肘关节镜三种远端前外侧入路对周围神经损伤风险比较  

A comparison of risk of three distal anterolateral portals to injury peripheral nerve by elbow arthroscopy

作　　者：季贵柱 汪武祥 曾亚兰 陈松 李嘉宇 杨洪彬 Ji Guizhu;Wang Wuxiang;Zeng Yalan;Chen Song;Li Jiayu;Yang Hongbin(Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院骨与关节外科,泸州646000

出　　处：《解剖学杂志》2022年第5期453-455,484,共4页Chinese Journal of Anatomy

摘　　要：目的:比较肘关节镜3种远端前外侧入路穿刺后对前臂外侧皮神经及桡神经(深支)的影响。方法:选用新鲜冰冻的成人肘关节标本,关节镜下对3种入针点(肱骨外上髁远端3 cm,前方1 cm;肱骨外上髁远端2 cm,前方2 cm;肱骨外上髁远端1 cm,前方1 cm)进行定位、穿刺克氏针,并在肘关节屈曲90°时,解剖、测量与前臂外侧皮神经及桡神经(深支)的最短距离。结果:3种入路距前臂外侧皮神经的最短距离分别为(18.51±2.07)mm、(19.14±1.53)mm、(21.95±1.83)mm,距桡神经(深支)的最短距离分别为(7.18±1.17)mm、(7.59±0.88)mm、(9.22±1.51)mm。后一入路点(肱骨外上髁远端1 cm,前方1 cm)距2条神经的距离为最短,且与前2者的差异具有统计学意义。结论:肘关节镜前外侧入路(肱骨外上髁远端1 cm,前方1 cm)距前臂外侧皮神经及桡神经(深支)的最短距离最远,建立远端前外侧入路时选此入路穿刺比较安全。Objective:To compare the surgical risks of three distal anterolateral portal sites for elbow arthroscopy to the lateral forearm cutaneous nerve and the radial nerve.Methods:On fresh frozen adult elbow joint specimens,three portal sites(3 cm distal and 1 cm anterior to the lateral humeral epicondyle;2 cm distal and 2 cm anterior to it;1 cm distal and 1 cm anterior to it) were located under arthroscopy and punctured with K-wires.The shortest distances from the K-wires to the lateral forearm cutaneous nerve and the radial nerve(deep branch) were measured when elbow was in 90°flexion.Results:The shortest distance between the three portal sites and the lateral forearm cutaneous nerve were(18.51±2.07) mm,(19.14±1.53) mm,and(21.95±1.83) mm,respectively.For the radial nerve,they were(7.18±1.17) mm,(7.59±0.88) mm,and(9.22±1.51) mm,respectively.The last portal site(1 cm distal and 1 cm anterior to the lateral humeral epicondyle) was significantly closer to both nerves than the other two portal sites.Conclusion:Of the three portal sites studied,the anterolateral one(1 cm distal and 1 cm anterior to the lateral humeral epicondyle) gave the longest distance from the lateral forearm cutaneous nerve and the radial nerve(deep branch).Therefore,it is a safer option for the distal anterolateral approach under elbow arthroscopy.

关 键 词：肘关节镜 远端前外侧入路 前臂外侧皮神经 桡神经 

分 类 号：R687.4[医药卫生—骨科学]