Perkütan uygulanan kilitli proksimal humerus plağı ve aksiller sinir arasındaki ilişki: Kadavra çalışması

Öz

Amaç: Bu çalışmamızda perkütan plak yerleşimi sırasında aksiller sinir hasarlanma riskini ve aksiller sinir ile plak delikleri arasındaki ilişkiyi araştırmayı amaçladık.

Çalışma planı: Yirmi beş taze donmuş kadavranın 50 omuzu çalışmaya dahil edildi. Akromionun anterolateral köşesinden kola inen 5 cm bir kesi yapıldı. Beş delikli 3,5 mm proksimal humerus plağı yerleştirildi. Sonrasında aksiller sinir diseke edildi. Aksiller sinire gelen plak delikleri not edildi. Aksiller sinir ile akromiyon lateral köşesi arası mesafe ve kol uzunluğu ölçüldü. Aralarındaki ilişki korelasyon testi ile değerlendirildi.

Bulgular: Ortalama kol uzunluğu 319 mm idi. Aksiller sinir ile akromion lateral köşesi arası mesafe ortalama 60 mm idi. Kol uzunluğu ile akromion-aksiller sinir mesafesi arasında belirgin korelasyon vardı (pÐ0.05). Bir omuz haricinde tüm omuzlarda plak deltoid fasya altına yerleştirildi. Aksiller sinir lezyonu tespit edilmedi. Bir vakada plağın alt ucu deltoid içine yerleşmişti. Plak delikleri ile aksiller sinir arasında sabit bir ilişki yoktu.

Çıkarımlar: Perkütan plak yerleştirme sırasında aksiller sinir yaralanma riski vardır. Cerrahi girişim sırasında plağın deltoidin fasyası altına yerleştirildiğinden emin olunmalıdır. Hangi deliklerin aksiller sinire karşılık geldiğinin bilinmesi imkansız olduğu için vidalama sırasında aksiller sinir görülmelidir.

Anahtar Kelimeler

• Aksiller sinir; aksiller sinir hasarı; kırık; perkütan; perkütan plak; plakla tespit; proksimal humerus; proksimal humerus kırığı.

Relationship between axillary nerve and percutaneously inserted proximal humeral locking plate: a cadaver study

Abstract

Objective: The aim of this study was to investigate the relationship between the axillary nerve and the percutaneously inserted proximal humeral locking plate and to evaluate the risk of axillary nerve injury during percutaneous plate insertion.

Methods: The study included 50 shoulders of 25 fresh frozen cadavers. A 5 cm incision was made from the anterolateral border of the acromion to the arm and a 5-hole 3.5-mm proximal humeral plate was inserted. The axillary nerve was then dissected. Plate holes which crossed the axillary nerve were noted. The distance between the axillary nerve and the lateral edge of the acromion and the length of the arm were measured and their relations evaluated with a correlation test.

Results: The average arm length was 319 mm. The average distance between the axillary nerve and the lateral edge of the acromion was 60 mm. There was a significant correlation between the arm length and acromion-axillary nerve distance (p<0.05). The plate was inserted under the deltoid fascia in all shoulders except one. There were no axillary nerve lesions. In 1 case, the distal end of the plate was inserted in the deltoid muscle. No constant relationship between the plate holes and the axillary nerve was detected.

Conclusion: There is a risk of axillary nerve injury during percutaneous plate insertion. It must be ensured that the plate is inserted under the deltoid fascia during the surgery. The axillary nerve must be visible during application of the screws due to the impossibility of knowing which holes cross the axillary nerve.

Keywords

• Axillary nerve
• axillary nerve injury
• fracture
• percutaneous
• percutaneous plate
• plate fixation
• proximal humeral fracture
• proximal humerus

Kaynakça

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