Department of Orthopaedic Surgery, The Maulana Azad Medical College & Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, 110002 New Delhi, India.
Clin Orthop Relat Res. 2011 Sep;469(9):2638-44. doi: 10.1007/s11999-011-1791-4. Epub 2011 Feb 1.
The relationship of the radial nerve is described with various osseous landmarks, but such relationships may be disturbed in the setting of humerus shaft fractures. Alternative landmarks would be helpful to more consistently and reliably allow the surgeon to locate the radial nerve during the posterior approach to the arm.
QUESTIONS/PURPOSES: We investigated the relationship of the radial nerve with the apex of triceps aponeurosis, and describe a technique to locate the nerve.
We performed dissections of 10 cadavers and gathered surgical details of 60 patients (30 patients and 30 control patients) during the posterior approach of the humerus. We measured the distance of the radial nerve from the apex of the triceps aponeurosis along the long axis of the humerus in cadaveric dissections and patients. This distance was correlated with the height and arm length. For all patients, we recorded time until first observation of the radial nerve, blood loss, and postoperative radial nerve function.
The mean distance of the radial nerve from the apex of the triceps aponeurosis was 2.5 cm, which correlated with the patients' height and arm length. The mean time until the first observation of the radial nerve from beginning the skin incision was 6 minutes, as compared with 16 minutes in the control group. Mean blood loss was 188 mL and 237 mL, respectively. With the numbers available, we observed no difference in the incidence of patients with postoperative nerve palsy: none in the study group and three in the control group.
The apex of the triceps aponeurosis appears to be a useful anatomic landmark for localization of the radial nerve during the posterior approach to the humerus.
桡神经与各种骨性标志有关，但在肱骨干骨折的情况下，这种关系可能会受到干扰。替代标志将有助于更一致和可靠地允许外科医生在手臂的后入路中定位桡神经。
问题/目的：我们研究了桡神经与三头肌腱膜顶点的关系，并描述了一种定位神经的技术。
我们对 10 具尸体进行了解剖，并收集了 60 例患者（30 例患者和 30 例对照患者）在后入路肱骨时的手术细节。我们在尸体解剖和患者中测量了桡神经从三头肌腱膜顶点到肱骨长轴的距离。该距离与身高和臂长相关。对于所有患者，我们记录了首次观察到桡神经的时间、失血量和术后桡神经功能。
桡神经距三头肌腱膜顶点的平均距离为 2.5 厘米，与患者的身高和臂长相关。从皮肤切口开始首次观察到桡神经的平均时间为 6 分钟，而对照组为 16 分钟。平均失血量分别为 188 毫升和 237 毫升。就现有数量而言，我们观察到术后神经麻痹患者的发生率没有差异：研究组无，对照组 3 例。
三头肌腱膜顶点似乎是肱骨后入路中定位桡神经的有用解剖标志。
