CAJ | 학술논문

目的：探讨经屈肌和旋前圆肌肌间隙的肘前侧入路显露尺骨冠突的可行性及临床研究。方法成人肘关节标本5肢，分别经旋前圆肌和桡侧腕屈肌间隙显露冠突尖、经掌长肌和尺侧腕屈肌间隙显露冠突前内侧面及基底部，测量正中神经由肘部发出至旋前圆肌、桡侧腕屈肌、掌长肌和指浅屈肌的肌支长度、尺神经至尺侧腕屈肌最近端两肌支的长度及发出点和入肌门处距肱骨内、外上髁连线的距离。2013年9月至2014年8月，采用肘前侧入路治疗4例左侧尺骨冠突骨折男性患者，年龄16～42岁，平均32岁。按O’Driscoll分型，Ⅰb型和Ⅱb型骨折各2例；采用经屈肌和旋前圆肌肌间隙显露并复位固定尺骨冠突骨折。结果旋前圆肌肌支为2～3支，指浅屈肌肌支以一主干前行至邻近肌肉再发出2～5支短细肌支，桡侧腕屈肌和掌长肌肌支以1支型最多，掌长肌肌支多与指浅屈肌肌支共干。指浅屈肌肌支为跨越旋前圆肌和桡侧腕屈肌间隙最近侧的肌支，入肌点平均距内、外上髁连线37.22 mm。经旋前圆肌和桡侧腕屈肌间隙适合显露冠突尖，在指浅屈肌肌支近侧操作；经掌长肌和尺侧腕屈肌间隙适合显露冠突前内侧和基底，经尺神经和正中神经界面进入。4例冠突骨折患者平均随访9个月，冠突骨折顺利愈合，愈合时间为6周至3个月，平均9周。末次随访时，改良An和Mor?rey肘关节评分为94～100分，均评价为优。结论经屈肌和旋前圆肌肌间隙的肘前侧入路是显露尺骨冠突的理想入路。
목적：탐토경굴기화선전원기기간극적주전측입로현로척골관돌적가행성급림상연구。방법성인주관절표본5지，분별경선전원기화뇨측완굴기간극현로관돌첨、경장장기화척측완굴기간극현로관돌전내측면급기저부，측량정중신경유주부발출지선전원기、뇨측완굴기、장장기화지천굴기적기지장도、척신경지척측완굴기최근단량기지적장도급발출점화입기문처거굉골내、외상과련선적거리。2013년9월지2014년8월，채용주전측입로치료4례좌측척골관돌골절남성환자，년령16～42세，평균32세。안O’Driscoll분형，Ⅰb형화Ⅱb형골절각2례；채용경굴기화선전원기기간극현로병복위고정척골관돌골절。결과선전원기기지위2～3지，지천굴기기지이일주간전행지린근기육재발출2～5지단세기지，뇨측완굴기화장장기기지이1지형최다，장장기기지다여지천굴기기지공간。지천굴기기지위과월선전원기화뇨측완굴기간극최근측적기지，입기점평균거내、외상과련선37.22 mm。경선전원기화뇨측완굴기간극괄합현로관돌첨，재지천굴기기지근측조작；경장장기화척측완굴기간극괄합현로관돌전내측화기저，경척신경화정중신경계면진입。4례관돌골절환자평균수방9개월，관돌골절순리유합，유합시간위6주지3개월，평균9주。말차수방시，개량An화Mor?rey주관절평분위94～100분，균평개위우。결론경굴기화선전원기기간극적주전측입로시현로척골관돌적이상입로。
Objective To investigate the feasibility of a noval anterior cubital approach for the coronoid via flexor?prona?tor teres interval and assess the clinical result. Methods Five formalin?fixed adult cadaver elbows were used. Through a single universal anteromedial longitudinal skin incision, the coronoid tip was exposed via pronator and flexor carpiradialis interval, and coronoid anteromedial facet and base via palm longus and flexor carpi ulnaris interval. The distances from the entry point to the muscles or branching point of the nerves to the line passing through medial and lateral epicondyles, as well as the length were mea?sured with regard to the motor nerve branches arising from median nerve to pronator teres, flexor carpiradialis, palm longus and flexor digiti superficialis, as well as the most proximal two motor branches to flexor carpi ulnaris arising from ulnar nerve. From September 2013 to August 2014, 4 male patients with ulnar coronoid fracture were treated operatively through the above anterior cubital approach in our hospital. They were all left side involved, with an average age of 32 years (range, 16-42 years). According to O’Driscoll classification, there were two cases of type Ib and two cases IIb respectively. They were all treated by open reduction and internal fixation through flexor?pronator teres interval. Results At cubital fossa, there were 2-3 branches to the pronator teres mostly, 1 branch to flexor carpiradialis and palm longus arising from median nerve. The branch to the flexor digiti superficia?lis usually was long and thick, and divided into 2-5 short twigs near muscle. The branch to palm longus had the same trunk with that to flexor digiti superficialis. The branch to flexor digiti superficialis was the most proximal among those passed through the in?terval of pronator teres and flexor carpiradialis, and its entry point to the muscle had an averaged distance of 37.22 mm to the line passing through medial and lateral humeral epicondyles. It was optimal to expose coronoid tip through the interval of pronator teres and flexor carpiradialis. It was safe to expose coronoid proximal to the branch to flexor digiti superficialis. While, it was better to expose the anteromedial facet and base of corocoid through the interval of palm longus and flexor carpiulnaris via median and ul?nar nerve interface. All of the four patients were followed up for an average period of 9 months. They all achieved bone union from 6 weeks to 3months (mean, 9 weeks). All the patients obtained excellent result according to the modified An&Morrey elbow per?formance index with scores from 94 to 100. Conclusion The novel anteromedial cubital approach via flexor?pronator teres is opti?mal for exposure of coronoid.