Dorsal Scapular Exposure Surgical Pathway

· Siv Anatomy

Nyob rau hauv pem hauv ntej ntawm lub scapula yog lub subscapular fossa, qhov twg cov nqaij subscapularis pib.Hauv qab yog sab nrauv thiab me ntsis nce mus ncig scapular ridge, uas tau muab faib ua supraspinatus fossa thiab infraspinatus fossa, rau kev txuas ntawm supraspinatus thiab infraspinatus nqaij feem.Qhov kawg ntawm lub scapular ridge yog acromion, uas tsim cov acromioclavicular sib koom nrog lub acromion kawg ntawm lub clavicle los ntawm txoj kev ntawm ib tug ntev ovoid articular nto.Qhov zoo tshaj plaws ntawm lub scapular ridge muaj ib tug me me U-shaped notch, uas yog hla los ntawm ib tug luv luv tab sis tawv transverse suprascapular ligament, nyob rau hauv uas cov hlab ntsha suprascapular hla, thiab tshaj uas cov hlab ntsha suprascapular hla.Lub lateral margin (axillary margin) ntawm lub scapular ridge yog qhov tuab tshaj plaws thiab txav mus rau sab hauv lub hauv paus ntawm lub caj dab scapular, qhov uas nws tsim ib qho glenoid notch nrog ntug ntawm glenoid ntawm lub xub pwg sib koom.

· Cov lus qhia

1. Resection ntawm benign scapular hlav.

2. Kev tshem tawm hauv zos ntawm malignant qog ntawm scapula.

3. Siab scapula thiab lwm yam deformities.

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

5. Suprascapular paj hlwb entrapment syndrome.

· Lub cev txoj hauj lwm

Semi-nrawm txoj hauj lwm, tilted ntawm 30 ° rau lub txaj.Cov ceg tawv uas raug cuam tshuam yog qhwv nrog cov phuam tsis muaj menyuam kom nws tuaj yeem txav tau txhua lub sijhawm thaum ua haujlwm.

· Cov kauj ruam ua haujlwm

1. Ib qho kev hlais feem ntau yog ua raws li lub scapular ridge nyob rau hauv lub supraspinatus fossa thiab sab sauv ntawm lub infraspinatus fossa, thiab ib tug longitudinal incision yuav ua tau raws li medial ntug ntawm lub scapula los yog nruab nrab sab ntawm lub subscapularis fossa.Cov kab sib txuas thiab qhov ntev tuaj yeem ua ke los ua ib qho L-shaped, inverted L-shape, lossis cov duab thawj-chav kawm, nyob ntawm qhov xav tau kev pom ntawm qhov sib txawv ntawm scapula.Yog tias tsuas yog lub kaum sab sauv thiab sab qis ntawm lub scapula yuav tsum raug nthuav tawm, qhov kev txiav me me tuaj yeem ua rau hauv qhov sib thooj (Daim duab 7-1-5(1)).

2. Ntxig lub ntsej muag thiab tob fascia.Cov nqaij ntshiv ntawm lub scapular ridge thiab nruab nrab ciam teb yog incised transversely los yog longitudinally nyob rau hauv cov kev taw qhia ntawm qhov incision (Fig. 7-1-5(2)).Yog hais tias lub supraspinatus fossa yuav tsum tau nthuav tawm, cov fibers ntawm nruab nrab trapezius nqaij yog incised ua ntej.Lub periosteum yog incised tiv thaiv lub pob txha nto ntawm lub scapular gonad, nrog ib tug nyias txheej ntawm cov rog ntawm ob, thiab tag nrho cov ntawm supraspinatus fossa raug nthuav tawm los ntawm subperiosteal dissection ntawm supraspinatus cov leeg, nrog rau cov overlying trapezius nqaij.Thaum incising lub Upper fibers ntawm cov leeg trapezius, yuav tsum tau saib xyuas kom tsis txhob puas cov hlab ntsha parasympathetic.

3. Thaum cov hlab ntsha suprascapular yuav tsum tau nthuav tawm, tsuas yog cov fibers ntawm nruab nrab nruab nrab ntawm cov leeg trapezius tuaj yeem rub mus rau sab saud, thiab cov leeg supraspinatus tuaj yeem maj mam rub downwards yam tsis muaj stripping, thiab cov qauv dawb ci pom pom yog suprascapular transverse. ligament.Thaum cov hlab ntsha suprascapular thiab cov hlab ntsha tau raug txheeb xyuas thiab tiv thaiv, lub suprascapular transverse ligament tuaj yeem raug txiav, thiab cov scapular notch tuaj yeem tshawb nrhiav rau cov qauv txawv txav, thiab cov hlab ntsha suprascapular tuaj yeem raug tso tawm.Thaum kawg, lub stripped trapezius nqaij yog sutured rov qab ua ke kom nws txuas mus rau lub scapula.

4. Yog hais tias lub sab sauv ntawm lub infraspinatus fossa yuav tsum tau nthuav tawm, lub qis thiab nruab nrab fibers ntawm cov leeg trapezius thiab cov leeg deltoid tuaj yeem raug incised nyob rau hauv thaum pib ntawm lub scapular ridge thiab retracted upwards (Fig. 7-1- 5(3)), thiab tom qab cov leeg infraspinatus tau nthuav tawm, nws tuaj yeem raug tshem tawm (Daim duab 7-1-5(4)).Thaum mus txog qhov kawg ntawm qhov kawg ntawm axillary margin ntawm scapular gonad (piv txwv li, hauv qab ntawm glenoid), kev saib xyuas yuav tsum tau them rau cov hlab ntsha axillary thiab posterior rotator humeral artery dhau los ntawm quadrilateral foramen ncig los ntawm teres me, teres loj, lub taub hau ntev. ntawm lub triceps, thiab phais caj dab ntawm humerus, raws li zoo raws li lub rotator scapulae hlab ntsha hla los ntawm lub triangular foramen surrounded los ntawm thawj peb, thiaj li tsis ua rau raug mob rau lawv (Fig. 7-1-5(5)).

5. Txhawm rau nthuav tawm cov ciam teb nruab nrab ntawm lub scapula, tom qab incising cov fibers ntawm cov leeg trapezius, cov leeg trapezius thiab supraspinatus tau thim rov qab zoo dua thiab sab nraud los ntawm subperiosteal stripping kom nthuav tawm qhov nruab nrab ntawm supraspinatus fossa thiab sab saud ntawm tus ciam teb medial. ;Thiab cov leeg trapezius thiab infraspinatus, ua ke nrog cov leeg vastus lateralis txuas rau lub kaum sab xis ntawm lub scapula, yog subperiosteally stripped kom nthuav tawm qhov nruab nrab ntawm infraspinatus fossa, lub kaum sab xis ntawm lub scapula, thiab qis dua ntawm ciam teb nruab nrab. .

Daim duab 7-1-5 Txoj kev ntawm dorsal scapular exposure

(1) incision;(2) incision ntawm cov leeg nqaij;(3) tshem tawm cov leeg deltoid ntawm lub scapular ridge;(4) nqa cov leeg deltoid kom pom cov infraspinatus thiab teres me;(5) stripping cov leeg infraspinatus kom nthuav tawm dorsal nam ntawm scapula nrog vascular anastomosis

6. Yog hais tias lub subscapular fossa yuav tsum tau nthuav tawm, cov nqaij ntshiv uas txuas rau sab hauv ntawm cov ciam teb nruab nrab, piv txwv li, scapularis, rhomboids thiab serratus anterior, yuav tsum tau muab tshem tawm tib lub sijhawm, thiab tag nrho cov scapula tuaj yeem raug tshem tawm sab nraud.Thaum tso cov ciam teb nruab nrab, kev saib xyuas yuav tsum tau saib xyuas los tiv thaiv cov ceg qis ntawm cov hlab ntsha transverse carotid thiab dorsal scapular paj.Cov ceg qis ntawm cov hlab ntsha transverse carotid pib los ntawm cov thyroid caj dab lub cev thiab taug kev los ntawm lub kaum sab xis ntawm lub scapula mus rau lub kaum sab xis ntawm lub scapula ntawm lub scapularis tenuissimus, cov leeg rhomboid thiab cov leeg rhomboid, thiab cov leeg rotator scapulae artery tsim cov hlab ntsha nplua nuj. network nyob rau hauv lub dorsal ib feem ntawm lub scapula, yog li nws yuav tsum tau nruj nreem adhered rau saum npoo ntawm cov pob txha rau lub subperiosteal tev.