[1]陈红卫,杨新东,吴国林.改良肘关节前内侧过顶入路显露冠突骨折的解剖学研究[J].中医正骨,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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改良肘关节前内侧过顶入路显露冠突骨折的解剖学研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年06期
页码:
8-11
栏目:
基础研究
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:
陈红卫1; 杨新东2; 吴国林1
1.浙江省义乌市中心医院,浙江 义乌 322000; 2.温州医科大学,浙江 温州 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
关键词:
肘关节;  冠突;  手术入路;  尸体解剖
Keywords:
Key words elbow joint;  coronoid process of ulna;  operative approach;  autopsy
摘要:
目的:探讨经改良肘关节前内侧过顶入路显露冠突骨折的解剖学基础。方法:对20具成人上肢标本进行解剖学测量,男12具、女8具。在浅层,将肱骨内上髁标记为A,将内、外上髁连线与正中神经内侧缘交点标记为B,测量AB的长度。在中层,将正中神经旋前圆肌支的分叉点标记为D,将其入肌点标记为E,测量AD、AE的长度。将尺动脉与尺神经的交点标记为C,测量AC、BC的长度。将尺侧返动脉前支在尺动脉的分叉点标记为F,测量AF、BF的长度。在深层,将冠突顶点标记为O,将关节面平面与尺侧副韧带外侧缘交点标记为M,测量AM、OM的长度。结果:AB长度为(10.37±2.67)cm,BC长度为(10.19±2.57)cm,AC长度为(3.03±0.84)cm,AD长度为(3.53±1.55)cm,AE长度为(4.61±1.55)cm,AF长度为(4.96±1.74)cm,BF长度为(4.51±1.56)cm,AM长度为(2.75±0.57)cm,OM长度为(1.59±0.26)cm,肱肌附着点到冠突的距离为(1.56±0.93)cm。在肌组织深层可建立ABC和ABF 2个三角形安全区,其中ABC区域由正中神经中段、尺动脉下段与尺神经构成,在结扎尺侧返动脉前支后该区域是显露冠突的相对安全区域; ABF区域除支配屈肌群的部分正中神经分支外,并无其他重要神经、血管,为显露冠突的绝对安全区域。结论:经改良肘关节前内侧过顶入路能很好地暴露冠突,有足够的安全区域进行冠突骨折的手术,是一种安全的手术入路。
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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备注/Memo

备注/Memo:
基金项目:浙江省科技厅项目(2013C33216); 浙江省卫生厅项目(2014KYB296); 义乌市科技攻关项目(2013-G3-02) 通讯作者:陈红卫 E-mail:chw6988@aliyun.com
更新日期/Last Update: 2017-06-20