腕掌侧双通道改良手术入路治疗桡尺骨远端骨折的解剖学基础

目的　报道腕掌侧双通道入路治疗桡尺骨远端骨折的应用解剖学基础。 方法 10侧新鲜成人尸体上肢标本，于腕掌侧在桡侧腕屈肌腱与掌长肌腱之间做纵行切口，进入皮下后向桡侧、尺侧绕过腕管内结构，通过双通道入路来观测桡骨、尺骨远端的暴露情况。 结果 在腕横纹上方3.0 cm水平，桡侧通路牵拉最大横向暴露距离为(3.0±0.29) cm，尺侧通路牵拉最大横向暴露距离为(2.3±0.26) cm，桡侧通路暴露桡骨远端尺侧半效果欠佳，而尺侧通路可以有效暴露桡骨远端尺侧半及尺骨远端。 结论 腕掌侧双通道改良手术入路治疗桡尺骨远端骨折具有可行性，暴露效果良好，值得在临床上推广。

The anatomical study of volar dual-channel surgical approach for treatment of distal radioulnar fracture

Objective To study the anatomical basis of volar dual-channel surgical approach for treatment of distal radioulnar fracture. Methods Ten fresh adult upper limb specimens were dissected and observed. A longitudinal incision was made between the flexor carpi radialis tendon and palmaris longus tendon. Carpal canal was bypassed from the ulnar and radial sides respectively and the surgical field exposure of distal radioulnar fracture was observed. Result Maximum transverse exposed distance of radial lateral channel was (3.0±0.29) cm and maximum transverse exposed distance of ulnar lateral channel was (2.3±0.26) cm, 3 cm above the volar wrist creases. Compared with radial lateral channel, ulnar lateral channel got better exposure of the ulnar aspect of the distal radius and distal ulnar bone. Conclusion Volar dual-channel surgical approach of the distal radioulnar fracture, which is a safe and effective surgical methods with satisfying exposure, is worth of clinical promotion.