Simone Juan P, Streubel Philipp N, Sánchez-Sotelo Joaquín, Steinmann Scott P, Adams Julie E
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Simon, Dr. Streubel, Dr. Sánchez-Sotelo, Dr. Steinmann, and Dr. Adams).
J Am Acad Orthop Surg Glob Res Rev. 2019 Feb 20;3(2):e005. doi: 10.5435/JAAOSGlobal-D-19-00005. eCollection 2019 Feb.
The purpose of this study was to investigate whether a safe zone rule could be applied to prevent iatrogenic injuries to the radial nerve (RN); and determine whether there is a relationship between the diameter of the radial head and capitellum and the distance of the posterior interosseous nerve (PIN) to the radiocapitellar joint.
Ten fresh-frozen cadaveric specimens were used to measure the distances between the RN and the lateral epicondyle; the PIN and the radiocapitellar joint; the lateral epicondyle and the PIN as it crossed the ulnohumeral joint; the diameter of the radial head; the width of the capitellum; and the fingerbreadths of the specimens.
Four fingerbreadths determined a safe zone between the lateral epicondyle and the RN proximally at the point at which it pierced the intermuscular septum and the mid-lateral portion of the humeral shaft. Two fingerbreadths provided a safe zone for the PIN from the radiocapitellar joint to the midpoint of the axis of the radius only with the forearm in pronation.
A four-finger rule, two-finger rule, and radial head diameter or capitellum size may predict a safe zone for the RN and PIN except for the segment of the nerve where it crosses the anterior cortex of either the humerus or radius.
Preclinical cadaveric study.
本研究的目的是调查是否可以应用安全区规则来预防桡神经（RN）的医源性损伤；并确定桡骨头和肱骨小头的直径与骨间后神经（PIN）到桡肱关节的距离之间是否存在关系。
使用10个新鲜冷冻的尸体标本测量RN与外侧髁之间的距离；PIN与桡肱关节之间的距离；PIN穿过尺肱关节时外侧髁与PIN之间的距离；桡骨头的直径；肱骨小头的宽度；以及标本的指宽。
在RN穿过肌间隔和肱骨干中外侧部分的近端，四指宽确定了外侧髁与RN之间的安全区。仅在前臂旋前时，两指宽为PIN从桡肱关节到桡骨轴线中点提供了安全区。
除神经穿过肱骨或桡骨前皮质的节段外，四指规则、两指规则以及桡骨头直径或肱骨小头大小可预测RN和PIN的安全区。
临床前尸体研究。
