微创治疗桡骨远端骨折时避免克氏针损伤桡神经浅支的研究  

The study of avoiding damage to the superficial radial nerve due to percutaneous K-wire fixation of the distal radius fracture

作　　者：陈一心[1] 郑欣[1] 邱勇[1] 朱亚文[2] 詹朝双[2] 董平[2] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,南京210008 [2]南京大学医学院疼痛解剖学研究室,南京210093

出　　处：《中国临床解剖学杂志》2009年第5期523-525,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的：探讨微创治疗桡骨远端骨折时避免克氏针损伤桡神经浅支的方法。方法：（1）尸体标本20例，解剖测量桡神经浅支的分布走行。（2）尸体标本18例，克氏针A由桡骨茎突尖钻入，克氏针B平行、紧贴桡-月关节面钻入；连接A、B入针点形成线段AB，克氏针C沿线段AB尽量靠近桡骨茎突尖钻入，解剖记录桡神经浅支的分布及其与各克氏针的距离。（3）47例骨折患者，采取闭合复位外固定支架固定，沿AB线尽量靠近桡骨茎突尖经皮钻人2～3枚克氏针加强固定，于术后第1周和第4周评估患者有无桡神经浅支损伤。结果：（1）桡神经浅支的一级分支R1和U1围成神经分布的盲区。（2）仅1例（5．6％）桡神经浅支被克氏针触碰移位，线段AB均位于R1和u1围成的神经盲区。克氏针A、C、B离最近的神经分支的距离分别为4．49、4．48和3．40mm。（3）2例骨折患者（4．2％）桡神经浅支被损伤。结论：沿线段AB、尽可能靠近桡骨茎突尖经皮克氏针固定桡骨远端骨折，能有效降低桡神经浅支的损伤率。Objective： To develop a reliable technique to avoid damage to the superficial radial nerve （SBRN） due to percutaneous K-wire fixation of the distal radius fracture. Materials： In Cadaver Study-1, twenty cadaver forearms were dissected to identify the SBRN distribution. In Cadaver Study-2, eighteen forearms were involved. One K-wire （K-A） was insetted percutaneously into the tip of radial styloid （TRS）, and the other （K-B） was placed into the distal radius just under the radiolunate joint. In the true anterior-posterior radiography image of the wrist, the two insertions of K-A and K-B formed a curve AB. The third K-wire （K-C） was placed along the curve AB and placed as far as possible in proximity to the TRS. The SBRN distribution and its relationship with the points of K-wire insertion were identified. In the Clinical Study, 47 patients-with unstable distal radius fracture were fixed with external fixator and augmented with 2-3 percutaneous K-wires. Over the distribution of SBRN, pain, numbness, dysesthesia and static two-point discrimination were assessed in the first and fourth week respectively after surgery. Results： In Cadaver Study-l, there is a ＂no never area ＂ for K-wiring. In Cadaver Study-2, the nerve branch was displaced by K-wire only in 1 of 18 cadavers, the curve AB was located in the ＂no never area ＂. The mean distance of the three wires （A, C, B） to the closest nerve branch was 4.49 mm, 4.48 mm, and 3.40 mm respectively. In the Clinical Study, 2 of 47 patients had reduced sensation and numbness. Conclusion： When the K-wire is placed in the curve AB and as possible as in proximity to the TRS, the injury rate of SBRN can be effectively diminished.

关 键 词：桡神经浅支 克氏针 桡骨远端骨折 神经损伤 

分 类 号：R323.71[医药卫生—人体解剖和组织胚胎学]