微创治疗桡骨远端骨折安全进针区域的解剖学研究

目的　测量桡骨茎突在腕关节不同角度时与周围肌腱、血管的距离，探讨手法复位经皮闭合穿针内固定术微创治疗桡骨骨折经桡骨茎突的相对安全进针区域。 方法　20侧成人前臂标本，以腕部外固定支架固定腕部，分别在腕关节掌屈0°、20°、40°、60°和尺偏0°、30°等8个位置，测量桡骨茎突最高点与桡侧腕长伸肌腱、拇短伸肌腱的最短距离，桡骨茎突最高点与桡侧腕长伸肌腱、拇长伸肌腱、拇短伸肌腱、桡动脉各交点的距离。 结果　腕关节掌屈、尺偏运动引起桡骨茎突周围肌腱相对位置规律性地变化，腕关节在尺偏30°掌屈0°~20°范围内时，桡骨茎突的相对安全进针区域最大。 结论　以桡骨茎突最高点为体表标志，当腕关节在尺偏30°掌屈0°~20°范围内，桡骨茎突最高点周围一定距离范围内，经皮克氏针固定桡骨骨折，能最大限度降低对肌腱及血管的损伤率。

Safe nail insertion area for treating distal radius fracture by minimally invasive surgery: anatomic investigation

Objective　To explore the relative safe nail insertion area, for manipulative reduction and the closed transcutaneous pining internal fixation microtrauma treatment of radius fracture, by measuring the distances from the wrist joint to radial styloid, tendon and blood-vessel at different wrist angles.　Methods　The wrist specimens of 20 adult forearm were fasted with external fixator. Under the palmar flexion positions of 0°, 20°, 40° and 60°, and the ulnar deviation of 0° and 30° respectively, the shortest distances between radius styloid vertex and carpi radialis longus muscle tendon, and that between radius styloid vertex and extensor pollicis brevis muscle tendon, between radius styloid vertex and the intersection point of carpi radialis longus muscle tendon, extensor carpi radialis brevis muscle tendon, extensor pollicis brevis muscle tendon and radial artery were measured respectively.　Results　Under the palmar flexion and ulnar deviation, the tendons surrounding radius styloid changed their position regularly. Safe nail insertion area amplified under the position of ulnar deviation about 30°, and palmar flexion 0° to 20°.　Conclusions　Taking radius styloid vertex as the surface landmark, with the wrist position of the ulnar deviation 30°, and palmar flexion about 0° to 20°, the treatment of radius fracture by Kirschner wire will be favorable for protecting the adjacent vessels and neves.