肘前侧入路治疗尺骨冠突骨折的解剖与临床研究

来源 :中华骨科杂志 | 被引量 : 0次 | 上传用户:lh305879918
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:探讨经屈肌和旋前圆肌肌间隙的肘前侧入路显露尺骨冠突的可行性及临床研究。方法成人肘关节标本5肢,分别经旋前圆肌和桡侧腕屈肌间隙显露冠突尖、经掌长肌和尺侧腕屈肌间隙显露冠突前内侧面及基底部,测量正中神经由肘部发出至旋前圆肌、桡侧腕屈肌、掌长肌和指浅屈肌的肌支长度、尺神经至尺侧腕屈肌最近端两肌支的长度及发出点和入肌门处距肱骨内、外上髁连线的距离。2013年9月至2014年8月,采用肘前侧入路治疗4例左侧尺骨冠突骨折男性患者,年龄16~42岁,平均32岁。按O’Driscoll分型,Ⅰb型和Ⅱb型骨折各2例;采用经屈肌和旋前圆肌肌间隙显露并复位固定尺骨冠突骨折。结果旋前圆肌肌支为2~3支,指浅屈肌肌支以一主干前行至邻近肌肉再发出2~5支短细肌支,桡侧腕屈肌和掌长肌肌支以1支型最多,掌长肌肌支多与指浅屈肌肌支共干。指浅屈肌肌支为跨越旋前圆肌和桡侧腕屈肌间隙最近侧的肌支,入肌点平均距内、外上髁连线37.22 mm。经旋前圆肌和桡侧腕屈肌间隙适合显露冠突尖,在指浅屈肌肌支近侧操作;经掌长肌和尺侧腕屈肌间隙适合显露冠突前内侧和基底,经尺神经和正中神经界面进入。4例冠突骨折患者平均随访9个月,冠突骨折顺利愈合,愈合时间为6周至3个月,平均9周。末次随访时,改良An和Mor?rey肘关节评分为94~100分,均评价为优。结论经屈肌和旋前圆肌肌间隙的肘前侧入路是显露尺骨冠突的理想入路。“,”Objective To investigate the feasibility of a noval anterior cubital approach for the coronoid via flexor?prona?tor teres interval and assess the clinical result. Methods Five formalin?fixed adult cadaver elbows were used. Through a single universal anteromedial longitudinal skin incision, the coronoid tip was exposed via pronator and flexor carpiradialis interval, and coronoid anteromedial facet and base via palm longus and flexor carpi ulnaris interval. The distances from the entry point to the muscles or branching point of the nerves to the line passing through medial and lateral epicondyles, as well as the length were mea?sured with regard to the motor nerve branches arising from median nerve to pronator teres, flexor carpiradialis, palm longus and flexor digiti superficialis, as well as the most proximal two motor branches to flexor carpi ulnaris arising from ulnar nerve. From September 2013 to August 2014, 4 male patients with ulnar coronoid fracture were treated operatively through the above anterior cubital approach in our hospital. They were all left side involved, with an average age of 32 years (range, 16-42 years). According to O’Driscoll classification, there were two cases of type Ib and two cases IIb respectively. They were all treated by open reduction and internal fixation through flexor?pronator teres interval. Results At cubital fossa, there were 2-3 branches to the pronator teres mostly, 1 branch to flexor carpiradialis and palm longus arising from median nerve. The branch to the flexor digiti superficia?lis usually was long and thick, and divided into 2-5 short twigs near muscle. The branch to palm longus had the same trunk with that to flexor digiti superficialis. The branch to flexor digiti superficialis was the most proximal among those passed through the in?terval of pronator teres and flexor carpiradialis, and its entry point to the muscle had an averaged distance of 37.22 mm to the line passing through medial and lateral humeral epicondyles. It was optimal to expose coronoid tip through the interval of pronator teres and flexor carpiradialis. It was safe to expose coronoid proximal to the branch to flexor digiti superficialis. While, it was better to expose the anteromedial facet and base of corocoid through the interval of palm longus and flexor carpiulnaris via median and ul?nar nerve interface. All of the four patients were followed up for an average period of 9 months. They all achieved bone union from 6 weeks to 3months (mean, 9 weeks). All the patients obtained excellent result according to the modified An&Morrey elbow per?formance index with scores from 94 to 100. Conclusion The novel anteromedial cubital approach via flexor?pronator teres is opti?mal for exposure of coronoid.
其他文献
光催化氧化法降解水中有机污染物是近来发展较为迅速的废水处理技术.以锐钛型载银TiO2为催化剂,在发射光谱波长为254nm、功率的15W紫外灯照射下,考察不同H2O2浓度对Aroclor12
There are nearly 1 000 rice landrace varieties in the Taihu basin, China. To assess the genetic diversity of the rice, 24 intragenic molecular markers(represent
通过把起相转移作用的聚乙二醇(PEG)链,键合到硅胶上,再将聚乙烯吡咯烷酮(PVP)络合双金属Pd-Cu后负载其上,制成一种新型双负载双金属催化剂PVP-PdCl2-CuCl2/SiO2-PEG600,以甲
该文从挂篮荷载计算、施工流程、支座及临时固结施工、挂篮安装及试验、合拢段施工、模板制作安装、钢筋安装、混凝土的浇筑及养生、测量监控等方面人手,介绍了S226海滨大桥
期刊
Photoperiodic response is an important characteristic that plays an important role in plant adaptability for various environments. Wheat cultivars grow widely a
为了改善明胶生产废水高碱、高钙和高悬浮有机物污染,探索了磷酸氢钙清洁回收工艺.首先沉淀除去浸灰废液中的石灰,得浸灰清液.将浸酸废液加入浸灰清液中,调节pH至4.7~11.5,沉
Six cultivated and two wild genotypes of mungbean(Vigna radiata L. Wilczek) possessing variation for phenotypic and genotypic response for salt tolerance were h
Cotton Verticillium wilt is a serious soil-borne disease that leads to significant losses in fiber yield and quality worldwide. Currently, the most effective wa