肘关节前方入路切口“安全区域”的解剖学研究

Anatomic research on the ＂safe zone＂ of anterior approach of elbow

目的：解剖学观察肱二头肌腱和前臂内、外侧皮神经之间的解剖位置关系，为肘关节前方入路手术切口设计提供理论依据。方法解剖30例成人肘关节标本，均无外伤、畸形、肿瘤、骨折。其中新鲜冰冻标本8例（性别不详，左5例、右3例），经10%甲醛溶液浸泡的标本22例（男12例、女10例，左11例、右11例）。仔细观察肘关节前方的肱二头肌腱和前臂内、外侧皮神经，并测量前臂内、外侧皮神经穿出深筋膜的位置，及其与肱二头肌肌腱之间的解剖位置关系。结果前臂外侧皮神经走行于肘关节的前方偏桡侧，与肱二头肌腱相毗邻，在肱骨外上髁平面下方（20.5±2.5）mm处穿出深筋膜，穿出点与肱二头肌腱桡侧缘之间的水平距离为（12.6±0.9）mm；前臂内侧皮神经沿肱动脉下行，在肱骨内上髁上方约5 cm 处穿出深筋膜，在肱骨内上髁平面处，后支与肱二头肌腱尺侧缘之间的水平距离为（33.1±2.7）mm。两者之间的安全宽度约为40 mm。结论距肱二头肌腱两侧缘之间约40 mm 的宽度为肘关节前方入路的相对安全区域，以肱二头肌腱为参照设计切口，可以减少医源性前臂内、外侧皮神经损伤的发生。

Objective To research the anatomical relationship of the anterior approach of elbow among lateral antebrachial cutaneous nerve, the medial antebrachial cutaneous nerve and the biceps tendon, to provide a theoretical basis for the anterior approach of elbow. Methods Thirty adult elbow specimens without scar, malformation, tumour and fracture, including 8 fresh frozen and 22 formaldehyded specimens, were dissected. The lateral antebrachial cutaneous nerve, the medial antebrachial cutaneous nerve and the biceps tendon were observed carefully. Anatomical relationship was measured among the lateral antebrachial cutaneous nerve, the medial antebrachial cutaneous nerve, and the biceps tendon. Results The lateral antebrachial cutaneous nerve is adjacent to the biceps tendon, at the radial side of the forearm. The distance between the level of the nerve that passes through the deep fascia and the lateral epicondyle of humerus was （20. 5 ± 2. 5） mm at the below of lateral epicondyle. The distance between lateral antebrachial cutaneous nerve and radial edge of biceps tendon was （12. 6 ± 0. 9） mm. The distance between the posterior branch of medial antebrachial cutaneous nerve and the ulnar side of biceps tendon was （33. 1 ± 2. 7） mm at the level of interior epicondyle of humerus. The safe width of the two nerve was about 40 mm. Conclusions The width of the safe area is about 40mm between the lateral and medial antebrachial cutaneous nerve. The biceps tendon is an important anatomical mark. It is a safe method to decrease the injuries of nerve through anterior elbow approach according to the biceps tendon.