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[1]陳紅衛(wèi),楊新東,吳國林.改良肘關(guān)節(jié)前內(nèi)側(cè)過頂入路顯露冠突骨折的解剖學(xué)研究[J].中醫(yī)正骨,2017,29(06):8-11.
　CHEN Hongwei,YANG Xindong,WU Guolin.Anatomical research on improved anteromedial elbow over-the-top approach to ulnar coronoid process fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):8-11.
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改良肘關(guān)節(jié)前內(nèi)側(cè)過頂入路顯露冠突骨折的解剖學(xué)研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年06期
頁碼:
8-11
欄目:
基礎(chǔ)研究
出版日期:
2017-06-20

文章信息/Info

Title:
Anatomical research on improved anteromedial elbow over-the-top approach to ulnar coronoid process fractures
作者:
陳紅衛(wèi)1; 楊新東2; 吳國林1
1.浙江省義烏市中心醫(yī)院,浙江 義烏 322000; 2.溫州醫(yī)科大學(xué),浙江 溫州 325035
Author(s):
CHEN Hongwei1; YANG Xindong2; WU Guolin1
1.Yiwu Central Hospital,Yiwu 322000,Zhejiang,China 2.Wenzhou Medical University,Wenzhou 325035,Zhejiang,China
關(guān)鍵詞:
肘關(guān)節(jié);  冠突;  手術(shù)入路;  尸體解剖
Keywords:
Key words elbow joint;  coronoid process of ulna;  operative approach;  autopsy
摘要:
目的:探討經(jīng)改良肘關(guān)節(jié)前內(nèi)側(cè)過頂入路顯露冠突骨折的解剖學(xué)基礎(chǔ)。方法:對20具成人上肢標(biāo)本進(jìn)行解剖學(xué)測量,男12具、女8具。在淺層,將肱骨內(nèi)上髁標(biāo)記為A,將內(nèi)、外上髁連線與正中神經(jīng)內(nèi)側(cè)緣交點(diǎn)標(biāo)記為B,測量AB的長度。在中層,將正中神經(jīng)旋前圓肌支的分叉點(diǎn)標(biāo)記為D,將其入肌點(diǎn)標(biāo)記為E,測量AD、AE的長度。將尺動脈與尺神經(jīng)的交點(diǎn)標(biāo)記為C,測量AC、BC的長度。將尺側(cè)返動脈前支在尺動脈的分叉點(diǎn)標(biāo)記為F,測量AF、BF的長度。在深層,將冠突頂點(diǎn)標(biāo)記為O,將關(guān)節(jié)面平面與尺側(cè)副韌帶外側(cè)緣交點(diǎn)標(biāo)記為M,測量AM、OM的長度。結(jié)果:AB長度為(10.37±2.67)cm,BC長度為(10.19±2.57)cm,AC長度為(3.03±0.84)cm,AD長度為(3.53±1.55)cm,AE長度為(4.61±1.55)cm,AF長度為(4.96±1.74)cm,BF長度為(4.51±1.56)cm,AM長度為(2.75±0.57)cm,OM長度為(1.59±0.26)cm,肱肌附著點(diǎn)到冠突的距離為(1.56±0.93)cm。在肌組織深層可建立ABC和ABF 2個三角形安全區(qū),其中ABC區(qū)域由正中神經(jīng)中段、尺動脈下段與尺神經(jīng)構(gòu)成,在結(jié)扎尺側(cè)返動脈前支后該區(qū)域是顯露冠突的相對安全區(qū)域; ABF區(qū)域除支配屈肌群的部分正中神經(jīng)分支外,并無其他重要神經(jīng)、血管,為顯露冠突的絕對安全區(qū)域。結(jié)論:經(jīng)改良肘關(guān)節(jié)前內(nèi)側(cè)過頂入路能很好地暴露冠突,有足夠的安全區(qū)域進(jìn)行冠突骨折的手術(shù),是一種安全的手術(shù)入路。
Abstract:
ABSTRACT Objective:To explore the anatomical basis of improved anteromedial elbow over-the-top approach to ulnar coronoid process fractures.Methods:Twenty adult cadaveric upper limb specimens(12 males and 8 females)were selected and their anatomical parameters were measured.At the level of superficial layer,the medial epicondyle of humerus was labelled as A,and the intersection of the line from medial epicondyle to lateral epicondyle and the inner margin of median nerve was labelled as B.The distance between A and B was measured.At the level of medio-layer,the bifurcation point of pronator teres branch of median nerve was labelled as D and its entering muscle point was labelled as E.The distance between A and D and the distance between A and E were measured.The intersection of ulnar artery and ulnar nerve was labelled as C,and the distance between A and C and the distance between B and C were measured.The bifurcation point of ramus anterior arteriae recurrentis ulnaris of ulnar artery was labelled as F,and the distance between A and F and the distance between B and F were measured.At the level of deep layer,the culminated point of coronoid process was labelled as O,and the intersection point of articular surface and lateral margin of ulnar collateral ligament was labelled as M.The distance between A and M and the distance between O and M were measured.Results:The length of line segment AB,BC,AC,AD,AE,AF,BF,AM and OM were 10.37+/-2.67 cm,10.19+/-2.57 cm,3.03+/-0.84 cm,3.53+/-1.55 cm,4.61+/-1.55 cm,4.96+/-1.74 cm,4.51+/-1.56 cm,2.75+/-0.57 cm and 1.59+/-0.26 cm respectively,and the distance from attachment point of brachialis to coronoid process was 1.56+/-0.93 cm.Two triangular safety zones(ABC and ABF)could be build up in the deep layer of muscular tissues.The sides of triangle ABC consist of midpiece of median nerve,inferior segment of ulnar artery and ulnar nerve.The ABC zone was the relatively safe zone for exposing ulnar coronoid process after ligaturing the ramus anterior arteriae recurrentis ulnaris.The ABF zone was the absolutely safe zone for exposing ulnar coronoid process because there weren't important nerves and blood vessels in the zone except for some median nerve branch thatdominated the flexor groups.Conclusion:The ulnar coronoid process can be successfully exposed through improved anteromedial elbow over-the-top approach,and the approach provides ample safe zone for surgery of ulnar coronoid process fractures.

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備注/Memo

備注/Memo:
基金項(xiàng)目:浙江省科技廳項(xiàng)目(2013C33216); 浙江省衛(wèi)生廳項(xiàng)目(2014KYB296); 義烏市科技攻關(guān)項(xiàng)目(2013-G3-02) 通訊作者:陳紅衛(wèi) E-mail:[email protected]
更新日期/Last Update: 2017-06-20