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目的 为减少前臂骨间背侧神经 (posteriorinterosseousnerveofforearm ,PINOF)的损伤提供解剖学资料 ,并探讨手术安全性。 方法 在 30具 (6 0例 )成人尸体上 ,通过肘关节外侧切口 ,在桡骨近端后外侧或外侧面 ,放置 1块 4cm长的微型钢板。对PINOF的起点和该神经与微型钢板的关系等进行观测。 结果 PINOF起点距桡骨头上缘的距离为 (1.1± 1.8)mm。桡侧腕长伸肌肌支发出点距桡骨头上缘的距离为 (6 .2± 1.9)mm。 5 6例 (93% )PINOF至微型钢板的距离为(5 .0± 1.1)mm ,4例 (7% )PINOF通过微型钢板远端的上方进入旋后肌。前臂旋前位时 ,PINOF离开该切口 ,向内侧移动的距离为 (10 .0± 1.3)mm。应用改良式预弯微型钢板治疗桡骨头粉碎性骨折 11例 ,伴发外伤性和术中牵拉造成PINOF损伤各 1例。 11例均获随访 ,平均随访 2 5个月 ,2例PINOF损伤完全恢复 ,平均恢复时间 2 .8个月。 结论 采用肘关节外侧切口时 ,在桡骨近端的外侧面或后外侧面 ,距离桡骨头上缘 3.5cm的范围内 ,是放置微型钢板的安全区。
Objective To provide anatomical data to reduce the damage of the posterior interosseous nerve of the forearm (PINOF) and to investigate the safety of surgery. Methods Thirty (60) adult cadavers were fitted with a 4cm long micro-plate on the posterolateral or lateral surface of the proximal radius after elbow incision. The starting point of PINOF and the relationship between the nerve and the micro-plate were observed. Results The distance between the starting point of PINOF and the upper edge of radial head was (1.1 ± 1.8) mm. The distance from the radial wrist longus extensor muscle to the upper edge of radial head was (6.2 ± 1.9) mm. Fifty-six patients (93%) had a PINOF to micro-plate distance of (5.0 ± 1.1) mm, and four (7%) PINOFs entered the spin-like muscle through the distal tip of the micro-plate. When the forearm is pronated, the PINOF leaves the incision and moves inwardly a distance of (.10 ± 1.3) mm. 11 cases of comminuted radial head fractures were treated with modified pre-bent micro-plate, 1 case of PINOF injury accompanied by traumatic and intraoperative traction. Eleven patients were followed up for an average of 25 months. Two cases of PINOF were completely recovered with an average recovery time of 2.8 months. Conclusions When the lateral incision of the elbow is used, it is a safe area to place the micro-plate in the lateral or posterior lateral surface of the proximal radius, within 3.5cm from the upper edge of the radial head.