肘关节前内侧入路治疗冠状突骨折的解剖学研究及临床应用  

Anteromedial elbow approach for coronoid process fractures： a cadaveric study and case report

作　　者：贺韬[1] 张云辉[1] 李亘[1] 张超[1] 董宇启[1] 

机构地区：[1]上海交通大学医学院附属仁济医院创伤骨科,200127

出　　处：《中华创伤骨科杂志》2017年第7期559-565,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的通过解剖学研究为肘关节前内侧入路治疗冠状突骨折提供解剖学参数，评价该入路的临床价值。方法收集40例成人上肢标本，解剖观察并测量与肘前内侧入路相关的主要神经的走行特点。回顾性分析2014年6月至2015年6月在解剖学研究的基础上手术治疗的10例冠状突骨折伴有肘关节脱位患者资料。男7例，女3例；年龄17～63岁，平均43岁。骨折O’Dfiscoll分型：11型2例，Ⅰ2型3例；Ⅱ型1例，Ⅱ2型3例；Ⅲ2型1例。所有患者通过肘关节前内侧切口经旋前圆肌桡侧腕屈肌入路来复位固定尺骨冠状突及探查修复内侧副韧带。末次随访时测量患肢肘关节的屈伸、旋转活动度及用Mayo肘关节评分（MEPS）来评估患者的功能情况。结果正中神经主干在肱骨内外上髁连线水平距离肱骨内上髁平均为27．34mm。旋前圆肌第1分支入肌点至冠状突尖的距离平均为13．19mm。桡侧腕屈肌入肌点至冠状突尖的距离平均为47．02mm，至肱骨内上髁的距离平均为64．40mm。所有患者术后平均随访时间12个月（6—18个月）。骨折愈合时间平均1．8个月（1．5～2．0个月）。随访期间所有患者均未出现肘关节畸形、不稳定、疼痛及肘关节功能受限。末次随访时肘关节平均屈伸度为133．0°（120°～140°），旋转度为144．5°（130°-160°），平均MEPS评分为98分（95—100分）。结论通过经旋前圆肌桡侧腕屈肌间隙的肘关节前内侧入路来复位固定冠状突骨折是安全、有效的。该入路较前侧入路不仅降低了术中损伤正中神经的风险，同时较内侧入路能更好地显露冠状突以利于骨折块的复位及固定。Objective To provide an anatomical basis for treatment of coronoid process fractures through an anteromedial elbow approach and evaluate its clinical effects. Methods Forty cadaveric specimens of adult upper limb were dissected to evaluate the anatomical relationships between the median nerve branches and the nearby muscles in the field of the anteromedial elbow approach. On the basis of the anatomical study, 10 patients with coronoid fracture were treated from June 2014 to June 2015. They were 7 males and 3 females, from 17 to 63 years of age （average, 43 years）. By the O＇Driscoll classification, there were 2 cases of type I1, 3 ones of type I2, one of type II1, 3 ones of type II2 and one of type III2. The anteromedial elbow approach through the intramuscular space between the pronator teres and the flexor carpi radialis was used to reduce and fixate the fractures of unlar coronoid process and to explore and repair the medial collateral ligaments in all the patients. The ranges of extension, flexion and rotation of the elbow joint were measured at the last follow-ups; the function of the elbow was evaluated according to Mayo elbow per- formance scores （MEPS）. Results The main branch of the median nerve ran between the lateral and the medial epicondyles of the humerus, 27.34 mm away to the medial epicondyle of the humerus. The mean distance between the first pronator teres nerve branch and the coronoid process was 13. 19 mm. The mean distance between the flexor carpi radialis nerve branch and the coronoid process was 47.02 mm. The mean distance from the medial epicondyle to the flexor carpi radialis nerve branch was 64. 40 mm. All the patients were followed up for an average of 12 months （from 6 to 18 months）. Fractures united after an average of 1.8 months （from 1.5 to 2. 0 months）. Deformity, instability, pain or limited motion of the elbow joint was not observed during the follow-ups. At the last follow-ups, the mean flexion-extension arc of the elbow was 133.0° （from 120° to 140°）, th

关 键 词：尺骨 神经 解剖研究 临床应用 

分 类 号：R687.3[医药卫生—骨科学]