前臂骨间背侧神经的解剖学研究及临床应用

Anatomical study of the posterior interosseous nerve

目的 为减少前臂骨间背侧神经 (posteriorinterosseousnerveofforearm ,PINOF)的损伤提供解剖学资料 ,并探讨手术安全性。 方法 在 30具 (6 0例 )成人尸体上 ,通过肘关节外侧切口 ,在桡骨近端后外侧或外侧面 ,放置 1块 4cm长的微型钢板。对PINOF的起点和该神经与微型钢板的关系等进行观测。 结果 PINOF起点距桡骨头上缘的距离为 (1.1± 1.8)mm。桡侧腕长伸肌肌支发出点距桡骨头上缘的距离为 (6 .2± 1.9)mm。 5 6例 (93% )PINOF至微型钢板的距离为(5 .0± 1.1)mm ,4例 (7% )PINOF通过微型钢板远端的上方进入旋后肌。前臂旋前位时 ,PINOF离开该切口 ,向内侧移动的距离为 (10 .0± 1.3)mm。应用改良式预弯微型钢板治疗桡骨头粉碎性骨折 11例 ,伴发外伤性和术中牵拉造成PINOF损伤各 1例。 11例均获随访 ,平均随访 2 5个月 ,2例PINOF损伤完全恢复 ,平均恢复时间 2 .8个月。 结论 采用肘关节外侧切口时 ,在桡骨近端的外侧面或后外侧面 ,距离桡骨头上缘 3.5cm的范围内 ,是放置微型钢板的安全区。

Objective To provide an anatomical description of the posterior interosseous nerve of forearm (PINOF) in order to reduce injury risk during operation. Methods In 60 specimens from 30 adult cadavers, a steel miniplate was placed on posterolateral or lateral aspect proximal to the end of the radius by the lateral approach. The PINOF and the relationship of the nerve with the steel miniplate were observed. Results The average distance of the PINOF between its origin and the radial head was (1.1±1.8) mm. The takeoff of the musculus extensor carpi radialis longus was located (6.2±1.9) mm proximal to the radial head. In 56 cases (93%), the distance from the PINOF to the steel miniplate was (5.0±1.1) mm. However, in 4 cases (7%), the nerve passed over the distal end of the steel miniplate within the supinator. Then the PINOF moves medially about (10.0±1.3) mm and away from the surgical approach. Of all, 11 cases were operated on to fix comminuted fractures of the radial head with a bending steel miniplate. In 2 cases, the PINOF was injured due to trauma and over retraction by retractor respectively. The average period for follow up in 11 cases was 25 months; 2 cases recovered with an average recovery time of 2.8 months. Conclusions The posterolateral or lateral aspect of proximal end of the radius, and distal end of the aspect within 3.5 cm to the radial head are the safe zones for a steel miniplate fixation of radial head and neck fractures, which cause very little injury of the PINOF.