CAJ | 학술논문

目的　为减少前臂骨间背侧神经（posterior interosseous nerve of forearm, PINOF）的损伤提供解剖学资料，并探讨手术安全性。　方法　在30具（60例）成人尸体上，通过肘关节外侧切口，在桡骨近端后外侧或外侧面，放置1块4　cm长的微型钢板。对PINOF的起点和该神经与微型钢板的关系等进行观测。　结果　PINOF起点距桡骨头上缘的距离为（1.1±1.8）　mm。桡侧腕长伸肌肌支发出点距桡骨头上缘的距离为（6.2±1.9）　mm。56例（93%）PINOF至微型钢板的距离为（5.0±1.1）　mm，4例（7%）PINOF通过微型钢板远端的上方进入旋后肌。前臂旋前位时，PINOF离开该切口，向内侧移动的距离为（10.0±1.3）　mm。应用改良式预弯微型钢板治疗桡骨头粉碎性骨折11例，伴发外伤性和术中牵拉造成PINOF损伤各1例。11例均获随访，平均随访25个月，2例PINOF损伤完全恢复，平均恢复时间2.8个月。　结论　采用肘关节外侧切口时，在桡骨近端的外侧面或后外侧面，距离桡骨头上缘3.5　cm的范围内，是放置微型钢板的安全区。
목적　위감소전비골간배측신경（posterior interosseous nerve of forearm, PINOF）적손상제공해부학자료，병탐토수술안전성。　방법　재30구（60례）성인시체상，통과주관절외측절구，재뇨골근단후외측혹외측면，방치1괴4　cm장적미형강판。대PINOF적기점화해신경여미형강판적관계등진행관측。　결과　PINOF기점거뇨골두상연적거리위（1.1±1.8）　mm。뇨측완장신기기지발출점거뇨골두상연적거리위（6.2±1.9）　mm。56례（93%）PINOF지미형강판적거리위（5.0±1.1）　mm，4례（7%）PINOF통과미형강판원단적상방진입선후기。전비선전위시，PINOF리개해절구，향내측이동적거리위（10.0±1.3）　mm。응용개량식예만미형강판치료뇨골두분쇄성골절11례，반발외상성화술중견랍조성PINOF손상각1례。11례균획수방，평균수방25개월，2례PINOF손상완전회복，평균회복시간2.8개월。　결론　채용주관절외측절구시，재뇨골근단적외측면혹후외측면，거리뇨골두상연3.5　cm적범위내，시방치미형강판적안전구。
Objective　To provide an anatomical description of the posterior interosseous nerve of forearm (PINOF) in order to reduce injury risk during operation.　Methods　In 60 specimens from 30 adult cadavers, a steel miniplate was placed on posterolateral or lateral aspect proximal to the end of the radius by the lateral approach. The PINOF and the relationship of the nerve with the steel miniplate were observed. 　Results　The average distance of the PINOF between its origin and the radial head was (1.1±1.8) mm. The takeoff of the musculus extensor carpi radialis longus was located (6.2±1.9) mm proximal to the radial head. In 56 cases (93%), the distance from the PINOF to the steel miniplate was (5.0±1.1) mm. However, in 4 cases (7%), the nerve passed over the distal end of the steel miniplate within the supinator. Then the PINOF moves medially about (10.0±1.3) mm and away from the surgical approach. Of all, 11 cases were operated on to fix comminuted fractures of the radial head with a bending steel miniplate. In 2 cases, the PINOF was injured due to trauma and over retraction by retractor respectively. The average period for follow-up in 11 cases was 25 months; 2 cases recovered with an average recovery time of 2.8 months. 　Conclusions　The posterolateral or lateral aspect of proximal end of the radius, and distal end of the aspect within 3.5 cm to the radial head are the safe zones for a steel miniplate fixation of radial head and neck fractures, which cause very little injury of the PINOF.