Chan Julie, Habis Ahmed A, Alzaben Essam, Bicknell Ryan T, Daneshvar Parham
Department of Surgery, Queen's University, Kingston, ON, Canada.
Department of Surgery, Queen's University, Kingston, ON, Canada; Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
J Shoulder Elbow Surg. 2024 Feb;33(2):381-388. doi: 10.1016/j.jse.2023.08.019. Epub 2023 Sep 27.
The risk of posterior interosseous nerve (PIN) injury during surgical approaches to the lateral elbow varies depending on the chosen approach, level of dissection, and rotational position of the forearm. Previous studies evaluated the trajectory of the PIN in specific surgical applications to reduce iatrogenic nerve injuries. The goal of this study is to examine the location of the PIN using common lateral approaches with varying forearm rotation.
The Kaplan, extensor digitorum communis (EDC) split, and Kocher approaches were performed on 18 cadaveric upper extremity specimens. Measurements were recorded with a digital caliper from the radiocapitellar (RC) joint and the lateral epicondyle to the point where the PIN crosses the approach in full supination, neutral, and full pronation with the elbow at 90°. The ratio of the nerve's location in relation to the entire length of the radius was also evaluated to account for different-sized specimens.
The PIN was not encountered in the Kocher interval. For Kaplan and EDC split, with the forearm in full supination, the mean distance from the lateral epicondyle to the PIN was 52.0 ± 6.1 mm and 59.1 ± 5.5 mm, respectively, and the mean distance from the RC joint to the PIN was 34.7 ± 5.5 mm and 39.3 ± 4.7 mm, respectively; with the forearm in full pronation, the mean distance from the lateral epicondyle to the PIN was 63.3 ± 9.7 mm and 71.4 ± 8.3 mm, respectively, and the mean distance from the RC joint to the PIN was 44.2 ± 7.7 mm and 51.1 ± 8.7 mm, respectively.
The PIN is closer to the lateral epicondyle and RC joint in the Kaplan than EDC split approach and is not encountered during the Kocher approach. The PIN was not encountered within 26 mm from the RC joint and 39 mm from the lateral epicondyle in any approach and forearm position and is generally safe from iatrogenic injury within these distances.
在外侧肘部手术入路过程中，骨间后神经（PIN）损伤的风险因所选入路、解剖水平和前臂旋转位置而异。以往研究评估了PIN在特定手术操作中的走行轨迹，以减少医源性神经损伤。本研究的目的是使用不同前臂旋转角度的常见外侧入路来检查PIN的位置。
对18个尸体上肢标本进行了Kaplan、指总伸肌（EDC）劈开和Kocher入路操作。使用数字卡尺记录在肘关节屈曲90°时，从桡骨头小头（RC）关节和外侧髁到PIN在完全旋前、中立和完全旋后位穿过入路点的测量值。还评估了神经位置与桡骨全长的比值，以考虑不同尺寸的标本。
在Kocher间隙未发现PIN。对于Kaplan和EDC劈开入路，当前臂完全旋前时，从外侧髁到PIN的平均距离分别为52.0±6.1mm和59.1±5.5mm，从RC关节到PIN的平均距离分别为34.7±5.5mm和39.3±4.7mm；当前臂完全旋后时，从外侧髁到PIN的平均距离分别为63.3±9.7mm和71.4±8.3mm，从RC关节到PIN的平均距离分别为44.2±7.7mm和51.1±8.7mm。
与EDC劈开入路相比，在Kaplan入路中PIN更靠近外侧髁和RC关节，且在Kocher入路过程中未发现PIN。在任何入路和前臂位置，距离RC关节26mm以内和距离外侧髁39mm以内均未发现PIN，在这些距离内一般可避免医源性损伤。
