Dorsal Scapular Exposure Surgical Pathway

· Applied Anatomy

Pamberi pe scapula ndiyo inonzi subscapular fossa, apo iyo subscapularis muscle inotanga. Kumashure kune kunze uye zvishoma kumusoro kunofamba scapular ridge, iyo yakakamurwa kuva supraspinatus fossa uye infraspinatus fossa, yekunamatira ye supraspinatus uye infraspinatus tsandanyama zvichiteerana. Kupera kwekunze kwe scapular ridge ndeye acromion, iyo inoumba acromioclavicular joint ne acromion end of clavicle nenzira yakareba ovoid articular surface. Iyo yepamusoro yekumusoro ye scapular ridge ine diki yakaita U-notch, iyo inoyambuka nepfupi asi yakaoma transverse suprascapular ligament, pasi peiyo suprascapular nerve inopfuura, uye pamusoro peiyo suprascapular artery inopfuura. The lateral margin (axillary margin) ye scapular ridge ndiyo yakakora uye inofamba ichienda kunze kumudzi we scapular neck, iyo inoumba glenoid notch nechekumucheto kweglenoid yejojo ​​repafudzi.

· Zviratidzo

1. Resection ye benign scapular tumors.

2. Kubviswa kwenharaunda kwechirwere chakaipa che scapula.

3. High scapula nezvimwe zvirema.

4. Kubviswa kwepfupa rakafa mu scapular osteomyelitis.

5. Suprascapular nerve entrapment syndrome.

· Chinzvimbo chemuviri

Semi-prone position, yakarereka pa30° pamubhedha. Nhengo yekumusoro yakabatwa inoputirwa netauro isina utachiona kuitira kuti ikwanise kufamba chero nguva panguva yekuvhiya.

· Matanho ekushanda

1. A transverse incision inowanzoitwa pamwe chete ne scapular ridge mu supraspinatus fossa uye chikamu chepamusoro che infraspinatus fossa, uye chidimbu chenguva refu chinogona kuitwa pamwe chete nechepakati pe scapula kana rutivi rwemukati rwe subscapularis fossa. The transverse and longitudinal incisions inogona kusanganiswa kuti iite L-shape, inverted L-shape, kana yekutanga-class shape, zvichienderana nekudiwa kwekuona kwezvikamu zvakasiyana zve scapula. Kana chete makona epamusoro uye ezasi e scapula achida kubudiswa, zviduku zviduku zvinogona kuitwa munzvimbo dzinoenderana (Mufananidzo 7-1-5 (1)).

2. Isai iyo yepamusoro uye yakadzika fascia. Misungo yakasungirirwa kune scapular ridge uye muganhu wepakati inoiswa transversely kana longitudinally munzira yekucheka (Fig. 7-1-5 (2)). Kana iyo supraspinatus fossa ichizobudiswa pachena, mafiibhi epakati trapezius muscle anoiswa kutanga. Iyo periosteum inoputirwa pamusoro pebhoni pamusoro pe scapular gonad, ine chidimbu chemafuta pakati pezviviri, uye yose ye supraspinatus fossa inoratidzwa ne subperiosteal dissection ye supraspinatus muscle, pamwe chete nepamusoro petrapezius muscle. Paunenge uchipinza mafiber epamusoro emusumbu we trapezius, kutarisirwa kunofanira kutorwa kuti kurege kukuvadza tsinga yeparasympathetic.

3. Apo tsinga ye-suprascapular inofanira kuratidzwa, chete mafiibhi ekumusoro kwepakati chikamu chetrapezius muscle anogona kudhonzwa kumusoro, uye supraspinatus muscle inogona kudhonzwa zvinyoro pasi pasina kubvisa, uye chimiro chichena chinopenya chinoonekwa is suprascapular transverse ligament. Kana imwe nguva midziyo ye-suprascapular uye mitsipa yakaonekwa uye yakadzivirirwa, iyo suprascapular transverse ligament inogona kudimburwa, uye scapular notch inogona kuongororwa kune chero maitiro asina kujairika, uye iyo suprascapular nerve inogona kusunungurwa. Pakupedzisira, iyo yakabviswa trapezius muscle inosungirirwa shure pamwe chete kuitira kuti inosungirirwa kune scapula.

4. Kana chikamu chepamusoro che infraspinatus fossa chichizobudiswa pachena, mafiber ezasi uye epakati emuscle trapezius uye deltoid muscle inogona kuvharwa pakutanga kwe scapular ridge uye yakadzoserwa kumusoro uye pasi (Fig. 7-1-5 (3)), uye mushure mokunge infraspinatus muscle yave yakaratidzwa, inogona kuiswa pasi peperiosteally peel. 7-1-5(4)). Kana ichisvika kumucheto wepamusoro weaxillary margin ye scapular gonad (kureva, pasi pe glenoid), kutarisa kunofanira kubhadharwa kune axillary nerve uye posterior rotator humeral artery inopfuura nepakati pe quadrilateral foramen yakakomberedzwa ne teres minor, teres huru, musoro wakareba we triceps, uye scaerus neck yehuropi tsinga inopfuura nepakati katatu foramen yakakomberedzwa nevatatu vokutanga, kuitira kuti irege kukuvadza kwavari (Fig. 7-1-5 (5)).

5. Kufumura muganhu wepakati we scapula, mushure mekuvhara mafibers emusumbu we trapezius, trapezius uye supraspinatus misumbu inodzoserwa kumusoro uye kunze ne subperiosteal stripping kuti ibudise chikamu chepakati che supraspinatus fossa uye chikamu chepamusoro chemuganhu wepakati; uye trapezius uye infraspinatus muscles, pamwe chete ne-vastus lateralis muscle yakasungirirwa kune yakaderera angle ye scapula, yakabviswa pasi peperiosteally kuti ibudise chikamu chepakati che infraspinatus fossa, yakaderera angle ye scapula, uye chikamu chepasi chemuganhu wepakati.

Mufananidzo 7-1-5 Nzira ye dorsal scapular exposure

(1) kucheka; (2) kucheka mutsara wetsandanyama; (3) kucheka tsandanyama ye deltoid kubva pa scapular ridge; (4) kusimudza deltoid muscle kuratidza infraspinatus uye teres minor; (5) kubvisa infraspinatus muscle kuratidza dorsal aspect ye scapula ine vascular anastomosis.

6. Kana iyo subscapular fossa ichizobudiswa pachena, misumbu inosungirirwa kumucheto wemukati wemuganhu wepakati, kureva, scapularis, rhomboids uye serratus anterior, inofanira kubviswa panguva imwe chete, uye scapula yose inogona kusimudzwa kunze. Paunenge uchisunungura muganhu wepakati, kutarisirwa kunofanira kutorwa kuchengetedza kuburuka kwebazi re transverse carotid artery uye dorsal scapular nerve. Davi rinodzika remukati we carotid artery rinobva kumutsipa wehuro trunk uye rinofamba kubva kumusoro kwekona ye scapula kusvika kumucheto wezasi we scapula kuburikidza ne scapularis tenuissimus, rhomboid muscle uye rhomboid muscle, uye iyo rotator scapulae artery inoumba hupfumi hwevascular network mu scapula, yakanamatira chikamu chepfupa re scapula. iyo subperiosteal peeling.