【摘要】：目的： 通過(guò)骨間后神經(jīng)(Posterior interosseous nerve)的解剖學(xué)研究尋找一種防止神經(jīng)損傷的新方法,探索一種更為安全的手術(shù)入路,從而指導(dǎo)臨床前臂手術(shù),進(jìn)一步增強(qiáng)手術(shù)的安全性。 材料與方法： 1.福爾馬林固定的成人上肢尸體標(biāo)本20例,左右各10例,新鮮成年上肢標(biāo)本8例,左右各4例。 2.對(duì)防腐標(biāo)本進(jìn)行大體解剖,顯露旋后肌及骨間后神經(jīng),觀察神經(jīng)的走行及位置,分別測(cè)量：L1(神經(jīng)發(fā)出點(diǎn)與橈骨小頭的距離)、L2(神經(jīng)發(fā)出點(diǎn)與進(jìn)入旋后肌點(diǎn)的距離)、L3(神經(jīng)穿出旋后肌的部位與橈骨小頭的距離)、L4(橈骨莖突與橈骨小頭的距離)、L5(神經(jīng)穿出旋后肌的部位與肱骨外上髁和Lister結(jié)節(jié)連線的水平距離)、L6(神經(jīng)從旋后肌穿出點(diǎn)至尺骨內(nèi)緣的水平距離)、L7(神經(jīng)與橈骨頸外側(cè)中線交叉點(diǎn)至橈骨小頭的距離)和R(神經(jīng)旋后肌出入點(diǎn)連線和橈髁線的夾角)。 3.將前臂置于旋前位,以肱骨外上髁(A)、尺骨莖突(D)、橈骨Lister結(jié)節(jié)(E)三點(diǎn)連成一個(gè)三角形,再將A點(diǎn)與DE連線的中點(diǎn)(F)連接起來(lái),觀察骨間后神經(jīng)各肌支與ADE三角、AF線的關(guān)系。 4.暴露骨間后神經(jīng)前臂各肌支,仔細(xì)分離出各肌支及其入肌點(diǎn),顯露并觀察各肌支的走行和分布情況,測(cè)量各肌支發(fā)出點(diǎn)和入肌點(diǎn)至肱骨外上髁的距離及肌支數(shù)目。 結(jié)果： 1.骨間后神經(jīng)主干測(cè)量結(jié)果單位：mm (x±s, n左側(cè)=14,n右側(cè)=14) L1左14.74±0.24,右15.82±0.56；L2左31.76±0.32,右30.52±0.48；L3左65.70±0.92,右63.26±0.31；L4左230.26±0.23,右232.34±0.54；L5左6.22±0.34,右6.86±0.26；L6左25.34±0.53,右24.82±0.67；L7左42.74±0.62,右43.58±0.28。 2.骨間后神經(jīng)旋后肌出入點(diǎn)連線和橈髁線的夾角R左30.0°±0.2°,右32.0°±0.1°(x±s,n左側(cè)=14,n右側(cè)=14) 3.骨間后神經(jīng)各肌支發(fā)出點(diǎn)和入肌點(diǎn)至肱骨外上髁的距離和入肌支數(shù)單位：mm(x±s,n=28) 肱橈肌支39.44±0.15,11.78±0.32,1.9±0.2；橈側(cè)腕長(zhǎng)伸肌支35.52±0.16,10.94±0.36,1.8±0.1;橈側(cè)腕短伸肌支45.92±0.32,66.92±0.12,2.6±0.1；旋后肌支61.94±0.57,67.92±0.14,1.6±0.3；指伸肌支69.82±0.36,93.98±0.02,4.9±0.2；尺側(cè)腕伸肌支76.92±0.58,92.94±0.37,2.9±0.4；小指伸肌支78.82±0.48,95.76±0.12,1.3±0.2；拇長(zhǎng)展肌支96.74±0.18,125.92±0.36,1.1±0.1；拇短伸肌支103.22±0.52,144.52±0.12,1.5±0.3；拇長(zhǎng)伸肌支102.92±0.64,130.36±0.82,1.0±0.1；示指伸肌支130.98±0.74,148.46±0.48,1.0±0.2;肘肌支101.38±0.58,10.18±0.78,1.1±0.2。 4.骨間后神經(jīng)主干位于AF線上者占78.6%(22例),位于AF線橈側(cè)者占10.7%(3例),尺側(cè)者占10.7%(3例)。 結(jié)論： 1.區(qū)域定位和線性定位相結(jié)合是一種更為準(zhǔn)確的骨間后神經(jīng)的定位方法。 2.旋后肌穿出點(diǎn)可作為骨間后神經(jīng)一個(gè)重要的定位標(biāo)志。
[Abstract]:Objective: to find a new method to prevent nerve injury through anatomical study of posterior interosseous nerve (Posterior interosseous nerve), and to explore a more safe surgical approach to guide clinical forearm operation and further enhance the safety of operation. Materials and methods: 1. 20 adult cadavers were fixed with formalin, 10 cases were left and right, 8 cases were fresh adult upper limbs, 4 cases were left and right. 2. The antiseptic specimens were dissected and exposed to the reflex muscle and the posterior interosseous nerve. The route and position of the nerve were observed and measured: L1 (distance between the nerve emitting point and the radial head), L2 (the distance between the nerve emitting point and the point entering the pronation muscle), L3 (distance between the nerve passing through the pronator muscle and the head of the radius), L4 (the distance between the styloid process of the radius and the capitulum of the radius), L5 (the horizontal distance between the location of the nerve passing through the pronator muscle and the line between the lateral epicondyle of the humerus and the Lister nodule), L6 (horizontal distance from the point of exiting the pronator muscle to the inner margin of the ulna), L7 (the distance between the nerve and the lateral midline of the radial neck and the radial head) and R (the angle between the entry and exit point of the pronator muscle and the radial condyle line). 3. The forearm was placed in the pronation position and was triangulated by the Lister node (E) of the ulna styloid process (D), of the lateral epicondyle of the humerus (E), and then the A point was connected with the midpoint (F) of the DE line. The relationship between muscle branches of posterior interosseous nerve and ADE triangle and AF line was observed. 4. The muscle branches of the forearm of the posterior interosseous nerve were exposed, the muscle branches and their entry points were carefully separated, the movement and distribution of the muscle branches were observed and the distance between the origin and entry points of the muscle branches to the external epicondyle of the humerus and the number of the muscle branches were measured. Results: 1. The main trunk of posterior interosseous nerve was measured in units of: mm (x 鹵s, n left = 14n right = 14) L1 left 14.74 鹵0.24, right 15.82 鹵0.56L 2, left 31.76 鹵0.32, right 30.52 鹵0.48 L 3, left 65.70 鹵0.92, right 63.26 鹵0.31; L4 left 230.26 鹵0.23, right 232.34 鹵0.54L 5 left 6.22 鹵0.34, right 6.86 鹵0.26L 6 left 25.34 鹵0.53, right 24.82 鹵0.67L 7 left 42.74 鹵0.62, right 43.58 鹵0.28. 2. The angle between the line and the radial condyle was 30.0 擄鹵0.2 擄left and 32.0 擄鹵0.1 擄right (x 鹵stin left = 14 n, right side = 14 擄). The distance between the muscular branches of the posterior interosseous nerve and the lateral epicondyle of the humerus and the number of branches in the muscle of the posterior interosseous nerve were 39.44 鹵0.1511.78 鹵0.321.9 鹵0.2; The branch of extensor Carpi longus radialis was 35.52 鹵0.16 鹵10.94 鹵0.36 鹵1.8 鹵0.1, the branch of extensor Carpi brevis was 45.92 鹵0.32 鹵0.122.62 鹵0.1, the branch of pronator muscle was 61.94 鹵0.57 鹵0.47 鹵0.147.92 鹵0.147.92 鹵0.14 鹵0.3, the branch of extensor Carpi longus radialis was 45.92 鹵0.32 鹵0.12 鹵0.1; The branches of extensor digitorum musculi 69.82 鹵0.3693.98 鹵0.02fl. 9 鹵0.2, extensor carpi ulnaris 76.92 鹵0.58l92.94 鹵0.372.94 鹵0.44,78.82 鹵0.482 鹵0.125.76 鹵0.121.3 鹵0.2, branch of abductor pollicis longus 96.74 鹵0.18125.92 鹵0.365.92 鹵0.1. The branches of extensor pollicis brevis were 103.22 鹵0.52144.52 鹵0.121.51.5 鹵0.3, the branches of extensor pollicis longus 102.92 鹵0.64130.36 鹵0.821.0 鹵0.1, the branches of extensor digitorum 130.98 鹵0.74148.46 鹵0.481 鹵0.2, and the branches of elbow muscle 101.38 鹵0.5810.18 鹵0.781.1 鹵0.2. 4. The posterior interosseous nerve trunk was located on the AF line in 22 cases (78.6%), in the radial side of the AF line in 3 cases (10.7%), and in the ulnar side in 3 cases (10.7%). Conclusion: 1. The combination of regional location and linear location is a more accurate method for locating posterior interosseous nerve. 2. The perforating point of pronator muscle can be used as an important localization marker of posterior interosseous nerve.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R322

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