Txoj Kev Phais Mob Dorsal Scapular Exposure

· Kev Siv Anatomy

Nyob rau pem hauv ntej ntawm lub scapula yog lub subscapular fossa, qhov twg cov leeg nqaij subscapularis pib. Tom qab yog lub scapular ridge sab nraud thiab me ntsis mus rau saum toj, uas tau muab faib ua supraspinatus fossa thiab infraspinatus fossa, rau kev txuas ntawm cov leeg nqaij supraspinatus thiab infraspinatus. Qhov kawg sab nraud ntawm lub scapular ridge yog acromion, uas tsim cov pob qij txha acromioclavicular nrog qhov kawg ntawm clavicle los ntawm kev siv lub ntsej muag ovoid articular ntev. Qhov ntug sab saud ntawm lub scapular ridge muaj ib qho me me U-puab notch, uas hla los ntawm ib qho luv luv tab sis tawv transverse suprascapular ligament, hauv qab uas cov hlab ntsha suprascapular hla, thiab hla uas cov hlab ntsha suprascapular hla. Lub ntug sab nraud (axillary margin) ntawm lub scapular ridge yog qhov tuab tshaj plaws thiab txav mus rau sab nraud mus rau hauv paus ntawm lub caj dab scapular, qhov twg nws tsim ib qho glenoid notch nrog ntug ntawm glenoid ntawm lub xub pwg pob qij txha.

· Cov cim qhia

1. Kev txiav cov qog nqaij hlav benign scapular.

2. Kev txiav tawm ntawm cov qog nqaij hlav phem ntawm lub scapula hauv zos.

3. Mob pob txha caj qaum thiab lwm yam kev puas tsuaj.

4. Tshem tawm cov pob txha tuag hauv mob pob txha scapular osteomyelitis.

5. Mob caj dab ntawm cov hlab ntsha suprascapular.

· Qhov chaw ntawm lub cev

Txoj hauj lwm semi-pronounceable, qaij ntawm 30° rau lub txaj. Cov ceg sab saud uas raug mob raug qhwv nrog phuam huv kom nws tuaj yeem txav mus los txhua lub sijhawm thaum lub sijhawm phais.

· Cov kauj ruam ua haujlwm

1. Feem ntau, yuav muaj kev txiav transverse raws ntug scapular hauv supraspinatus fossa thiab sab saud ntawm infraspinatus fossa, thiab yuav muaj kev txiav longitudinal raws ntug medial ntawm scapula lossis sab medial ntawm subscapularis fossa. Cov kev txiav transverse thiab longitudinal tuaj yeem ua ke los ua ib daim duab L, inverted L, lossis ib daim duab zoo tshaj plaws, nyob ntawm seb koj xav pom ntau qhov sib txawv ntawm scapula. Yog tias tsuas yog cov ces kaum sab saud thiab qis ntawm scapula xwb, ces yuav muaj kev txiav me me rau hauv cov cheeb tsam sib xws (Daim Duab 7-1-5(1)).

2. Txiav cov fascia uas tob thiab tob. Cov leeg nqaij uas txuas rau ntawm lub scapular ridge thiab medial border raug txiav transversely lossis longitudinally rau hauv qhov kev txiav (Daim Duab 7-1-5(2)). Yog tias supraspinatus fossa yuav tsum tau nthuav tawm, cov fibers ntawm cov leeg nqaij trapezius nruab nrab yuav tsum tau txiav ua ntej. Lub periosteum raug txiav tawm tsam qhov pob txha ntawm lub scapular gonad, nrog ib txheej rog nyias nyias ntawm ob qho, thiab tag nrho cov supraspinatus fossa raug nthuav tawm los ntawm kev txiav subperiosteal ntawm cov leeg nqaij supraspinatus, nrog rau cov leeg nqaij trapezius uas nyob saum toj. Thaum txiav cov fibers sab saud ntawm cov leeg nqaij trapezius, yuav tsum ceev faj kom tsis txhob ua rau cov hlab ntsha parasympathetic puas tsuaj.

3. Thaum yuav tsum tau qhib cov hlab ntsha suprascapular, tsuas yog cov fibers ntawm qhov nruab nrab sab saud ntawm cov leeg trapezius thiaj li rub tau mus rau saum toj, thiab cov leeg supraspinatus tuaj yeem rub maj mam mus rau hauv qab yam tsis muaj stripping, thiab cov qauv dawb ci ntsa iab uas pom yog suprascapular transverse ligament. Thaum cov hlab ntsha suprascapular thiab cov hlab ntsha tau txheeb xyuas thiab tiv thaiv lawm, cov hlab ntsha suprascapular transverse ligament tuaj yeem txiav tau, thiab qhov scapular notch tuaj yeem tshawb nrhiav cov qauv tsis zoo, thiab cov hlab ntsha suprascapular tuaj yeem tso tawm. Thaum kawg, cov leeg trapezius stripped raug xaws rov qab ua ke kom nws txuas rau scapula.

4. Yog tias sab saud ntawm infraspinatus fossa yuav tsum tau nthuav tawm, cov leeg nqaij qis thiab nruab nrab ntawm cov leeg nqaij trapezius thiab cov leeg nqaij deltoid tuaj yeem txiav thaum pib ntawm lub scapular ridge thiab rub rov qab mus rau saum thiab nqis (Daim Duab 7-1-5(3)), thiab tom qab cov leeg nqaij infraspinatus tau raug nthuav tawm, nws tuaj yeem raug tev tawm hauv qab (Daim Duab 7-1-5(4)). Thaum mus txog qhov kawg ntawm axillary margin ntawm scapular gonad (piv txwv li, hauv qab glenoid), yuav tsum tau them sai sai rau cov hlab ntsha axillary thiab posterior rotator humeral artery uas hla dhau lub quadrilateral foramen uas nyob ib puag ncig los ntawm teres minor, teres major, lub taub hau ntev ntawm triceps, thiab lub caj dab phais ntawm humerus, nrog rau rotator scapulae artery uas hla dhau lub triangular foramen uas nyob ib puag ncig los ntawm peb thawj zaug, kom tsis txhob ua rau raug mob rau lawv (Daim Duab 7-1-5(5)).

5. Yuav kom pom qhov ciam teb nruab nrab ntawm lub scapula, tom qab txiav cov leeg ntawm cov leeg trapezius, cov leeg trapezius thiab supraspinatus raug rub rov qab rau sab saud thiab sab nraud los ntawm kev stripping subperiosteal kom pom qhov nruab nrab ntawm supraspinatus fossa thiab sab saud ntawm ciam teb nruab nrab; thiab cov leeg trapezius thiab infraspinatus, ua ke nrog cov leeg vastus lateralis txuas rau lub kaum sab qis ntawm scapula, raug stripped subperiosteal kom pom qhov nruab nrab ntawm infraspinatus fossa, lub kaum sab qis ntawm scapula, thiab qhov qis ntawm ciam teb nruab nrab.

Daim Duab 7-1-5 Txoj Kev ntawm kev nthuav tawm ntawm dorsal scapular

(1) kev txiav; (2) kev txiav ntawm cov leeg nqaij; (3) txiav cov leeg nqaij deltoid ntawm cov pob txha scapular; (4) tsa cov leeg nqaij deltoid kom pom cov infraspinatus thiab teres minor; (5) tshem cov leeg nqaij infraspinatus kom pom cov dorsal ntawm scapula nrog cov hlab ntsha anastomosis.

6. Yog tias qhov subscapular fossa yuav tsum tau nthuav tawm, cov leeg nqaij uas txuas nrog txheej sab hauv ntawm ciam teb medial, piv txwv li, scapularis, rhomboids thiab serratus anterior, yuav tsum tau tev tawm tib lub sijhawm, thiab tag nrho scapula tuaj yeem raug tsa mus rau sab nraud. Thaum tso ciam teb medial, yuav tsum tau ceev faj kom tiv thaiv ceg ntawm transverse carotid artery thiab dorsal scapular nerve. Ceg ntawm transverse carotid artery pib los ntawm lub cev caj dab thyroid thiab mus ncig los ntawm lub kaum sab saud ntawm scapula mus rau lub kaum sab qis ntawm scapula ntawm scapularis tenuissimus, cov leeg rhomboid thiab cov leeg rhomboid, thiab rotator scapulae artery tsim cov vascular network nplua nuj hauv dorsal ntawm scapula, yog li nws yuav tsum tau lo rau ntawm qhov chaw ntawm pob txha rau qhov subperiosteal peeling.