剖结构的变化。临床相关性：本研究试图加深对 Latarjet 手术后肩关节位置和关节盂骨质流失对 AN 解剖结构的位置依赖性影响的理解。提高 AN 解剖学知识对于防止 Latarjet 手术期间潜在的毁灭性 AN 损伤至关重要。