前侧入路LCP微创技术治疗肱骨干骨折中螺钉危险区的解剖学研究  

Anatomical study of the danger zone for locking screw placement in minimally invasive plate osteosynthesis of humeral shaft fractures by anterior approach using LCP

作　　者：万曲桥[1] 杨胜武[2] 徐刚[1] 金亚平[1] 金林海 黄浩新[1] 

机构地区：[1]温州医科大学附属乐清医院,温州325600 [2]温州医科大学附属第一医院

出　　处：《浙江创伤外科》2014年第1期22-26,共5页Zhejiang Journal of Traumatic Surgery

基　　金：温州市医药卫生科研项目(2012B037)

摘　　要：目的通过实验尸体解剖研究,明确前侧入路LCP微创技术治疗肱骨干骨折中螺钉危险区。方法通过对12具成人尸体上肢标本行前侧入路LCP微创技术固定肱骨干,经皮行肱骨双皮质螺钉固定,解剖测量各螺钉与肌皮神经和桡神经的距离,确认损伤神经的危险螺钉,明确经皮螺钉固定在肱骨前侧入路的危险区域。结果肱骨前方肌皮神损伤的危险区域在在肱骨外上髁上(9.1±1.8)cm。危险螺钉位置换算成对应肱骨长度百分比位在(31.8±5.9)%;双侧99%可信区间为(27.8,35.8)%;肱骨后方桡神损伤的危险区域在肱骨外上髁上(13.9±1.6)cm。危险螺钉位置换算成对应肱骨长度百分比位在(48.8±5.8)%;双侧99%可信区间为(46.2,51.4)%。结论经前路锁定接骨板MIPO技术固定肱骨的安全性好,但该技术存在特定区域的螺钉对肌皮神经和桡神经造成医源性损伤是有可能的,对螺钉危险区域的认识,能指导临床应用,可进一步减少相应神经的医源性损伤。Objective To identify the danger zone of the minimally invasive plate osteosynthesis （MIPO） technique in the treatment of humeral shaft fractures using locking compression plate （LCP） by anterior approach. Methods This study was performed on 24 arms from 12 adult cadavers. Each arm was fixed with 11-hole LCP by MIPO technique, then the arms were dissected both anterior and posterior to identify museulocutaneous and radial nerve injuries. The distances between the screws and the musculocutaneous or radial nerve were measured to identify the danger zone by anterior approach. Results The danger zone for the musculocutaneous nerve averaged 31.8＋5.9% of the humeral length from the lateral epieondyle, 99% Confideneelnterval （27.8, 35.8）%. The danger zone for the radial nerve averaged 48.8＋5.8% of the humeral length from the lateral epicondyle, 99% Confidence Interval （46.2, 51.4）%. Conclusion From this eadaveric study, the danger zone could be determined as a percentage of humeral length, then the nerve injury could be avoided through the operation.

关 键 词：肱骨干骨折 微创接骨板技术(MIPO) 肌皮神经损伤 桡神经损伤 应用解剖学 

分 类 号：R687.3[医药卫生—骨科学]