Hackl Michael, Damerow Deborah, Leschinger Tim, Scaal Martin, Müller Lars Peter, Wegmann Kilian
Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany.
Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
Arch Orthop Trauma Surg. 2015 Nov;135(11):1527-32. doi: 10.1007/s00402-015-2300-0. Epub 2015 Aug 9.
Radial neuropathy represents a devastating complication in a posterior approach to the distal humerus. This study aimed to propose "safe zones" regarding the radial nerve (RN) location at the posterior aspect of the humerus to minimize the risk of iatrogenic injury.
In 100 embalmed specimens, the distances of the proximal edge of the olecranon fossa (OF) to the radial nerve at the medial edge (R1), at the center (R2) and at the lateral edge (R3) of the posterior aspect of humeral shaft were measured. Humeral length (HL) and transcondylar width (TW) were evaluated and correlated to R1, R2 and R3.
R1 was 15.0 (±2.1; 10.6-19.5) cm, R2 averaged 12.7 (±1.6; 8.9-15.7) cm, R3 was 10.6 (±1.3; 7.6-13.7) cm. HL was 30.8 (±1.9) cm. TW averaged 6.3 (±0.6) cm. TW and HL correlate with R1, R2, R3 (r = 0.451-0.565 [95% CI 0.279-0.685]). The mean ratio was 2.3 (±0.18) for HL/R1, 2.6 (±0.23) for HL/R2 and 3.1 (±0.31) for HL/R3. The ratio averaged 2.2 (±0.20) for R1/TW, 1.9 (±0.18) for R2/TW and 1.6 (±0.15) for R3/TW.
We present the OF as an osseous landmark to reduce the risk of iatrogenic radial neuropathy. HL and TW can be reliably used to estimate the RN location. The consistent "safe zones" of the RN in relation to the OF are 10.5 cm at the medial edge, 9 cm at the center and 7.5 cm at the lateral edge of the posterior aspect of the humeral shaft.
桡神经损伤是肱骨远端后侧入路手术中一种严重的并发症。本研究旨在确定肱骨后侧桡神经（RN）的“安全区”，以降低医源性损伤的风险。
在100具防腐标本上，测量鹰嘴窝（OF）近端边缘至肱骨干后侧内侧边缘（R1）、中心（R2）及外侧边缘（R3）处桡神经的距离。评估肱骨长度（HL）和髁间宽度（TW），并分析其与R1、R2和R3的相关性。
R1为15.0（±2.1；10.6 - 19.5）cm，R2平均为12.7（±1.6；8.9 - 15.7）cm，R3为10.6（±1.3；7.6 - 13.7）cm。HL为30.8（±1.9）cm。TW平均为6.3（±0.6）cm。TW和HL与R1、R2、R3相关（r = 0.451 - 0.565 [95% CI 0.279 - 0.685]）。HL/R1的平均比值为2.3（±0.18），HL/R2为2.6（±0.23），HL/R3为3.1（±0.31）。R1/TW的平均比值为2.2（±0.20），R2/TW为1.9（±0.18），R3/TW为1.6（±0.15）。
我们提出将OF作为一个骨性标志，以降低医源性桡神经损伤的风险。HL和TW可可靠地用于估计RN的位置。相对于OF，RN在肱骨干后侧的一致“安全区”为内侧边缘10.5 cm、中心9 cm、外侧边缘7.5 cm。
