Mekhail A O, Ebraheim N A, Jackson W T, Yeasting R A
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699-0008, USA.
Clin Orthop Relat Res. 1995 Jun(315):199-208.
This study describes the anatomy of the posterior interosseous nerve and proposes how to protect it during the different approaches to the proximal radius. Based on the findings presented here, the choice of the approach and the pitfalls that might cause posterior interosseous nerve injury were defined. Three surgical approaches were used on 30 cadaveric upper limbs: modified Henry's anterior approach, Thompson's posterior approach, and a modified Gordon-Boyd's approach. Important anatomic structures were localized, marked, and shown on radiographs. Plates and screws were applied through the different approaches to determine the relationship of the hardware to the posterior interosseous nerve. Measurements were taken between the humeroradial joint, as a reference point, and different important anatomic structures. It was concluded that the anterior approach to the proximal radius is relatively safe and offers the possibility of proximal and distal extension. Caution should be taken while applying screws, however, to avoid posterior interosseous nerve injury. The radius is superficial posteriorly, and many surgeons favor Thompson's approach for exposure of the proximal radius; nonetheless, it carries the risk of posterior interosseous nerve injury with exposure of the most proximal portion of the radius. The modified Gordon-Boyd's approach offers the advantage of exposing both the radius and the ulna, but necessitates excessive muscle stripping.
本研究描述了骨间后神经的解剖结构，并提出了在不同的桡骨近端入路过程中如何对其进行保护。基于此处呈现的研究结果，明确了入路的选择以及可能导致骨间后神经损伤的陷阱。在30具尸体上肢上采用了三种手术入路：改良亨利氏前路、汤普森氏后路以及改良戈登 - 博伊德氏入路。对重要的解剖结构进行了定位、标记并在X线片上显示。通过不同入路应用钢板和螺钉，以确定内固定器械与骨间后神经的关系。以肱桡关节作为参考点，对不同重要解剖结构进行了测量。得出的结论是，桡骨近端的前路相对安全，并且提供了向近端和远端延伸的可能性。然而，在拧螺钉时应谨慎操作，以避免骨间后神经损伤。桡骨后侧表浅，许多外科医生倾向于采用汤普森氏入路来显露桡骨近端；尽管如此，在显露桡骨最近端部分时，该入路存在骨间后神经损伤的风险。改良戈登 - 博伊德氏入路具有同时显露桡骨和尺骨的优势，但需要过度剥离肌肉。
