桡骨交锁钉固定与桡神经深支相关的解剖学特点(英文)

Radial interlocking intramedullary nailing fixation and anatomical characteristics of the deep branch of the radial nerves

背景:交锁髓内钉在治疗桡骨多段骨折、骨不连、骨质疏松性骨折上显示独特的优越性,但置入远端锁钉可能会损伤桡神经深支。目的:对桡神经深支与交锁钉内固定时的相关解剖进行分析。设计、时间及地点:观察测量实验,于2002-11/12 在苏州大学附属第二医院骨科实验室完成。材料:成人前臂尸体标本 44 侧由苏州大学解剖教研室提供。游标卡尺由振华教学仪器厂生产。方法:前臂标本 44 侧解剖显露桡神经深支,将肱骨外上髁与 Lister 结节连线和桡骨头关节面凹,关节面凹下 1.0,1.5,2.0 cm,桡神经深支穿入旋后肌平面,桡神经深支跨越桡骨平面等 6 个面的交点,依次标记为 A,B,C,D,E,F 6 个点。主要观察指标:测量关节面凹下 1.0,1.5,2.0 cm 3 个定点在屈肘前臂旋前、中立、旋后位与桡神经深支的水平距离。结果:关节面凹下 1.0,1.5,2.0 cm 3 个定点离桡神经深支的距离依次减小;进钉点选定后,在前臂按旋前、中立、旋后位顺序依次变化时,进钉点离桡神经深支的距离越来越远。结论:桡骨交锁髓内钉固定时,宜于屈肘前臂中立位,在肱骨外上髁与 Lister 结节连线上,距桡骨头关节面凹约 1.5 cm 的位置,由前臂后外侧向前内侧插入远端交锁螺丝钉较为安全。

BACKGROUND： Interlocking intramedullary nailing exhibits unique superiority in treatment of multi-segment radial fracture, bone nonunion, and osteoperotic fracture. However, distal interlocking screw placement would injury the deep branch of radial nerves. OBJECTIVE： To analyze the anatomical characteristics of the deep branch of radial nerves during radial interlocking intramedullary nailing. DESIGN, TIME AND SETTING： An observational measurement was performed at the laboratory of Department of Orthopedics, Second Affiliated Hospital of Soochow University between November and December 2002. MATERIALS： A total of 44 pieces of fresh adult cadaver forearm specimens were provided by Department of Anatomy, Soochow University, China. A vernier caliper was purchased from Henan Yuanyang Zhenhua Instrument Factory, China. METHODS： The deep branches of radial nerve of 44 fresh forearm specimens were exposed. The lateral epicondyle of humerus was joined to the Lister tubercle of radius. The line passed through 6 horizontal planes, which were as follows in sequence： 0, 1.0, 1.5, and 2.0 cm lower than the articular surface of radial head respectively, the horizontal planes of the deep branch of radial nerve entering the supinator and winding across the radius. The crossed points were named points A, B, C, D, E, and F accordingly. MAIN OUTCOME MEASURES： The distance between the deep branch of radial nerve and fixed points B, C, and D was measured separately when the forearm was kept in pronation, neutral and supination positions. RESULTS： The distance between the deep branch of radial nerve and fixed points B, C, D became nearer and nearer in the sequence of B, C, and D. With the forearm in pronation, neutral and supination positions in sequence, each fixed point became farther and farther from the deep branch of radial nerve. CONCLUSION： When interlocking intramedullary nailing is used to fix radius, it is relatively safe to keep the forearm in neutral and flexion positions, and drilling and insertion of distal interlocking screw at 1.5 cm lower the articular surface of radial head from the posterolateral to anteromedial approach should be selected.