Gerwin M, Hotchkiss R N, Weiland A J
The Hospital for Special Surgery, New York City, N.Y. 10021, USA.
J Bone Joint Surg Am. 1996 Nov;78(11):1690-5. doi: 10.2106/00004623-199611000-00008.
An anatomical study was performed to define the course of the radial nerve in the posterior aspect of the arm, with particular reference to its relationship to operative exposures of the posterior aspect of the humeral diaphysis. In ten cadaveric specimens, the radial nerve was found to cross the posterior aspect of the humerus from an average of 20.7 +/- 1.2 centimeters proximal to the medial epicondyle to 14.2 +/- 0.6 centimeters proximal to the lateral epicondyle. As it crossed the posterior aspect of the humerus in each specimen, the nerve had several branches to the lateral head of the triceps; however, no branches were found innervating the medial head of the triceps in the posterior aspect of any of the specimens. At the lateral aspect of the humerus, the nerve trifurcated into a branch to the medial head of the triceps, the lower lateral brachial cutaneous nerve, and the continuation of the radial nerve into the distal part of the upper arm and the forearm. Three operative approaches were performed in each specimen. The posterior triceps-splitting approach exposed an average of 15.4 +/- 0.8 centimeters of the humerus from the lateral epicondyle to the point at which the radial nerve crossed the posterior aspect of the humerus. For the second approach, the radial nerve was mobilized proximally to allow an additional six centimeters of the humeral diaphysis to be visualized. The third approach (the modified posterior approach) involved the identification of the radial nerve distally as it crossed the lateral aspect of the humerus, followed by reflection of both the lateral and the medial heads of the triceps medially. This exposure permitted visualization of 26.2 +/- 0.4 centimeters of the humeral diaphysis from the lateral epicondyle proximally. The results after use of the modified posterior approach in seven patients were also reviewed.
进行了一项解剖学研究，以确定桡神经在臂后部的走行，尤其涉及其与肱骨干后部手术显露的关系。在10个尸体标本中，发现桡神经从平均位于内上髁近端20.7±1.2厘米处越过肱骨后部，至位于外上髁近端14.2±0.6厘米处。在每个标本中，当神经越过肱骨后部时，有几条分支至肱三头肌外侧头；然而，在任何标本的后部均未发现分支支配肱三头肌内侧头。在肱骨外侧，神经分为三支，一支至肱三头肌内侧头，一支为臂外侧下皮神经，另一支为桡神经延续至上臂远端和前臂。在每个标本上进行了三种手术入路。肱三头肌后正中劈开入路平均显露从外上髁至桡神经越过肱骨后部处的肱骨15.4±0.8厘米。第二种入路是将桡神经向近端游离，以便能多显露6厘米的肱骨干。第三种入路（改良后入路）是在桡神经越过肱骨外侧时于远端辨认该神经，然后将肱三头肌外侧头和内侧头均向内侧牵开。这种显露能从近端的外上髁开始显露26.2±0.4厘米的肱骨干。还回顾了7例患者采用改良后入路后的结果。
