摘要
目的为在桡、尺骨远端骨折处经皮穿针固定提供一个安全进针区域,减少桡、尺神经浅支的损伤提供解剖学依据。方法成人前臂标本18侧,观察桡、尺神经浅支的走行规律。结果桡神经浅支从肱桡肌和桡侧腕长伸肌腱平均间穿出点与桡骨茎突纵向平均距离(L_1)为[(7．4±0．7)cm,(?)±s,下同]。其中16侧在穿出点与桡骨茎突纵向平均距离(L_2)为(4．5±0．6)cm处发出一级分支,称为尺侧支(Ⅰ)和桡侧支(Ⅱ)；尺侧支的桡侧分支(I a)与桡骨茎突的横向平均距离(L_3)为(1．0±0．3)cm,桡侧支与桡骨茎突横向平均距离(L_4)为(0．8±0．3)cm,纵向平均距离(L_5)为(1．5±0．4)cm。2侧桡神经浅支桡侧支被前臂外侧皮神经所替代。尺神经浅支手背支均从尺骨茎突的掌侧走行,与尺骨茎突距离为(0．9±0．3) cm。结论以桡骨茎突为中心,横向距离0．4cm．纵向距离0．6cm的椭圆形区域为桡神经分布相对盲区．从该区经皮克氏针固定桡骨远端,可有效地减少桡神经浅支损伤的发生率。尺骨远端骨折应从尺骨茎突背侧经皮进针相对较安全。
Objective To offer a safe zone to avoid cutaneous nerve injury for Kirschner wire fixation in the treatment of distal radius or ulnar fractures. Methods 18 formalin embalmed adult cadaver forearms were dissected. The superficial radial nerve, from its piercing out between brachioradialis and extensor carpi radialis longus to the metecaparpophalangeal joint level, was dissected and its course observed. The ulnar cutaneous nerve, from distal third of the forearm to the wrist, was also dissected and its course observed. Results The distance between the point the superficial radial nerve piercing out between brachioradialis and extensor carpi radialis longus and the radial styloid was （7.4 ± 0.7）cm. In 16 of the 18 specimens the first bifurcate （radial branch and ulnar branch） was found to be at a distance of （4.5 ± 0.6） cm proximal to the radial styloid. The perpendicular distance of radial branch of the ulnar bifurcate to the radial styloid was （1.0 ± 0.3） cm. The perpendicular and longitudinal distance of the radial branch to the radial styloid was （0.8 ± 0.3） cm and （1.5 ± 0.4） cm respectively. 2 of the 18 specimens presented aberrance, the radial branch being replaced by the lateral antebrachial cutaneous nerve. The ulnar dorsal cutaneous nerve was found to course by the palmar side of the ulnar styloid in all specimens. Its distance to the ulnar styloid was （0.9 ± 0.3）cm. Conclusion An ellipse area, centered at the radial styloid and bound by 0.4 cm transversely and 0.6 cm longitudinally, was a comparative blind region of superficial radial nerve which we call the ＂safe zone＂. While treating the distal radial fractures, if placement of per＇cutaneous K-wiras was within the safe zone, the risk of injuring the superficial radial nerve could be effectively reduced. For the same reason, placement of pereutaneous K-wires should be dorsal to the ulnar styloid while treating the distal ulnar fractures.
出处
《中华手外科杂志》
CSCD
北大核心
2006年第2期87-89,共3页
Chinese Journal of Hand Surgery
基金
南京市医学科技发展基金(YKK05085)
关键词
桡神经
尺神经
解剖学
局部
腕
Radial nerves
Ulnar nerves
Anatomy, regional
Wrist
