肱肌止点的解剖学研究及其在钢板固定尺骨冠突骨折中的应用

Anatomy of the insertion of brachialis and its implication on the fixation of coronoid process fracture

目的测量肱肌止点的相关数据,为临床准确、安全地放置冠突钢板提供解剖学依据。方法 8例正常新鲜成人肘关节标本,解剖观察肱肌止点的位置,并测量肱肌止点的长度、宽度、与内侧副韧带前束附着的间隙宽度及近端距离冠突尖的长度。结果肱肌止点大部分位于尺骨鹰嘴尖与冠突尖连线的内侧,长度为(21.79±2.70)mm,分深浅两头:浅头止点为腱膜组织,宽度(4.11±1.12)mm;而深头止点由两侧的腱膜和中间的肌肉构成,宽度(11.25±3.07)mm。其中,桡侧腱膜宽度(1.77±0.46)mm,尺侧腱膜宽度(2.75±0.57)mm,两者夹持的肌肉宽度(6.82±2.08)mm。肱肌止点与内侧副韧带前束附着的间隙宽度(4.14±0.49)mm,近端距离冠突尖的长度(9.30±1.51)mm。结论 (1)肱肌止点与内侧副韧带前束附着的间隙可用于放置尺骨冠突钢板。(2)松解肱肌深头止点的尺侧腱膜可使该间隙的宽度达到6.89mm,继续松解中间的肌肉可达到13.71mm,足以安放冠突钢板。

Objective To explore anatomic features of the brachialis insertion and provide basis for the placement of the coronoid plate.Methods 8 normal adult fresh elbow specimens were dissected.The insertion site of brachialis,the length and width of the insertion,the distance from the insertion to the attachment of anterior bundle of medial collateral ligament,and the distance from the proximal edge of brachialis insertion to coronoid tip,were measured and analyzed respectively.Results For all cases,two brachialis insertions could be detected,which was in the medial side of the line of olecranon-coronoid tip,with the insertion length of （21.79±2.70）mm.The width of the superficial head insertion was about （4.11±1.12）mm,constituted with aponeurosis。The width of the deep head insertion was about （11.25±3.07）mm,constituted with aponeurosis and muscle.The widths of the radial and ulnar aponeurosis were （1.77±0.46）mm and （2.75± 0.57）mm respectively.The width of the muscle between two insertions was （6.82±2.08）mm.The distance from brachialis insertion to the attachment of anterior bundle of medial collateral ligament was about （4.14±0.49）mm,and the length from the proximal edge of brachialis insertion to coronoid tip was about （9.30 ±1.51）mm.Conclusions （1） The interval between the brachialis insertion and the attachment of the anterior bundle of medial collateral ligament is adaptive for coronoid plate placement.（2） The interval will be extended to 6.89mm once the the ulnar aponeurosis is released,and even reach about 13.71mm after releasing muscle between two insertions,which is enough for placing coronoid plate.