桡神经移位术在肱骨干骨折内固定中的应用解剖学研究

Applied Anatomical Study of Radial Nerve Transfer on Internal Fixation of Fracture of Humerus

目的:通过对桡神经的解剖观测,为桡神经移位术和肱骨中下段骨折内固定的顺利实施及避免桡神经术中和术后取内固定物时再损伤提供解剖学依据。方法:对15具10%福尔马林固定的成人男性尸体30侧上肢桡神经的走行进行了解剖观察与测量,同时对100侧干燥肱骨的桡神经沟长度及桡神经走行的角度(桡神经沟与肱骨纵轴夹角)进行观测,并将其结果进行统计学处理后应用于桡神经移位术的方案设计及实施。结果:①骨标本测量:桡神经沟长度左侧为56.52mm±10.13mm(43.82mm^7568mm),右侧65.74mm±5.80mm(55.42mm^78.82mm)。桡神经走行的角度左侧为13.00°±1.08°(10.00°~13.50°);右侧13.86°±0.97°(10.50°~14.50°)。②尸体标本观察,桡神经走行中的角度:桡神经在桡神经沟内由内上斜向外下方,穿过外侧肌间隔后行向内下方,形成向内开放的钝角。角度明显29侧占96.67%;不明显1侧,占3.33%。③从桡神经出口到桡神经分叉的距离(弧距)为14.26cm±1.01cm(12.80cm^19.20cm)。④临床56例行桡神经移位后骨折内固定,骨折全部愈合,无桡神经损伤等并发症。结论:桡神经移位术设计合理,减少桡神经再损伤的发生。

Objective: Through the anatomical observe and measurement on middle and distal humeral and radial nerve, the radial nerve transfer operation and the internal fixation of middle and distal humerus were carried on. Provide anatomical foundation for avoiding reinjury in operation and post operation while taking the internal fixation substance out. A new surgical method has been designed. Methods: Rradial nerve’s stretching branch in 30 upper climbs were observed and measured on 15 adults fixed in10% formalin.The anatomical structures of humerus of one hundred specimens were also observed.This data were made use of designing and performing the radial transfer operation after statistical analyzing. Results: The length of sulcus for radial nerve: the left side was 56.52±10.13mm(43.82~75.68mm), and the right side 65.74±5.80mm(55.42~78.82mm). The stretch angle of radial nerve: the left was 13.00°±1.08° (10.00°~13.50°), the right 13.86°±0.97° (10.50°~14.50°). The stretch angle of radial nerve: The radial nerve in the sulcus for radial nerve went from superomidial region to lateral lower region and the angle open to the inner part was formed. The angle is obvious in 29 sides, that is 96.67%, and not obvious only in 1 side, that is 3.33%. The curve distance between the exit of radial nerve and the branches is 14.26cm±1.01cm(12.80cm^19.20cm). The effects were satisfactory for 56 patients performed this operation. The fracture healed completely and there was no complication. Conclusion: The design of radial nerve transfer operation isreasonable. It reduces the injury of the radial nerve.