用于显露前臂骨间膜的桡骨背侧入路应用解剖

目的 找出显露前臂骨间膜的最佳入路.方法 用卡尺测量了30例成人上肢,测量项目如下:桡骨头至旋后肌腱弓处骨间背神经的长度(LHA);桡骨头到旋后肌管下口之间骨间背神经的长度(LHS);骨间背神经从旋后肌管下口至桡骨外缘的距离(DSR);骨间背神经从旋后肌管下口至尺骨内缘的距离(DSU);骨间背神经最外侧分支穿拇长展肌处至桡骨外缘的距离(DSP).结果 LHA、LHS、DSR、DSU和DSP的测量结果分别为19.3±4.4mm(11mm～29mm)、53.4±5.2mm(45mm～62mm)、9.7±3.1mm(4mm～15mm)、22.8±3.5mm(20mm～28mm)和7.5±1.6mm(5mm～9mm).牵开拇长展肌、拇短伸肌和拇长伸肌,于桡侧腕短伸肌与指伸肌之间显露前臂骨间膜中1/3和远1/3段.结论 桡骨背侧入路可较少剥离肌肉和软组织,能方便、安全显露前臂骨间膜中1/3和远1/3段.

Applied basis of dorsoradial approach for exposing the radioulnar interosseous membrane

Objective To identify the best approach for exposing the radioulnar interosseous membrane.Method 30 paired cadaver upper limbs were used.The following paramenters were measured with a caliper: the length of the posterior interosseous nerve(PIN)from the ra-dial head to the arcade of Frohse( LHA); the length of the PIN from the radial head to the PIN exit point from the supinator muscle( LHS); the distance between the PIN exit point from the supinator muscle to the lateral margin of the radius(DSR); the distance between the PIN exit point from the supinator muscle to the ulnar margin of the ulna( DSU); the distance from the point where the most lateral branch of the PIN enters the abductor pollicis longus muscle to the lateral margin of the radius( DSP) . Results The average value of the LHA, LHS, DSR, DSU and DSP were 19.3±.4 mm(llmm- 29mm),53.4±5.2mm(45mm- 62mm),9.7 ±3.1mm(4mm- 15mm),22.8 ±3.5mm(20mm - 28mm)and 7.5 ±1. 6mm(5mm - 9mm). The middle and distal thirds of the interosseous membrane were exposed through the interval between the extensor carpi radialis brevis and extensor digitorum communis muscle,after the origin of the abductor pollicis longus,extensor pollicis brevis and exten-sor pollicis longus muscle had been elevated from the lateral margin of the radius. Conclusion The present study suggests that using dorsoradi-al approach facilitates safe exposure of the middle and distal thirds of interosseous membrane with less muscle dissection and soft tissue strip-ping.