| 引用本文： |
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孙万驹,王子彬,蔡俊丰,等.肩外侧小切口内固定治疗肱骨近端骨折的解剖学研究[J].同济大学学报（医学版）,2012,33(1):19-23. [点击复制]
- SUN Wan-ju,WANG YU-bin,CAI Jun-feng,et al.Applied anatomy of anterolateral transverse incision in treatment of proximal humeral fractures[J].同济大学学报（医学版）,2012,33(1):19-23. [点击复制]
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| 摘要: |
| 目的为临床应用小切口治疗肱骨近端骨折提供解剖学依据。方法在30具成人肩标本上,测量腋神经上缘与大结节顶点、肩峰上缘的距离;模拟手术操作,观察肱骨头颈、腋神经、旋肱前后动脉与克氏针的关系。结果经统计分析大结节顶点、肩峰上缘距腋神经距离分别为34.1±3.7 mm,53.4±5.5 mm;大结节距水平基准线的距离为31.8±2.8 mm,固定肱骨头克氏针在距肱骨头至水平基准线1.5倍距离以上时进针不会损伤腋神经;固定大结节克氏针在≥60°进针时出针点在肱骨颈下方1~2 cm,远离血管神经。结论大结节下0~3 cm是手术操作的相对安全区域,固定肱骨头的克氏针进针点应在距肱骨头至水平基准线1.5倍以上距离,固定大结节的克氏针与肱骨干保持≥60°成角,有助于避免损伤腋血管神经。 |
| 关键词: 小切口 肱骨近端骨折 解剖 克氏针 |
| DOI：10.3969/j.issn1008-0392.2012.01.004 |
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| 基金项目: |
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| Applied anatomy of anterolateral transverse incision in treatment of proximal humeral fractures |
| SUN Wan-ju1,2,WANG YU-bin1,CAI Jun-feng1,NI Ming2 |
| (1.Dept.of Orthopedics,East Hospital,Tongji University,Shanghai 201200,China; 2.Dept.of Orthopedics,People’ s Hospital of Pudong District,Shanghai 201200,China) |
| Abstract: |
| Objective To provide anatomic basis for clinical application of anterolateral transverse incision for treatment of proximal humeral fractures.Methods The distances between the axillary nerve to culminating point of greater tuberosity and superior border of acromial bone were measured on 30 cadaveric shoulder joints.And K-wires were inserted from greater tuberosity toward to interoinferiorly for stabilize the fractured greater tuberosity.The relationship of K-wires with humeral neck, the nerves and the arteries were observed on the shoulder joints after insertion of pins.Results The distances from axillary nerve to culminating point of greater tuberosity and superior border of acromial bone were(34.1±3.7) mm and(53.4±5.8) mm,respectively.The distances from standard line to culminating point of greater tuberosity were(31.8±2.8) mm.When pin was inserted on the 1.5 times distances from standard line to culminating point of greater tuberosity,it would not injury the nerves.When inserted from greater tuberosity toward intero-inferiorly with 60°would not injury the nerves and the arteries.Conclusion The anatomic study suggests that with the anterolateral acromial approach,0~3 cm below greater tuberosity is relative safe area and proper manipulation of pin insertion would avoid nerve and artery injury. The point insert pin is far away 1.5 times from the distances from standard line to culminated point of greater tuberosity.When insert from greater tuberosity toward to intero-inferiorly with 60°,the Kwires always won’t injury the nerve and the arteries. |
| Key words: minimal incision proximal humeral fracture anatomy K-wire |
