前臂近中段Thompson入路中桡神经深支医源性损伤的解剖学因素及对策  

Anatomic reasons for the iatrogenic injury of deep branches of radial nerve in the Thompson approach in the proximal forearm and its countermeasures

作　　者：单建林[1] 王崇伟[1] 任大江[1] 聂政[2] 

机构地区：[1]北京军区总医院骨科,北京100700 [2]成都医学院人体解剖学实验室,成都610500

出　　处：《中国临床解剖学杂志》2016年第2期130-133,137,共5页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨前臂近中段Thompson入路中容易发生桡神经深支损伤的解剖学因素并提出对策。方法教学用成人尸体标本48具,按照Thompson入路显露,观察前臂伸肌与桡神经深支及其肌支的位置关系;测量桡神经深支穿出旋后肌的位置距离桡侧腕短伸肌的横向距离;观察指伸肌和桡侧腕短伸肌在前臂近段的愈着情况,测量二者在肱桡关节线以远的愈着长度。结果指伸肌和桡侧腕短伸肌在前臂近段相愈着,愈着长度在肱桡关节以远(7.1±2.1)cm;桡神经深支在旋后肌下缘的穿出点与桡侧腕短伸肌尺侧缘的水平距离为(1.3±0.3)cm,与肱桡关节线距离为(6.1±1.8)cm。结论前臂近中段Thompson入路中容易发生桡神经深支损伤存在着解剖学因素,了解桡神经深支的解剖特点及其与前臂伸肌的位置关系可以避免桡神经深支损伤。Objective To explore anatomic reasons for the iatrogenic injury of the deep branches of the radial nerve in the Thompson approach in the proximal forearm and propose countermeasures.Methods Forty-eight upper limbs from skeletally mature embalmed cadavers were studied. After Thompson approach was performed, the anatomic relationships of forearm extensor to the deep branches of radial nerve was observed. The transverse distance between the ulnar edge of the extensor carpi radialis brevis and the point where the deep branch of radial nerve exits from the supinator was measured, the fusing condition of the extensor digitorum communis with the extensor carpi radialis brevis at proximal forearm was observed, and the length of its fusion was measured. Results extensor digitorum communis and the extensor carpi radialis brevis fused at the proximal forearm, approximately（7.1±2.1）cm distally from the humeroradial joint.The transverse distance between the ulnar edge of the extensor carpi radialis brevis and the point where the deep branch of radial nerve exits from the supinator was（1.3 ± 0.3）cm, and the distance between the humeroradial joint and this point was（6.1 ± 1.8）cm. Conclusion There are anatomic reasons for the profound branches of radial nerve to be vulnerable to being injured during the Thompson approach. Its anatomic features and location relationship with other structures of forearm can be used to avoid iatrogenic injury.

关 键 词：Thompson入路 桡神经深支 应用解剖 

分 类 号：R323.71[医药卫生—人体解剖和组织胚胎学] R322.85[医药卫生—基础医学]