Bono C M, Grossman M G, Hochwald N, Tornetta P
Department of Orthopaedics, University of Medicine and Dentistry of New Jersey-Newark 07103, USA.
Clin Orthop Relat Res. 2000 Apr(373):259-64.
Because the axillary and radial nerves can be injured during operative exposure and fixation of the humerus, accurate delineation of their location is vital to avoid complications. The authors investigated the relationship of the radial and axillary nerves for radiographically and surgically identifiable bony landmarks. Fifty fresh human cadaveric upper extremities were dissected to identify the nerves as they crossed the lateral intermuscular septum and the humeral surgical neck, respectively. Longitudinal distances between the nerves and the superior aspect of the humeral head, the surgical neck, the superior extent of the olecranon fossa, and the distal aspect of the trochlea were measured with calipers. The average distance from the axillary nerve to the proximal humerus was 6.1 +/- 0.7 cm (range, 4.5-6.9 cm) and 1.7 +/- 0.8 cm (range, 0.7-4.0 cm) from the surgical neck. The radial nerve traversed the lateral intermuscular septum 17 +/- 2.3 cm (range, 13-22 cm) from the proximal humerus, 12 +/- 2.3 cm (range, 7.4-16.6 cm) from the olecranon fossa, and 16 +/- 0.4 cm (range, 9.0-20.5 cm) from the distal humerus, representing the approximate midpoint of the bone. Anteroposterior locking screws placed into the proximal humerus endanger the axillary nerve because it lies directly over the posterior cortex as little as 0.7 cm from the surgical neck. As the radial nerve crosses the lateral intermuscular septum more proximal than generally was thought, it is at risk during implant insertion in the distal half of the humerus. Using measurements calculated from preoperative and intraoperative imaging, the approximate position of the nerve could be determined to better plan fixation method and implant location.
由于在肱骨手术显露和固定过程中腋神经和桡神经可能受到损伤，准确描绘它们的位置对于避免并发症至关重要。作者研究了桡神经和腋神经与影像学及手术中可识别的骨性标志之间的关系。解剖了50具新鲜人类尸体的上肢，以分别确定神经穿过外侧肌间隔和肱骨外科颈的情况。用卡尺测量神经与肱骨头、外科颈、鹰嘴窝上缘以及滑车远端之间的纵向距离。腋神经到肱骨近端的平均距离为6.1±0.7厘米（范围4.5 - 6.9厘米），到外科颈的平均距离为1.7±0.8厘米（范围0.7 - 4.0厘米）。桡神经从肱骨近端穿过外侧肌间隔的距离为17±2.3厘米（范围13 - 22厘米），从鹰嘴窝穿过的距离为12±2.3厘米（范围7.4 - 16.6厘米），从肱骨远端穿过的距离为16±0.4厘米（范围9.0 - 20.5厘米），此位置大致为肱骨中点。置入肱骨近端的前后向锁定螺钉会危及腋神经，因为它直接位于外科颈后方皮质上方，距离仅0.7厘米。由于桡神经穿过外侧肌间隔的位置比一般认为的更靠近近端，在肱骨远端植入假体时它有受损风险。利用术前和术中影像学计算得出的测量值，可以确定神经的大致位置，从而更好地规划固定方法和植入物位置。
