Uzel A-P, Bulla A, Laurent-Joye M, Caix P
Service d'Orthopédie et Traumatologie, CHU Pointe-à-Pitre, Guadeloupe, France.
Folia Morphol (Warsz). 2011 Aug;70(3):204-10.
The Henry approach is the classical anterolateral surgical exposure of the volar aspect of the distal radius. This approach does not allow good access to the medial side of the volar distal radius (lunate facet) and the distal radio-ulnar joint, unless it is extended proximally, retracting the tendons and the median nerve medially, which can cause some trauma. The purpose of our study was to investigate the anatomic basis and to outline the advantages of the unusual anteromedial approach, reporting our experience in the treatment of 4 distal radius fractures, with a 90° or 180° twist of the lunate facet, and 10 wrist dissections on cadavers. The average follow-up was 68.8 months (range 18 to 115 months). In our series, this approach did not cause any nerve injuries or any sensory loss of the distal forearm and the palm. All the fractures of the lunate facet and of the radial styloid process healed. One patient with an ulnar styloid process fracture associated showed pseudarthrosis, but with no instability of the distal radio-ulnar joint or pain on the ulnar side. Using the criteria of Green and O'Brien, modified by Cooney, the results were: excellent in two cases, good in one case, and average in another. The evaluation of arthritis according to Knirk and Jupiter's classification showed grade 0 in three cases and grade 3 in one case with osteochondral sclerosis. We showed that the anteromedial approach is reliable and convenient in the case of fractures situated in the antero-medial portion of the radius, for the double objective of reducing the fracture under direct control and checking the congruence of the distal radio-ulnar joint.
亨利入路是桡骨远端掌侧经典的前外侧手术显露方法。除非向近端延长，将肌腱和正中神经向内侧牵开（这可能会造成一些创伤），否则该入路无法很好地显露桡骨远端掌侧内侧（月骨小面）和桡尺远侧关节。我们研究的目的是探讨一种特殊的前内侧入路的解剖学基础并概述其优点，报告我们治疗4例桡骨远端骨折（月骨小面有90°或180°扭转）的经验以及对10具尸体手腕进行解剖的情况。平均随访时间为68.8个月（范围18至115个月）。在我们的系列病例中，该入路未导致任何神经损伤或前臂远端及手掌的感觉丧失。所有月骨小面和桡骨茎突骨折均愈合。1例合并尺骨茎突骨折的患者出现假关节，但桡尺远侧关节无不稳定或尺侧疼痛。采用库尼修改的格林和奥布赖恩标准进行评估，结果为：2例优，1例良，1例一般。根据克尼克和朱庇特分类法对关节炎进行评估，3例为0级，1例为3级伴有骨软骨硬化。我们表明，对于位于桡骨前内侧部分的骨折，前内侧入路在直接控制下复位骨折和检查桡尺远侧关节的一致性这两个双重目标方面是可靠且方便的。
