肱骨近端骨折手术安全区的解剖学研究和临床意义

Anatomic measurement and clinic significance of the surgery safe zone for processing the proximal humeral fractures

目的测量旋肱前动脉和腋神经解剖学数据,为寻求肱骨近端骨折手术安全区提供必要的解剖学依据。方法 20具成人尸体标本,用游标卡尺测量肱骨近端旋肱前动脉、腋神经相对于手术切口和骨性标志的距离。结果肩峰锁骨端下缘与旋肱前动脉上缘垂直距离为（5.1±0.2）cm（4.6~5.5 cm）、小结节顶点与旋肱前动脉上缘垂直距离为（2.5±0.2）cm（2.0~3.0 cm）、旋肱前动脉的横径为（2.6±0.2）mm（2.2~3.1 mm）、旋肱前动脉与肱骨干长轴的夹角为（14±4）°（5~22°）、肩峰前下缘与腋神经上缘的垂直距离为（6.3±0.5）cm（5.2~7.0 cm）、大结节顶点与腋神经上缘的垂直距离为（3.5±0.2）cm（3.2~4.1 cm）、腋神经与肱骨干长轴垂线的夹角为（22±7）°（8~37°）、三角肌前外1/3间隙处腋神经横径为（4.2±0.8）mm（3.7~5.5 mm）。结论本研究得出了旋肱前动脉和腋神经上方相对于手术切口和骨性标志的安全区,以避免在肱骨近端骨折手术时损伤旋肱前动脉和腋神经。

Objective To explore anatomic features of the anterior humeral circumflex artery and axillary nerve,and provide clinic reference for processing safely the proximal humerus fracture.Methods 20 healthy adult upper limb specimens were used in this study.The distances from the anterior humeral circumflex artery and axillary nerve to the operative incision and the special bony landmarks were measured respectively.Results The vertical distance between the undersurface of the tip of acromion next to clavicle and the superior border of the anterior humeral circumflex artery was（5.1±0.2）cm（4.6~5.5 cm）,and the distance between the prominence of small tuberosity and the superior border of anterior humeral circumflex artery（2.5±0.2）cm（2.0~3.0 cm）.The internal diameter of anterior humeral circumflex artery was（2.6±0.2）mm（2.2~3.1 mm）,and the obliquity of anterior humeral circumflex artery with the vertical axis of the humerus was（14±4）°（5~22°）.The distance between the anterior-inferior border of acromion and the superior border of axillary nerve was（6.3±0.5）cm（5.2~7.0cm）,and the distance between the prominence of greater tuberosity and the superior edge of axillary nerve（3.5±0.2）cm（3.2~4.1 cm）.The obliquity of the the axillary nerve with the vertical axis of humerus was（22±7）°（8~37°）.The transverse diameter of axillary nerve at the anterolateral 1/3 space of deltoid muscle was（4.2±0.8）mm（3.7~5.5mm）,respectively.Conclusions The present study shows the safe area above the anterior humeral circumflex artery and the axillary nerve,with the incision and the bone landmarks.Using the safe area should avoid damaging the anterior humeral circumflex artery and the axillary nerve during the proximal humerus fracture operations.