肱骨前外侧手术入路与解剖

Anterolateral Approach to the Humerus and Anatomy

目的:为肱骨前外侧手术入路时避免损伤桡神经提供解剖学资料。方法:在42侧成人尸上肢标本上,根据手术进路和易损伤部位对桡神经和旋肱前动脉的行径及毗邻关系进行了观测。结果:桡神经进入桡神经管上口位于胸大肌腱止端内侧2.3±0.24cm,喙突下方10.73±0.45cm。旋肱前血管经胸大肌腱上缘上方0.66±0.03cm处横过。结论:沿胸大肌腱止端处纵行切开骨膜并将其连同胸大肌腱一同翻向内侧,可避免损伤桡神经近段(管上段);沿骨膜下向远侧分离,可避免损伤桡神经中段(管内段);沿肱肌中线分开肱肌至骨膜下,可避免损伤桡神经远段(管下段)。

Objective : In order to provide anatomical date for anterolateral approach to the humerus. Methods :The course and relation of radial nerve and anterior circumflex humeral artery were observed on 42 sides of adult cadaveric upper limbs on the basis of operational approach and vulnerable position; Results : The radial nerve which enters the upper entrance of the canal of the radial nerve wes medially 2. 3 ± 0.24cm to the pectoralis major tendon and under the coracoid process 10.73 ± 0.45cm.The anterior circumflex humeral vessels transit 0.66 ± 0.03cm above the upper border of the pectoralis major tendon. Condusions : Incising longi tudinadlly the humeral periosteam along the lateral and of the pectoralis major tendon and turmmy them medially, could avoid harming the proximal part (above the canal) of the radial nerve; stripping distally by subperiosteal could avoid harming middle part (in the canal) of the radial nerve; cutting along the midian plane of the brachialis to bone could avoid harming the distellis part (under the canal) of the radial nerve.