Tryfonidis M, Charalambous C P, Mills S P, Jass G K, Jacob S, Stanley J K, Hayton M J
Department of Anatomy, Sheffield Medical School, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
Hand Surg. 2010;15(3):161-4. doi: 10.1142/S0218810410004783.
The radial and ulnar styloids as well as Lister's tubercle are important surgical landmarks in the surgical treatment of distal forearm fractures. There have been limited studies assessing their relative safety in terms of their distance from superficial nerves which are in danger during surgical procedures. The aim of this cadaveric study was to assess and compare the distance of superficial nerves to these important surgical landmarks.
Twenty embalmed cadaveric upper limbs were dissected exposing the nerves and tendons around the wrist. The radial styloid, Lister's tubercle, ulnar styloid and nerve branches were marked with pins. The distance of the nearest nerve branch to each landmark was measured with a digital calliper. Statistical analysis of the data was performed using SPSS for Windows 11.5 (SPSS Inc., Chicago, IL) using Friedman Tests and Wilcoxon Signed Ranks tests.
The median distance of the nearest nerve branch to the radial styloid was 5.42 mm, to the Lister's tubercle was 16.68 mm and to the ulnar styloid was 13.56 mm. There was unequal safety for these three surgical landmarks regarding proximity to nerve branches (p < 0.00001). Paired comparison using Wilcoxon Signed Ranks Test showed that the Lister's tubercle was safer than the radial styloid (p < 0.0001) and ulnar styloid (p = 0.04). In addition, the ulnar styloid was safer than the radial styloid (p < 0.001).
There is a higher risk of injury to superficial nerves when operating near the radial styloid as it is significantly closer to nerve branches as compared to Lister's tubercle and ulnar styloid.
桡骨茎突、尺骨茎突以及利斯特结节是前臂远端骨折手术治疗中的重要手术标志。关于它们在手术过程中与处于危险中的浅表神经的距离，评估其相对安全性的研究有限。本尸体研究的目的是评估并比较浅表神经与这些重要手术标志的距离。
解剖20具防腐处理的尸体上肢，暴露腕部周围的神经和肌腱。用大头针标记桡骨茎突、利斯特结节、尺骨茎突和神经分支。用数字卡尺测量每个标志最近的神经分支的距离。使用适用于Windows 11.5的SPSS（SPSS公司，伊利诺伊州芝加哥）对数据进行统计分析，采用弗里德曼检验和威尔科克森符号秩检验。
最近的神经分支到桡骨茎突的中位距离为5.42毫米，到利斯特结节为16.68毫米，到尺骨茎突为13.56毫米。这三个手术标志在靠近神经分支方面的安全性不相等（p < 0.00001）。使用威尔科克森符号秩检验进行配对比较显示，利斯特结节比桡骨茎突更安全（p < 0.0001），也比尺骨茎突更安全（p = 0.04）。此外，尺骨茎突比桡骨茎突更安全（p < 0.001）。
在桡骨茎突附近操作时，浅表神经损伤的风险更高，因为与利斯特结节和尺骨茎突相比，它离神经分支更近。
