Da Silva T, Mueck D, Knop C, Merkle T
Klinikum Stuttgart, Stuttgart, Germany.
University of Tuebingen, Tuebingen, Germany.
Musculoskelet Surg. 2025 Mar;109(1):47-53. doi: 10.1007/s12306-024-00841-1. Epub 2024 Jul 23.
The close proximity of the radial nerve to the humerus poses a risk during upper arm surgery. Although the general course of the radial nerve is well-known, its exact position in relation to anatomical reference points remains poorly investigated. This study aimed to develop a standardized protocol for the sonographic and clinical identification of the radial nerve in the upper arm. The ultimate goal is to assist surgeons in avoiding iatrogenic radial nerve palsy.
A total of 76 measurements were performed in 38 volunteers (both sides). Ultrasound measurements were performed using a linear transducer (10 MHz) to identify the radial nerve at two key points: RD (where the radial nerve crosses the dorsal surface of the humerus) and RL (where the radial nerve crosses the lateral aspect of the humerus). Distances from specific reference points (acromion, lateral epicondyle, medial epicondyle, olecranon fossa) to RD and RL were measured, and the angle between the course of the nerve and the humeral axis was recorded. Humeral length was defined as the distance between the posterodorsal corner of the acromion and the lateral epicondyle.
The distance from the lateral epicondyle to RD was on average 15.5 cm ± 1.3, corresponding to 50% of the humeral length. The distance from the lateral epicondyle to RL was on average 6.7 cm ± 0.8, corresponding to 21% of the humeral length. The course of the nerve between RD and RL showed an average angulation of 37° to the anatomical axis of the humerus. Gender, BMI, dominant hand, and arm thickness did not correlate with the distances to RD or RL. Measurements were consistent between the left and right side.
The radial nerve can typically be identified by employing a 1/2 and 1/5 ratio on the dorsal and lateral aspects of the humerus. Due to slight variations in individual anatomy, the utilization of ultrasound-assisted visualization presents a valuable and straightforward approach to mitigate the risk of iatrogenic radial nerve palsy during upper arm surgery. This study introduces an easy and fast protocol for this purpose.
在进行上臂手术时，桡神经与肱骨位置接近，存在风险。尽管桡神经的大致走行已为人熟知，但其相对于解剖学参考点的确切位置仍研究不足。本研究旨在制定一种标准化方案，用于超声及临床识别上臂的桡神经。最终目标是帮助外科医生避免医源性桡神经麻痹。
对38名志愿者（双侧）共进行了76次测量。使用线性探头（10MHz）进行超声测量，以识别桡神经的两个关键点：RD（桡神经穿过肱骨背面处）和RL（桡神经穿过肱骨外侧处）。测量从特定参考点（肩峰、外侧髁、内侧髁、鹰嘴窝）到RD和RL的距离，并记录神经走行与肱骨轴线之间的角度。肱骨长度定义为肩峰后外侧角与外侧髁之间的距离。
从外侧髁到RD的平均距离为15.5cm±1.3，相当于肱骨长度的50%。从外侧髁到RL的平均距离为6.7cm±0.8，相当于肱骨长度的21%。RD和RL之间神经的走行与肱骨解剖轴平均成角37°。性别、体重指数、优势手和手臂厚度与到RD或RL的距离无关。左右两侧的测量结果一致。
通常可通过肱骨背侧和外侧的1/2和1/5比例来识别桡神经。由于个体解剖结构存在细微差异，超声辅助可视化的应用为降低上臂手术中医源性桡神经麻痹的风险提供了一种有价值且直接的方法。本研究为此目的引入了一种简便快速的方案。
