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肘关节镜检查时骨间后神经与桡骨头的距离:一项解剖学研究

Distance of the Posterior Interosseous Nerve from the Radial Head during Elbow Arthroscopy: An Anatomical Study.

作者信息

Arrigoni Paolo, Cucchi Davide, Guerra Enrico, Marinelli Alessandro, Menon Alessandra, Randelli Pietro Simone, Pederzini Luigi Adriano

机构信息

Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.

U.O.C. 1 a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.

出版信息

Joints. 2017 Aug 4;5(3):147-151. doi: 10.1055/s-0037-1605388. eCollection 2017 Sep.

Abstract

The aims of this study were to measure the distance of the posterior interosseous nerve (PIN) from the radial head (RH) and its variations with forearm movements.  Five fresh frozen cadaver specimens were dissected under arthroscopy. An anterior capsulectomy extended to the entire lateral compartment was performed. The need of soft tissue dissection to isolate the nerve in the extracapsular space was recorded. The distance between the nerve and the anterior part of the RH was then measured with a graduated caliper inserted via the midlateral portal with the forearm in neutral position, full pronation, and full supination.  The PIN was identifiable in all the specimens. In four cases, it was surrounded by a thick layer of adipose tissue, and further dissection was necessary to isolate it. Damage of the PIN during dissection occurred in one case, in which the proximal part of the nerve was accidentally cut. In three of the remaining cases, an increased distance was measured with the forearm in supination, as compared with neutral and full pronation position.  This anatomical study suggests that in most of the cases, the PIN does not lay just extracapular at the level of the radiocapitellar joint, but is surrounded by a thick layer of adipose tissue. Furthermore, its distance from the RH appears to increase with forearm supination. This position could increase the safe working space between RH and PIN.  Knowledge of PIN position in relation to the anterior elbow capsule and its changes with forearm movements can help reduce the iatrogenic injuries during elbow arthroscopy.

摘要

本研究的目的是测量骨间后神经(PIN)与桡骨头(RH)之间的距离及其随前臂运动的变化。

对5个新鲜冷冻尸体标本进行关节镜下解剖。进行了延伸至整个外侧间室的前侧关节囊切除术。记录在关节外间隙分离神经所需的软组织解剖情况。然后,通过外侧正中入路插入分度卡尺,在前臂处于中立位、完全旋前和完全旋后时,测量神经与桡骨头前部之间的距离。

在所有标本中均可识别出PIN。在4例中,它被一层厚厚的脂肪组织包围,需要进一步解剖以分离它。解剖过程中1例发生PIN损伤,神经近端意外切断。在其余3例中,与中立位和完全旋前位相比,前臂旋后时测量的距离增加。

这项解剖学研究表明,在大多数情况下,PIN在桡肱关节水平并非仅位于关节外,而是被一层厚厚的脂肪组织包围。此外,它与桡骨头之间的距离似乎随着前臂旋后而增加。这个位置可能会增加桡骨头与PIN之间的安全工作空间。

了解PIN相对于肘前关节囊的位置及其随前臂运动的变化,有助于减少肘关节镜检查期间的医源性损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86e1/5738474/8d263ffc0b0a/10-1055-s-0037-1605388-i1704-1.jpg

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