顺行肱骨髓内钉进钉点定位的应用解剖学

The entry point in antegrade humeral nailing: An anatomic study

目的研究适合中国人群的顺行肱骨髓内钉进钉点。方法 （1）成年新鲜冰冻肩部标本8例,解剖观测腋神经、旋肱前、后动脉、肱二头肌长头腱、肩胛上神经、肩胛上动脉与参考进钉点的距离,确定相对安全区域;（2）肱骨干标本60例,随机分成6组,在相对安全区行模拟打钉和影像学检测,从而确定理想进钉点。结果进钉点相对安全区域为肱二头肌长头腱后方及冈上肌肌腱内侧的肱骨头软骨面上。理想进钉点位于肱二头肌长头腱后方（12.12±0.68）mm（11.69-13.57mm）,冈上肌肌腱内侧8.5mm。结论在顺行肱骨髓内钉植入术中,理想进钉点的确定利于手术顺利进行,减少术后并发症。

Objective To investigate the entry point in antegrade humeral nailing for Chinese population. Methods（1）the relatively safe area was obtained though observation and the distance between the axillary nerve, anterior humeral circumflex artery, post humeral circumflex artery,long head of the biceps tendons, suprascapular nerve, suprascapular artery and the reference entry point on 8 fresh- frozen shoulder joints were measured;（2）the correct entry point was localized though insertion of a nail in simulated surgery on 60 humeri, which were divided equally into 6 groups. Results The relative safe area was located behind the long head of the biceps tendons and medial the supraspinatus tendon. The distance between the correct entry point and supraspinatus tendon was 8.5 mm; Distance between the correct entry point to the long head of the biceps tendons was（12.12 ± 0.68）mm（11.69-13.57mm）. Conclusions It is important to obtain a correct entry point,which can not only improve the accuracy in inserting the humeral nailing, but also reduce the postoperative complications.