Strong Benjamin M, Voloshin Ilya
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
J Hand Surg Am. 2019 Jul;44(7):613.e1-613.e6. doi: 10.1016/j.jhsa.2018.09.002. Epub 2018 Oct 6.
Fixation with a cortical button is the biomechanically strongest surgical approach for distal biceps repair, and utilization of the 2-incision approach may provide a more anatomical repair and improved terminal supination strength. The risk of injury to the posterior interosseous nerve (PIN) associated with this approach requires further investigation.
A distal biceps repair with a cortical button was performed on 10 cadavers, 5 utilizing the single-incision approach and 5 utilizing the 2-incision approach. Contrast was injected into the radial nerve and computed tomography scans were obtained. The distance between the drilled cortical perforation and the PIN was measured.
The mean distance from the cortical perforation to the PIN was not significantly different between approaches (9.4 mm and 8.8 mm). A PIN entrapment was seen in 0 out of 5 for the single-incision approach and 1 out of 5 for the 2-incision approach.
Distal biceps repair with cortical button fixation places the PIN at risk of injury regardless of the approach used. Methods of fixation that require bicortical drilling should be especially avoided when using the 2-incision approach.
Distal biceps repair utilizing bicortical drilling for fixation through a 2-incision approach poses high risk of injury to the PIN and should be avoided.
使用皮质纽扣固定是肱二头肌远端修复生物力学上最强的手术方法，采用双切口入路可能提供更符合解剖结构的修复并提高终末旋后力量。与此入路相关的骨间后神经（PIN）损伤风险需要进一步研究。
对10具尸体进行肱二头肌远端皮质纽扣固定修复，5例采用单切口入路，5例采用双切口入路。向桡神经内注入造影剂并进行计算机断层扫描。测量钻孔皮质穿孔与PIN之间的距离。
两种入路从皮质穿孔到PIN的平均距离无显著差异（分别为9.4毫米和8.8毫米）。单切口入路5例中0例出现PIN卡压，双切口入路5例中有1例出现PIN卡压。
无论采用何种入路，使用皮质纽扣固定进行肱二头肌远端修复均会使PIN面临损伤风险。采用双切口入路时，应特别避免需要双侧皮质钻孔的固定方法。临床意义：通过双切口入路使用双侧皮质钻孔进行肱二头肌远端修复对PIN造成损伤的风险很高，应予以避免。
