Theeuwes H P, van der Ende B, Potters J W, Kerver A J, Bessems J H J M, Kleinrensink G-J
Department of Neuroscience-Anatomy and Erasmus MC Anatomy Research Project (EARP), Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of Surgery, VieCuri Medical Center, Tegelseweg BL Venlo, The Netherlands.
PLoS One. 2017 Oct 26;12(10):e0186890. doi: 10.1371/journal.pone.0186890. eCollection 2017.
Measurements were done on both arms of ten specially embalmed specimens. Arms were dissected and radiopaque wires attached to the radial nerve in the distal part of the upper arm. Digital radiographs were obtained to determine the course of the radial nerve in the distal 20 cm of the humerus in relation to bony landmarks; medial epicondyle and capitellum-trochlea projection (CCT). Analysis was done with ImageJ and Microsoft Excel software. We also compared humeral nail specifications from different companies with the course of the radial nerve to predict possible radial nerve damage.
The distance from the medial epicondyle to point where the radial nerve bends from posterior to lateral was 142 mm on AP radiographs and 152 mm measured on the lateral radiographs. The average distance from the medial epicondyle to point where the radial nerve bends from lateral to anterior on AP radiographs was 66 mm. On the lateral radiographs where the nerve moves away from the anterior cortex 83 mm to the center of capitellum and trochlea (CCT). The distance from the bifurcation of the radial nerve into the posterior interosseous nerve (PIN) and superficial radial nerve was 21 mm on AP radiographs and 42 mm on the lateral radiographs (CCT).
The course of the radial nerve in the distal part of the upper arm has great variety. Lateral fixation is relatively safe in a zone between the center of capitellum-trochlea and 48 mm proximal to this point. The danger zone in lateral fixation is in-between 48-122 mm proximal from CCT. In anteroposterior direction; distal fixation is dangerous between 21-101 mm measured from the medial epicondyle. The more distal, the more medial the nerve courses making it more valuable to iatrogenic damage. The IMN we compared with our data all show potential risk in case of (blind) distal locking, especially from lateral to medial direction.
对10个经过特殊防腐处理的标本的双臂进行测量。解剖双臂，并在上臂远端将不透射线的金属丝附着于桡神经上。获取数字X线片以确定桡神经在肱骨远端20厘米处相对于骨性标志（内侧髁和肱骨小头-滑车投影（CCT））的走行。使用ImageJ和Microsoft Excel软件进行分析。我们还将不同公司的肱骨钉规格与桡神经的走行进行比较，以预测可能的桡神经损伤。
在前后位X线片上，从内侧髁到桡神经从后向前弯曲点的距离为142毫米，在侧位X线片上测量为152毫米。在前后位X线片上，从内侧髁到桡神经从外侧向前弯曲点的平均距离为66毫米。在侧位X线片上，神经从肱骨前皮质向外侧移动83毫米至肱骨小头和滑车中心（CCT）。在前后位X线片上，桡神经分为骨间后神经（PIN）和桡浅神经的分叉处距离为21毫米，在侧位X线片上（CCT）为42毫米。
上臂远端桡神经的走行差异很大。在肱骨小头-滑车中心与该点近端48毫米之间的区域进行外侧固定相对安全。外侧固定的危险区域在距CCT近端48 - 122毫米之间。在前后方向上，从内侧髁测量，远端固定在21 - 101毫米之间是危险的。神经走行越向远端，越偏向内侧，这使其更容易受到医源性损伤。我们与我们的数据进行比较的髓内钉在（盲目）远端锁定时均显示出潜在风险，尤其是从外侧向内侧方向。
