_Anatomy for Arthroscopic Anterior and Posterior 关节镜下前后的应用解剖课件.ppt

Principles and Applied Anatomy for Arthroscopic Anterior and Posterior Instability Surgery of the Shoulder Anterior and Posterior Instability of the Shoulder The loss of capsulolabral support on the anterior or posterior glenoid Anterior and Posterior Instability Principles of Arthroscopic Anterior and Posterior Instability Repairs Appropriate Portal Placement Must allow access to the inferior aspect of the anterior and posterior glenoid for capsule and labrum mobilization and suture anchor placement Anterior Inferior Portal Capsulolabral release Bone preparation For low anterior suture anchor placement (5 o’clock position) Appropriate Location of Anterior Inferior Portal Posterior Inferior Portal Capsulolabral Release Bone Preparation For Low Posterior Suture Anchor Placement (7 o’clock position) *This usually is the standard posterior portal which is 2cm inferior and medial to the posterolateral border of the acromium Posterior Inferior Portal Mobilize Anterior Capsule and Labrum Frequently, the capsule and labrum heals in a medially displaced position on the glenoid Therefore, it should be released to the 6 o’clock position to allow it to be advanced to the normal anatomic position Mobilize Anterior Capsule and Labrum Axillary Nerve Anatomy The axillary nerve may be at risk when manipulating tissue at the inferior aspect of the glenoid rim. Where is it? “Determining the Relationship of the Axillary Nerve to the Shoulder Joint Capsule from an Arthroscopic Perspective” By: M.R. Price, MD, MS, Edward D. Tillett, MD, Robert D. Acland, MD, and G. Stephen Nettleton, PhD Journal of Bone and Joint Surgery, October, 2004 Axillary Nerve Anatomy The axillary nerve is closest to the glenoid rim at the 6 o’clock position It lays about 12mm from the inferior glenoid rim and is adjacent to the capsule Axillary Nerve Anatomy Axillary Nerve Anatomy Prepare Bone for a Healing Response Bone Should be decorticated on the medial scapular neck just off the glenoid ri