改良肘关节前正中经神经血管入路治疗冠状突骨折

doi:10.13418/j.issn.1001-165x.2025.4.02

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中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (4) : 373-378. DOI: 10.13418/j.issn.1001-165x.2025.4.02

肘关节运动损伤诊疗策略

改良肘关节前正中经神经血管入路治疗冠状突骨折

张清，邓明月，李一平，郑金文，杨金松，代飞，向明*

作者信息 +

Modified anterior median neurovascular approach for the treatment of coronoid process fractures of elbow joint

Zhang Qing, Deng Mingyue, Li Yiping, Zheng Jinwen, Yang Jinsong, Dai Fei, Xiang Ming*

Author information +

文章历史 +

摘要

目的探讨一种新的前正中经神经血管入路治疗肘关节冠状突骨折的解剖学基础及临床应用。方法采用臂丛神经阻滞联合全身麻醉肘关节冠状突骨折患者，副韧带损伤评估。沿肘前皮肤横纹下、肘前内侧切口，经肘关节前方肱血管与正中神经间隙入路，显露内侧副韧带及内后侧结构、尺骨冠状突及前关节囊和内侧副韧带前束，纵切前关节囊，暴露尺骨冠状突骨折部位，直视下复位、固定处理，修补内侧副韧带、前关节囊等结构。术后透视确认肘关节内、外翻应力试验及前后抽屉试验，确认肘关节稳定性的恢复。结果改良前正中经神经血管入路能提供清晰的手术视野、骨折区暴露清晰，可避免损伤正中神经和肱动脉，骨折块获得精准复位。术后通过主动及辅助功能锻炼，可促进肘关节力功能恢复。结论改良前正中经神经血管入路在治疗肘关节冠状突骨折方面具有显著优势，能够提高骨折愈合率和关节功能，促进患者早期康复。

Abstract

Objective To explore the anatomical basis and clinical application of a novel anterior median neurovascular approach for the treatment of coronoid process fractures of elbow joint. Methods After brachial plexus block combined with general anesthesia, patients with elbow coronoid fracture were assessed of damage degree of the collateral ligament. An incision is made along the transverse crease of the skin in front of the elbow and the inner side of the elbow. The medial collateral ligament and the posterior structures, the coronoid process of the ulna, the anterior joint capsule, and the anterior bundle of the medial collateral ligament were exposed through the space between the brachial artery and the median nerve in front of the elbow joint, The anterior joint capsule is longitudinally cut to expose the fracture site of the coronoid process, and then the medial collateral ligament, anterior joint capsule, and other structures were repaired under direct visualization for reduction and fixation. Elbow joint stability was evaluated by postoperative stress tests and the anterior and posterior drawer tests. Results The improved median nerve vascular approach could provide a clear surgical field of view for surgical procedure. By this approach, the fracture area exposed clearly, protected the median nerve and brachial artery, and achieved precise recovery of the fracture fragment. Postoperative functional exercises was favorable for function recovery of elbow joint. Conclusions The modified anterior median neurovascular approach has significant advantages in treating coronal process fractures of the elbow joint, which can improve fracture healing, and promote early functional recovery of patients.

导出引用

张清, 邓明月, 李一平, 郑金文, 杨金松, 代飞, 向明. 改良肘关节前正中经神经血管入路治疗冠状突骨折[J]. 中国临床解剖学杂志. 2025, 43(4): 373-378 https://doi.org/10.13418/j.issn.1001-165x.2025.4.02

Zhang Qing, Deng Mingyue, Li Yiping, Zheng Jinwen, Yang Jinsong, Dai Fei, Xiang Ming. Modified anterior median neurovascular approach for the treatment of coronoid process fractures of elbow joint[J]. Chinese Journal of Clinical Anatomy. 2025, 43(4): 373-378 https://doi.org/10.13418/j.issn.1001-165x.2025.4.02

中图分类号： R683.41

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