臂部外固定支架的置钉点与桡神经和腋神经的安全范围  

The nail placement point and safety range of radial and axillary nerves for arm external fixation

作　　者：伍萍珍 熊征豪 邵剑青 石远伟 周丽华 王东[1] WU Ping-zhen;XIONG Zheng-hao;SHAO Jian-qing;SHI Yuan-wei;ZHOU Li-hu;WANG Dong(Department of Microsurgery and Trauma Orthopedics,The Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen,Guangdong Province 518107,China;School of Medicine,Sun Yat-sen University,Shenzhen,Guangdong Province 518107,China;Zhongshan School of Medicine,Sun Yat-sen University,Guangzhou,Guangdong Province 510080,China)

机构地区：[1]中山大学附属第七医院显微创伤骨科,广东深圳518107 [2]中山大学医学院,广东深圳518107 [3]中山大学中山医学院,广东广州510080

出　　处：《解剖学研究》2023年第6期505-510,共6页Anatomy Research

基　　金：国家自然科学基金(82171369);广东省科技计划项目“国际科技合作领域”(2021A0505030086)。

摘　　要：目的 观察成年男性外支架置钉点与臂部桡神经及腋神经行程的解剖关系,探讨制定置钉点的安全范围。方法 成年男性尸体26具,按身高分为150~160 cm组(A组)和161~170 cm组(B组)。设定肱骨外上髁与大结节连线为臂外侧线、内上髁与喙突连线为臂内侧线、肩峰与尺骨鹰嘴连线为臂后线,解剖暴露臂部腋神经和桡神经全程;找到其与3条线的垂直交点,测量骨性标志与神经交点的垂直距离,计算肱骨上、中、下段置钉的安全范围。结果 A、B组肱骨外上髁至桡神经近端距离分别为(13.7±1.36)cm和(13.4±1.27)cm,肱骨外上髁至桡神经远端的距离(7.7±0.98)cm和(7.5±0.90)cm,肩峰顶点至腋神经后支的距离为(6.4±0.70)cm和(7.1±0.94)cm,肱骨内上髁距离桡神经近端的距离分别为(20.4±1.36)cm和(21.4±1.35)cm。A、B组于肱骨上、中、下段外固定置钉的安全距离分别为身高的2.2%~6.0%、2.5%~6.7%(上段),3.1%~5.0%、3.0%~4.4%(中段),3.9%~6.5%、3.4%~6.0%(下段)。结论 应用外固定支架治疗肱骨骨折时,不仅参照腋神经和桡神经的安全范围的绝对值,还要考虑身高的影响,采用安全距离占身高百分比的相对值可能更精准。Objective In order to guide the protection of the radial and axillary nerve protection during the operation of adult male humeral external fixation stent placement,the study explores the anatomical relationship among the humerus,the radial and axillary nerves in the arm.To apply the safe zone for the clinical practice.Meth⁃ods Twenty six adult male cadavers,divided into 150-160 cm group(group A)and 161-170 cm group(group B)according to height.The bony landmarks the humerus,scapula and the ulna bones were marked with letters.Three artificial lines were defined as the lateral line between the lateral epicondyle and the greater tubercle of the humerus,the posterior line between the acromion and the apex of the olecranon of the ulna,and the medial line between the medial epicondyle of the humerus and the most medial border of the radial nerve behind the axillary artery in the axil⁃lary fossa.The cross sites of the axillary and radial nerve passages with above three lines were marked with different letters.The shortest distance of the cross sites with the three lines were measured.The safe zones of the stent place⁃ment were calculated and statistically analyzed.Results In group A and group B,the distances from the external epigondyle of humerus to the proximal end of the radial nerve were(13.7±1.36)cm and(13.4±1.27)cm,respec⁃tively.The distances from the external epigondyle of humerus to the distal end of the radial nerve were(7.7±0.98)cm and(7.5±0.90)cm,and the distances from the shoulder crest point to the posterior branch of the axillary nerve were(6.4±0.70)and(7.1±0.94)cm,respectively.The distance between the medial epicondyle of the humerus and the proximal end of the radial nerve was(20.4±1.36)cm and(21.4±1.35)cm,respectively.The safe distance of ex⁃ternal fixation in the upper,middle and lower humerus segments of group A and B was 2.2%-6.0%,2.5%-6.7%(upper segment),3.1%-5.0%,3.0%-4.4%(middle segment),3.9%-6.5%,3.4%-6.0%(lower segment),re⁃spectively.Conclusion This study showed the safe zone

关 键 词：桡神经 腋神经 肱骨骨折 外固定支架 安全距离 

分 类 号：R68[医药卫生—骨科学]