桡骨交锁髓内钉近端锁钉3种不同入路与桡神经深支的关系  

Relation of the posterior interosseous nerve with locking screw insertion site in locked intramedullary nail of radius through three approaches

作　　者：赵洪[1] 郑祖根 严军[1] 言湛军[1] 

机构地区：[1]苏州大学附属二院骨科,江苏苏州215004

出　　处：《中国临床解剖学杂志》2004年第4期350-352,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:研究桡骨交锁髓内钉近端锁钉在3种不同入路的情况下与桡神经深支的解剖关系,确定安全入路及桡神经深支的安全区域。方法:将9个成人上肢标本随机分成3组,按照标准锁钉方法(距肱桡关节面1.5cm),在不暴露桡神经深支的情况下分别于前臂过度旋前位、中立位和过度旋后位从前侧入路、外侧入路和后侧入路拧入近端锁钉。然后解剖出桡神经深支,测量和观察锁钉与桡神经深支的关系。结果:本组有2例桡神经深支损伤,其中1例在前臂中立位,后侧入路锁钉拧破对侧皮质所致。在前臂中立位,外侧入路锁钉与桡神经深支的最短距离为8.9mm。并且在外侧入路前臂过度旋前时,桡神经深支跨越桡骨干轴线距离肱桡关节面的最短距离为37mm,平均为50.8mm。结论:桡骨交锁髓内钉近端锁钉于前臂过度旋前位,从外侧入路进钉损伤桡神经深支的可能性较小。其进钉的安全区域为离肱桡关节面3cm以内。Objective:To assess the relation of the posterior interosseous nerve (PIN) to the locking screw insertion site in locked intramedullary nail of radius from a standard anterior, posterolateral and posterior approach. Methods: 9 fresh anatomic specimen arms were divided into 3 groups.After a standard anterior(Henry incision),posterolateral(Tompson incision)and posterior(Boyd incision)approach, blind subperiosteal dissection was performed distally until standard proximal locking screw was inserted. Dissection of the radial nerve was performed. Results: In only two (22.2%) arm did the posterior interosseous nerve be injuried ,one of them was endangered as the screw exits the far cortex in neutral position from posterior approach .The minimum distance between the screw and the PIN was 8.9 mm with the forearm in neutral position from posterolateral approach. The PIN crossed the mid-axis of the radius at a minimum of 37 mm and an average of 50.8 mm in 90°of pronation. Conclusions: Insertion a proximal locking screw from a directly posterolateral approach with the forearm in 90°pronation offers the least chance of injuring the PIN.

关 键 词：桡神经深支 交锁髓内钉 桡骨 

分 类 号：R322.71[医药卫生—人体解剖和组织胚胎学] R681.7[医药卫生—基础医学]