尺骨头进针固定尺骨的解剖及临床应用研究

Anatomic and clinical study of a new method to fix ulna with intramedullary nail entrancing from head of ulna

目的 :报道尺骨头进针固定尺骨骨折的解剖基础及其临床应用效果。方法 :观察 7具 1 4侧成人上肢标本 ,测量尺骨茎突的长度。以尺侧腕伸肌腱沟内缘 2mm尺骨茎突远端以上 1 5mm处为进针点 ,测量该点到尺神经手背支的距离、该点在前后两侧到尺骨头环状关节面的距离。以该点进针模拟手术并试用于临床。结果 :①尺骨茎突长为 (6 .0± 1 .2 )mm ;②进针点与尺神经手背支距离为 (1 4 .1± 3 .8)mm ;③进针点在前后两侧到尺骨头环状关节面的距离分别为 (1 6 .7± 0 .7)mm、(1 6 .6± 1 .1 )mm ,配对t检验比较两者差异 (P >0 .0 5) ;④术后随访未见严重并发症。结论 :自尺骨头背侧进针能避免传统的从尺骨鹰嘴进针的并发症 。

Objective: To investigate the anatomic basis and the clinical effect of a new method to fix broken ulna with intramedullary nail entrancing from head of ulna. Methods: Fourteen upper limbs of seven corpses were studied to measure the length of styloid process of ulna.The new entrance was positioned at the crossing of internal 2mm of tendinous groove of ulnar extensor muscle of wrist and proximal 15mm of styloid process of ulna.The distance between the new entrance point and dorsal branch of ulnar nerve,the ventral and dorsal distances from new entrance to articular circumference of head of ulna were measured.And then the new method was applied in treatment of patients with fracture of ulna to test the clinical effect. Results:The length of styloid process of ulna was 6.0±1.2 mm.The distance between the new entrance point and dorsal branch of ulnar nerve was 14.1±3.8 mm,the ventral and dorsal distances from new entrance to articular circumference of head of ulna were 16.7±0.7 mm and 16.6±1.1 mm respectively.There was no significantly difference between the latter two distances( P >0.05).The clinical effect of fixing fractured ulna was satisfied and there was no severe complication. Conclusion: The new method to fix ulna have a good clinical result.It can reduce complication and have no effect on the rotation of forearm and the function of wrist.