| 桡神经移位术在肱骨中下段骨折内固定中的解剖与临床应用 |
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Received:December 25, 2006
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| 作者 | Author | 单位 | Unit | E-Mail |
| 杨彬 |
YANG Bin |
日照市中医医院骨科,山东日照276800 |
Department of Orthopaedics,the Hospital of TCM of Rizhao,Rizhao 276800,Shandong,China |
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| 尹晓 |
YIN Xiao |
日照市中医医院骨科,山东日照276800 |
Department of Orthopaedics,the Hospital of TCM of Rizhao,Rizhao 276800,Shandong,China |
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| 张玲 |
ZHANG Ling |
日照市中医医院骨科,山东日照276800 |
Department of Orthopaedics,the Hospital of TCM of Rizhao,Rizhao 276800,Shandong,China |
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| 马海波 |
MA Hai-bo |
日照市中医医院骨科,山东日照276800 |
Department of Orthopaedics,the Hospital of TCM of Rizhao,Rizhao 276800,Shandong,China |
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| 李静 |
LI jing |
日照市中医医院骨科,山东日照276800 |
Department of Orthopaedics,the Hospital of TCM of Rizhao,Rizhao 276800,Shandong,China |
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| 张雯雯 |
ZHANG Wen-wen |
日照市中医医院骨科,山东日照276800 |
Department of Orthopaedics,the Hospital of TCM of Rizhao,Rizhao 276800,Shandong,China |
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| 期刊信息：《中国骨伤》2007年20卷，第7期，第445-447页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:通过对肱骨中下段和桡神经的解剖观测,设计桡神经移位术,为肱骨中下段骨折内固定术中或术后取内固定物避免损伤提供解剖学依据。
方法:采用解剖学技术,对15具10%甲醛固定的成人男性尸体30侧上肢桡神经的走行、分支与肱深血管的关系进行了解剖观察与测量,同时对100侧干燥肱骨的长度、桡神经沟长度及桡神经走行的角度(桡神经沟与肱骨纵轴夹角)进行观测,并将其结果进行统计学处理后应用于桡神经移位术的方案设计及实施。
结果:①骨标本测量:肱骨平均长度左侧为(30.60±1.46)cm(27.80～33.00cm),右侧为(31.38±1.23)cm(29.20～33.70cm);桡神经沟平均长度左侧为(56.52±10.13)mm(43.82～75.68mm),右侧为(65.74±5.80)mm(55.42～78.82mm);桡神经走行的平均角度左侧为(13.00±1.08)°(10.00°～13.50°),右侧为(13.86±0.97)°(10.50°～14.50°)。②尸体标本观察:桡神经走行中的角度:桡神经在桡神经沟内由内上斜向外下方,穿过外侧肌间隔后行向内下方,形成向内开放的钝角。角度明显29侧(占96.67%);不明显1侧(占3.33%)。③桡神经分为浅深支的位置:在肱骨内外上髁连线(髁间线)以上17侧(占56.67%),在髁间线以下10侧(占33.33%),平髁间线3侧(占10.00%)。④从桡神经出口到桡神经分叉的平均距离(弧距)为(14.26±1.01)cm(12.80～19.20cm)。⑤桡神经和相邻肱深血管的关系:桡神经在肱深血管内侧12侧,在肱深血管外侧10侧,和肱深血管相交叉8侧。⑥临床56例肱骨中下段骨折患者,行桡神经移位术后肱骨中下段骨折内固定,骨折全部愈合,无桡神经损伤等并发症。
结论:桡神经移位术设计合理,符合桡神经的解剖生理,为肱骨中下段骨折进行各种内固定提供了更大的操作空间,减少了术中或术后(取内固定时)桡神经再损伤的发生,且不增加手术难度和损伤,是一种理想的术式。 |
| [关键词]:桡神经 神经移位术 人体模型 神经解剖学 |
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| Anatomical base and clinical application of radial nervetransfer on internal fixation of fracture of middle and distal humerus |
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Abstract:
Objective:Through the anatomic observation and measurement on middle and distal humerus and radial nerve,of the design of nerve transposition to avoid radial nerve injury in the first and second surgery.
Methods:By means of anatomic methods,radial nerve route and branches,and the relationship between radial nerve and deep brachial vessel of 30 upper limbs in 15 adult bodies fixed with 10% formalin were observed and measured.Meanwhile,the anatomical structures of 100 humeral specimens were also observed including length of humerus and radial groove,angle of radial nerve courser(included angle between radial groove and longitudinal axis of humerus).After statistical treatment these datas were used to design and apply in radial nerve transposition.
Results: ①The length of humerus:the mean of left side was (30.60±1.46) cm (27.80-33.00 cm) and the right side (31.38±1.23) cm (29.20-33.70 cm).The length of radial groove:the mean of left side was (56.52±10.13) mm (43.82-75.68 mm) and the right side (65.74±5.80) mm (55.42-78.82 mm).The angle of radial nerve route:the mean of left side was (13.00±1.08)°(10.00°-13.50°) and the right side (13.86±0.97)°(10.50°-14.50°).②The angle of radial nerve route was from mediosupper of the radial groove oblique to lateroinferion,through intermuscular septum to mediosupper forming inward exoteric obtuse angle.The angle was obvious in 29 sides,that was 96.67%,and not obvious only in 1 side,that was 3.33%.③The position of the radial nerve divided into superficial and deep branches: 17 sides (56.76%) above the interepicondylar line and 10 sides (33.33%) below the line and 3 sides (10.00%) on the line .④The mean distance between the exit of radial nerve and the branches was (14.26±1.01) cm (12.80-19.20 cm).⑤The relationship between radial nerve and deep brachial vessel: radial nerve positioned medial to the deep brachial vessel in 12 sides,lateral to deep brachial vessel in 10 sides and radial nerve crossed the deep brachial vessel in 8 sides.⑥The outcome was satisfactory for 56 patients performed this operation.The fractures healed completely and there was no complication.
Conclusion:The design of radial nerve transposition is reasonable,conforms to the radial nerve anatomy and physiology and provides much wider operation space for various kinds of internal fixation of fractures of middle and distal humerus.It can reduce the injury of the radial nerve in the course of the first operation and the second operation,moreover,operative difficulty and injury is not increased,It is an ideal technique. |
| KEYWORDS:Radial nerve Nerve transposition Manikins Neuroanatomy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 杨彬,尹晓,张玲,马海波,李静,张雯雯.桡神经移位术在肱骨中下段骨折内固定中的解剖与临床应用[J].中国骨伤,2007,20(7):445~447 |
| 英文格式: | YANG Bin,YIN Xiao,ZHANG Ling,MA Hai-bo,LI jing,ZHANG Wen-wen.Anatomical base and clinical application of radial nervetransfer on internal fixation of fracture of middle and distal humerus[J].zhongguo gu shang / China J Orthop Trauma ,2007,20(7):445~447 |
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