肱骨近端骨折内固定相关应用解剖学研究
Applied anatomy of the internal fixation of proximal humeral fracture
目的 为肱骨近端骨折内固定提供解剖学基础。 方法 成人尸体肩关节标本10具20侧。从三角肌前中部肌束间隙钝性分离游离出腋神经，将钢板插入腋神经与骨之间，固定于肱骨大结节顶点下方，结节间沟后方。测量腋神经上缘与大结节顶点、与肩峰上缘的距离。截取带钢板的肱骨近端进行体外测量并观察钢板螺钉与肱骨头颈、大结节顶点和结节间沟的关系。 结果 大结节顶点、肩峰上缘距腋神经距离分别为(3.44±0.38)cm和(5.44±0.62)cm；钢板上缘到肱骨大结节顶点距离为(0.59±0.14)cm，到结节间沟距离为(0.74±0.19)cm。体外观察并测量见钢板置于肱骨大结节顶点下0.5 cm，结节间沟后方0.5 cm时螺钉平行肱骨颈并位于肱骨颈中央。 结论 (1)肱骨大结节下2.90~4.32 cm是容易损伤腋神经的危险区域。(2)肱骨大结节顶点下0.50 cm，结节间沟后方0.50 cm是钢板放置的最佳位置。(3) PHILOS钢板的C、D、E孔和LPHP的C、D孔是危险区域。
Objective To provide anatomic basis for the internal fixation of proximal humeral fracture. Methods 20 shoulder joint specimens from 10 adult cadavers were dissected. Axillary nerves were isolated from the muscle bundle interspace of deltoid, and followed by the insertion of the plate between the nerve and humerus, under the apex of greater tuberosity and behind the intertubercular sulcus. The distances from the superior border of axillary nerve to the apex of greater tuberosity and the superior border of acromial bone were measured and analyzed. The proximal humerus connected with the plate were resected for observing the relationship of the head and neck of humerus with the plate, while, the distance from the upper border of the plate to the apex of greater tuberosity, from the anterior border of the plate to the intertubercular sulcus were measured. Results The distances from axillary nerve to the apex of greater tuberosity and the superior border of acromial bone were separately (3.44±0.38)cm and (5.44±0.62)cm；The distance from the upper border of the plate to the apex of greater tuberosity was (5.44±0.62) cm, as well from anterior border of the plate to the intertubercular sulcus (0.74±0.19) cm. The screws paralleled with the neck of humerus and located in the middle of it when the plate placed 0.5mm below the apex of greater tuberosity, and 0.5cm behind the intertubercular sulcus. Conclusions (1) The site below the greater tuberosity about 29~43.2 mm is the dangerous area for damaging axillary nerve during the anterolateral acromial approach. (2) The optimal plate inserting position is below the apex of greater tuberosity about 0.5cm, and behind the intertubercular sulcus about 0.5cm. (3) The screw holes of C，D and E of PHILOS, as well that of C and D of LPHP, are dangerous zones during the fixation approach.
Proximal humeral fracture / Applied anatomy / interal fixation / Minimal invasive surgery
[1] Gardner MJ, Boraiah S, Helfet DL, et al. The anterolateral acromial approach for fractures of the proximal humerus
[J]. J Orthop Trauma, 2008, 22(2):132-137.
[2]安智全, 王烨明, 曾炳芳. 肩部前外侧小切口入路肱骨近端锁定钢板（LPHP）治疗肱骨近端骨折
[J].中华创伤骨科杂志, 2005, 7(9):820-822.
[3] Gardner MJ, Griffith MH, Dines JS, et al. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus
[J]. Clin Orthop Relat Res, 2005, (434): 123-129.
[4] La?覱amme GY, Rouleau DM, Berry GK, et al. Percutaneous humeral plating of fractures of the proximal humerus: results of a prospective multicenter clinical trial
[J]. J Orthop Trauma
[J]. 2008, 22(3):153-158.
[5] Roderer G, AbouElsoud M, Gebhard F, et al. Minimally invasive application of the Non-Contact-Bridging (NCB) plate to the proximal humerus: an anatomical study
[J]. J Orthop Trauma, 2007, 21(9):621-627.
[6] Prince EJ, Breien KM, Fehringe EV, et al. The relationship of proximal locking screws to the axillary nerve during antegrade humeral nail insertion of four commercially available implants
[J]. J Orthop Trauma, 2004,18(9):585-588.
[7] Nicandri GT, Trumble TE, Warme WJ, et al. Lessons learned from a case of proximal humeral locked plating gone awry
[J]. J Orthop Trauma, 2009, 23(8):607-611.
[8] Uz A, Apaydin N, ozkurt M, et al. The anatomic branch pattern of the axillary nerve
[J]. J Shoulder Elbow Surg, 2007, 16(2):240-244.
[9] 金 宇, 管 力, 徐 从, 等. 腋神经分支方式的解剖学观察及其临床意义
[J].北京医学, 2008, 30(1):51-52.
[10]Burkhead WZ, Scheinberg RR, Box G, et al. Surgical anatomy of the axillary nerve
[J]. J Shoulder Elbow Surg, 1992,1:131-136.
[11]Kontakis GM, Steriopoulos K, Damilakis J, et al. The position of the axillary nerve in the deltoid muscle: A cadaveric study
[J]. Acta Orthop Scand , 1999,70(1):9-11.
[12]Vathana P, Chiarapattanakom P, Ratanalaka R, et al. The relationship of the axillary nerve and the acromion
[J]. J Med Assoc Thai, 1998, 81(12):953-957.
京ICP备08002354号-3/
| 〈 |
|
〉 |
