改良肘关节前内侧过顶入路显露冠突骨折的解剖学研究  

Anatomical research on improved anteromedial elbow over-the-top approach to ulnar coronoid process fractures

作　　者：陈红卫[1] 杨新东[2] 吴国林[1] 

机构地区：[1]浙江省义乌市中心医院,浙江义乌322000 [2]温州医科大学,浙江温州325035

出　　处：《中医正骨》2017年第6期8-11,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省科技厅项目(2013C33216);浙江省卫生厅项目(2014KYB296);义乌市科技攻关项目(2013-G3-02)

摘　　要：目的:探讨经改良肘关节前内侧过顶入路显露冠突骨折的解剖学基础。方法:对20具成人上肢标本进行解剖学测量,男12具、女8具。在浅层,将肱骨内上髁标记为A,将内、外上髁连线与正中神经内侧缘交点标记为B,测量AB的长度。在中层,将正中神经旋前圆肌支的分叉点标记为D,将其入肌点标记为E,测量AD、AE的长度。将尺动脉与尺神经的交点标记为C,测量AC、BC的长度。将尺侧返动脉前支在尺动脉的分叉点标记为F,测量AF、BF的长度。在深层,将冠突顶点标记为O,将关节面平面与尺侧副韧带外侧缘交点标记为M,测量AM、OM的长度。结果:AB长度为(10.37±2.67)cm,BC长度为(10.19±2.57)cm,AC长度为(3.03±0.84)cm,AD长度为(3.53±1.55)cm,AE长度为(4.61±1.55)cm,AF长度为(4.96±1.74)cm,BF长度为(4.51±1.56)cm,AM长度为(2.75±0.57)cm,OM长度为(1.59±0.26)cm,肱肌附着点到冠突的距离为(1.56±0.93)cm。在肌组织深层可建立ABC和ABF 2个三角形安全区,其中ABC区域由正中神经中段、尺动脉下段与尺神经构成,在结扎尺侧返动脉前支后该区域是显露冠突的相对安全区域;ABF区域除支配屈肌群的部分正中神经分支外,并无其他重要神经、血管,为显露冠突的绝对安全区域。结论:经改良肘关节前内侧过顶入路能很好地暴露冠突,有足够的安全区域进行冠突骨折的手术,是一种安全的手术入路。Objective： To explore the anatomical basis of improved anteromedial elbow over-the-top approach to ulnar coronoid process fractures. Methods： Twenty adult cadaveric upper limb specimens（ 12 males and 8 females） were selected and their anatomical parameters were measured. At the level of superficial layer,the medial epicondyle of humerus was labelled as A,and the intersection of the line from medial epicondyle to lateral epicondyle and the inner margin of median nerve was labelled as B. The distance between A and B was measured. At the level of medio-layer,the bifurcation point of pronator teres branch of median nerve was labelled as D and its entering muscle point was labelled as E. The distance between A and D and the distance between A and E were measured. The intersection of ulnar artery and ulnar nerve was labelled as C,and the distance between A and C and the distance between B and C were measured. The bifurcation point of ramus anterior arteriae recurrentis ulnaris of ulnar artery was labelled as F,and the distance between A and F and the distance between B and F were measured. At the level of deep layer,the culminated point of coronoid process was labelled as O,and the intersection point of articular surface and lateral margin of ulnar collateral ligament was labelled as M. The distance between A and M and the distance between O and M were measured. Results： The length of line segment AB,BC,AC,AD,AE,AF,BF,AM and OM were 10. 37 ＋/-2. 67 cm,10. 19 ＋/-2. 57 cm,3. 03 ＋/-0. 84 cm,3. 53 ＋/-1. 55 cm,4. 61 ＋/-1. 55 cm,4. 96 ＋/-1. 74 cm,4. 51 ＋/-1. 56 cm,2. 75 ＋/-0. 57 cm and 1. 59 ＋/-0. 26 cm respectively,and the distance from attachment point of brachialis to coronoid process was 1. 56 ＋/-0. 93 cm. Two triangular safety zones（ ABC and ABF） could be build up in the deep layer of muscular tissues. The sides of triangle ABC consist of midpiece of median nerve,inferior segment of ulnar artery and ulnar nerve. The ABC zone was the relatively safe zone for exposing ulnar coronoid proce

关 键 词：肘关节 冠突 手术入路 尸体解剖 

分 类 号：R322.7[医药卫生—人体解剖和组织胚胎学] R687[医药卫生—基础医学]