Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Bathinda, India.
Department of Orthopaedics, Government Medical College, Amritsar, Amritsar, India.
Surg Radiol Anat. 2021 May;43(5):689-694. doi: 10.1007/s00276-021-02683-z. Epub 2021 Jan 30.
Injury to the radial nerve is not an uncommon phenomenon in fracture displacement of distal humerus and its operative management as the nerve is immobile and superficial at its point of entry into the anterior compartment and in close proximity to humerus. Such injuries can be reduced by defining a 'safe area' for the radial nerve in relation to the triceps aponeurosis in the distal humerus.
Radial nerve was dissected in 40 arms and distance of the nerve from triceps aponeurosis was measured at five sites; first one at the level of proximal or medial apex of aponeurosis, followed by four sites along its lateral border. These distances were analyzed to identify its location and to define a 'safe area' in relation to the triceps aponeurosis in the distal humerus.
In majority of cases (67.50%), the point of entry of radial nerve into anterior compartment was at the level of proximal or medial apex at a mean distance of 2.11 ± 0.31 cm. The mean distance of radial nerve from the lateral border of triceps aponeurosis was 1.98 ± 0.60 cm with a range of 1.00-2.50 cm. The closest distance between the nerve and the aponeurosis was found to be 1.00 cm at the level of distal or lateral apex.
The relationship between radial nerve and triceps aponeurosis is constant and easily reproducible. It is suggested that the rectangular zone immediately adjoining the lateral border of aponeurosis (< 1.00 cm) can be considered "safe" for soft tissue dissection while surgically approaching distal humeral fractures.
桡神经在肱骨远端骨折移位中并不少见，由于神经在进入前室的部位固定且表浅，且与肱骨毗邻，因此其手术管理较为困难。通过确定肱骨远端三头肌腱膜上桡神经的“安全区”，可以减少此类损伤。
在 40 个臂部解剖桡神经，并在肱骨干远端的三头肌腱膜上测量神经与腱膜的距离，在五个部位测量：第一个在腱膜的近端或内侧顶点水平，然后在其外侧边界的四个部位测量。分析这些距离以确定其位置，并确定与肱骨干远端三头肌腱膜的“安全区”。
在大多数情况下（67.50%），桡神经进入前室的部位位于腱膜的近端或内侧顶点水平，平均距离为 2.11±0.31 cm。桡神经与三头肌腱膜外侧边界的平均距离为 1.98±0.60 cm，范围为 1.00-2.50 cm。神经与腱膜之间的最短距离在远端或外侧顶点水平为 1.00 cm。
桡神经与三头肌腱膜之间的关系是恒定的，且易于重现。建议紧邻腱膜外侧边界的矩形区域（<1.00 cm）在手术接近肱骨远端骨折时可视为“安全”的软组织解剖区域。
