肱骨近端骨折内固定相关应用解剖学研究  

Applied anatomy of the internal fixation of proximal humeral fracture

作　　者：蔡俊丰[1] 李旭[1] 刘林[1] 马敏[1] 徐贤[1] 尹峰[1] 

机构地区：[1]同济大学附属东方医院骨科,上海200120

出　　处：《中国临床解剖学杂志》2011年第3期268-271,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的为肱骨近端骨折内固定提供解剖学基础。方法成人尸体肩关节标本10具20侧。从三角肌前中部肌束间隙钝性分离游离出腋神经,将钢板插入腋神经与骨之间,固定于肱骨大结节顶点下方,结节间沟后方。测量腋神经上缘与大结节顶点、与肩峰上缘的距离。截取带钢板的肱骨近端进行体外测量并观察钢板螺钉与肱骨头颈、大结节顶点和结节间沟的关系。结果大结节顶点、肩峰上缘距腋神经距离分别为（3.44±0.38）cm和（5.44±0.62）cm;钢板上缘到肱骨大结节顶点距离为（0.59±0.14）cm,到结节间沟距离为（0.74±0.19）cm。体外观察并测量见钢板置于肱骨大结节顶点下0.5 cm,结节间沟后方0.5 cm时螺钉平行肱骨颈并位于肱骨颈中央。结论 （1）肱骨大结节下2.90~4.32 cm是容易损伤腋神经的危险区域。（2）肱骨大结节顶点下0.50 cm,结节间沟后方0.50 cm是钢板放置的最佳位置。（3）PHILOS钢板的C、D、E孔和LPHP的C、D孔是危险区域。Objective To provide anatomic basis for the internal fixation of proximal humeral fracture.Methods 20 shoulder joint specimens from 10 adult cadavers were dissected.Axillary nerves were isolated from the muscle bundle interspace of deltoid,and followed by the insertion of the plate between the nerve and humerus,under the apex of greater tuberosity and behind the intertubercular sulcus.The distances from the superior border of axillary nerve to the apex of greater tuberosity and the superior border of acromial bone were measured and analyzed.The proximal humerus connected with the plate were resected for observing the relationship of the head and neck of humerus with the plate,while,the distance from the upper border of the plate to the apex of greater tuberosity,from the anterior border of the plate to the intertubercular sulcus were measured.Results The distances from axillary nerve to the apex of greater tuberosity and the superior border of acromial bone were separately（3.44±0.38）cm and（5.44±0.62）cm;The distance from the upper border of the plate to the apex of greater tuberosity was（5.44±0.62） cm,as well from anterior border of the plate to the intertubercular sulcus（0.74±0.19） cm.The screws paralleled with the neck of humerus and located in the middle of it when the plate placed 0.5mm below the apex of greater tuberosity,and 0.5cm behind the intertubercular sulcus.Conclusions（1） The site below the greater tuberosity about 29~43.2 mm is the dangerous area for damaging axillary nerve during the anterolateral acromial approach.（2） The optimal plate inserting position is below the apex of greater tuberosity about 0.5cm,and behind the intertubercular sulcus about 0.5cm.（3） The screw holes of C,D and E of PHILOS,as well that of C and D of LPHP,are dangerous zones during the fixation approach.

关 键 词：肱骨近端骨折 应用解剖 内固定 微创外科 

分 类 号：R683.41[医药卫生—骨科学]