Hohenberger Gloria Maria, Schwarz Angelika Maria, Maier Marco Johannes, Grechenig Peter, Dauwe Jan, Grechenig Christoph, Krassnig Renate, Gänsslen Axel, Weiglein Andreas Heinrich
Department of Orthopaedics and Trauma Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
AUVA Trauma Hospital Graz, Göstinger Straße 24, 8020, Graz, Austria.
Surg Radiol Anat. 2018 Sep;40(9):1025-1030. doi: 10.1007/s00276-018-2004-6. Epub 2018 Apr 4.
The posterior interosseous nerve (PIN) is at risk during the posterior and lateral approaches to the proximal radius. We aimed to define a safe zone for these approaches to avoid injury of the PIN and to evaluate their close and changing relationship to the nerve during forearm rotation.
The study collective consisted of 50 upper limbs. After performance of the lateral approach, the distance between the tip of the radial head and the PIN's exit point from the supinator (= distance 1) and the shortest interval between the nerve's exit to the radial margin of the ulna (= distance 2) were measured in maximum pronation and supination. Then, the dorsal approach was conducted and again distance 1 and the interval between the distal margin of the anconeus and the nerve's exit point (distance 2) were evaluated (pronation and supination).
There were significantly shorter distances during supination in comparison to pronation. Regarding the lateral approach, distance 1 changed from a mean of 60.3 mm (supination) to 62.7 mm in pronation (p < 0.001). For the dorsal approach, distance 1 decreased significantly (p < 0.001) from 62.9 mm (pronation) to 60.2 mm (supination).
Supination during the lateral and dorsal approaches to the proximal radius needs to be avoided to protect the PIN. Furthermore, the nerve appeared at an interval between 45 and 84.1 mm (lateral approach) and 47.5-93.8 mm (dorsal approach), respectively. Therefore, care must be taken at this height during extension of the approaches in a distal direction.
在桡骨近端的后侧和外侧入路手术中，骨间后神经（PIN）存在风险。我们旨在确定这些入路的安全区域，以避免损伤PIN，并评估在前臂旋转过程中它们与该神经的紧密且变化的关系。
研究对象包括50条上肢。在进行外侧入路手术后，测量桡骨头尖端与PIN从旋后肌穿出点之间的距离（=距离1），以及神经穿出点至尺骨桡侧边缘的最短间距（=距离2），测量时分别处于最大旋前和旋后位。然后，进行背侧入路手术，并再次评估距离1以及肘肌远端边缘与神经穿出点之间的间距（距离2）（旋前和旋后位）。
与旋前位相比，旋后位时的距离明显更短。关于外侧入路，距离1从旋后位时的平均60.3毫米变为旋前位时的62.7毫米（p<0.001）。对于背侧入路，距离1从旋前位时的62.9毫米显著下降（p<0.001）至旋后位时的60.2毫米。
在桡骨近端的外侧和背侧入路手术中，应避免旋后动作以保护PIN。此外，该神经分别出现在45至84.1毫米（外侧入路）和47.5至93.8毫米（背侧入路）的间距处。因此，在向远端延长入路时，必须注意此高度。
