Dowdy P A, Bain G I, King G J, Patterson S D
Musculoskeletal Research Laboratory, St Joseph's Health Centre, London, Ontario, Canada.
J Bone Joint Surg Br. 1995 Sep;77(5):696-9.
The formation of a painful neuroma after operations on the medial or lateral sides of the elbow is a common problem. Our aim was to determine the relationship of the cutaneous nerves to the three usual skin incisions around the elbow. In 18 freshly frozen cadaver arms we made three standard 16 cm incisions in the skin medially, laterally, and posteriorly and explored them using loupe magnification. The number of nerves crossing each incision was determined by gross observation and their diameter measured by electronic microcallipers. In ten arms, biopsies of the nerves in each incision were sent for histological examination. We found significantly more cutaneous nerves crossing the medial and lateral incisions than the posterior. The diameter of the nerves crossing the posterior incision was significantly smaller than those crossing the lateral incision. Cutaneous nerves are at considerable risk of injury when medial or lateral incisions are used to approach the elbow, but the posterior approach carries less hazard. The routine use of the posterior incision may reduce the incidence of symptomatic paraesthesia and the formation of a painful neuroma after operation.
肘部内侧或外侧手术后形成疼痛性神经瘤是一个常见问题。我们的目的是确定皮神经与肘部周围三种常用皮肤切口的关系。在18只新鲜冷冻的尸体手臂上，我们在内侧、外侧和后侧皮肤上做了三个标准的16厘米切口，并用放大镜进行探查。通过肉眼观察确定穿过每个切口的神经数量，并用电子测微仪测量其直径。在10只手臂中，将每个切口中的神经活检标本送去做组织学检查。我们发现穿过内侧和外侧切口的皮神经明显多于后侧切口。穿过后侧切口的神经直径明显小于穿过外侧切口的神经。当使用内侧或外侧切口接近肘部时，皮神经有相当大的损伤风险，但后侧入路的风险较小。常规使用后侧切口可能会降低术后症状性感觉异常的发生率和疼痛性神经瘤的形成。
