新型微创前置肱骨中下段解剖锁定钢板的设计及相关解剖研究

目的 探讨应用自行研制的3.5 mm新型前置肱骨中下段解剖锁定钢板微创治疗肱骨干中下段骨折的可行性和安全性.方法 新鲜冷冻成人上肢6具,分别于上臂前侧远近端做3 cm皮肤切口,通过肌下隧道插入钢板,经切口打入螺钉固定.原位解剖重要神经结构,观察其与钢板的关系,测量桡神经在不同位置与钢板外侧缘、钢板最远端内侧与正中神经、螺钉头部与桡神经沟处桡神经的距离.结果 新增前置肱骨中下段解剖锁定钢板远端的绝大部分被肱肌覆盖,其与桡神经、肌皮神经及正中神经之间隔有肱肌肌腹,钢板与桡神经之间分别在穿经外侧肌间隔以及冠状窝水平的距离平均分别为14.53 mm和8.38 mm,桡神经穿经外侧肌间隔至冠状窝上缘连线中点处的平均距离为8.39 mm;屈肘80°和伸肘0°位时钢板最远端内侧与正中神经的距离平均分别为11.89 mm和l0.53mm,由近向远的第3枚螺钉头部与桡神经沟近侧缘的距离平均为5.90 mm.结论 采用自行研制的新型前置解剖锁定钢板微创固定肱骨干中下段骨折理论上是可行且安全的.

Abstract：

Objective To verify the feasibility and safety of a self-designed anatomical anterior locking plate for minimally invasive treatment of mid-distal humeral fractures. Methods Six fresh-frozen cadaveric specimens of upper extremity were used for the present anatomic study.A 3 cm incision was made on the anterior side of the arm between the deltoid muscle and biceps muscle and another 3 cm incision was made along the lateral side of biceps muscle proximal to the cubital crease to expose the anterior cortex.The plate was inserted from the distal incision proximally and positioned on the anterior side of the humeral shaft.The biceps muscle and brachialis were dissected to expose the radial,musculocutaneous and median nerves in situ.Relationships between the plate and nerves were observed.The distances between the lateral border of the plate and the radial nerve were measured where the nerve pierced the lateral intermuscular septum and at the point above the coronoid fossa and at the middle of the above 2 points.The distances between the distal end of the plate and the median nerve were measured when the elbow was in 80° flexion and full extension.The distance between the head of the third proximal screw and the spiral groove was also measured. Results Most part of the plate was covered by the brachial muscle.There was no direct contract between the plate and the radial,musculocutaneous and median nerves,all separated by the muscle belly of the brachialis.The average distances between the lateral border of the plate and the radial nerve where the nerve pierced the lateral intermuscular septum and at the superior edge of the coronoid fossa and at the middle of the 2 points were 14.53 mm (range,13.1 to 17.1 mm),8.38 mm (range,4.2 to 11.3 mm) and 8.39 mm (range,0 to 13.9 mm) respectively.The average minimum distances between the medial border of the distal end of the plate and the median nerve when the elbow was in 80° flexion and full extension was 11.89 mm (range 9.6 to 15.5 mm) and 10.53 mm (range 9.0 to 12.1 mm) respectively.The average distance between the head of the third proximal screw and the spiral groove was 5.90 mm (range,4.2 to 7.1 mm). Conclusions Our novel anatomical anterior locking plate is theoretically safe for the minimally invasive treatment of mid-distal humeral fractures.

A self-designed anatomical anterior locking plate for minimally invasive treatment of mid-distal humeral fractures

Objective To verify the feasibility and safety of a self-designed anatomical anterior locking plate for minimally invasive treatment of mid-distal humeral fractures. Methods Six fresh-frozen cadaveric specimens of upper extremity were used for the present anatomic study.A 3 cm incision was made on the anterior side of the arm between the deltoid muscle and biceps muscle and another 3 cm incision was made along the lateral side of biceps muscle proximal to the cubital crease to expose the anterior cortex.The plate was inserted from the distal incision proximally and positioned on the anterior side of the humeral shaft.The biceps muscle and brachialis were dissected to expose the radial,musculocutaneous and median nerves in situ.Relationships between the plate and nerves were observed.The distances between the lateral border of the plate and the radial nerve were measured where the nerve pierced the lateral intermuscular septum and at the point above the coronoid fossa and at the middle of the above 2 points.The distances between the distal end of the plate and the median nerve were measured when the elbow was in 80° flexion and full extension.The distance between the head of the third proximal screw and the spiral groove was also measured. Results Most part of the plate was covered by the brachial muscle.There was no direct contract between the plate and the radial,musculocutaneous and median nerves,all separated by the muscle belly of the brachialis.The average distances between the lateral border of the plate and the radial nerve where the nerve pierced the lateral intermuscular septum and at the superior edge of the coronoid fossa and at the middle of the 2 points were 14.53 mm (range,13.1 to 17.1 mm),8.38 mm (range,4.2 to 11.3 mm) and 8.39 mm (range,0 to 13.9 mm) respectively.The average minimum distances between the medial border of the distal end of the plate and the median nerve when the elbow was in 80° flexion and full extension was 11.89 mm (range 9.6 to 15.5 mm) and 10.53 mm (range 9.0 to 12.1 mm) respectively.The average distance between the head of the third proximal screw and the spiral groove was 5.90 mm (range,4.2 to 7.1 mm). Conclusions Our novel anatomical anterior locking plate is theoretically safe for the minimally invasive treatment of mid-distal humeral fractures.