标题：经皮微创钢板内固定治疗肱骨近端骨折的解剖学研究

      作者：王岩松，王晓东，李宏斌    (南通大学附属南通第三医院骨科，江苏 南通 226000)

      卷次： 2018年29卷13期

      【摘要】 目的 探讨经皮微创钢板内固定治疗肱骨近端骨折过程中，腋神经与内固定钢板的解剖关系及腋神经损伤的风险评估。方法 解剖12例成人上肢标本，按标准置入Synthes公司PHILOS钢板，了解腋神经走行，并测量腋神经与钢板各孔中心点、肩峰与腋神经、肩峰与钢板顶端之间的距离。结果 近端的7个孔(A1-D)及远端的4个孔(G-J)距离腋神经均>10 mm；E孔位于腋神经走行区域；F孔距离腋神经平均6.2 mm，其中2例<2 mm；肩峰至钢板顶端平均32.1 mm，肩峰至腋神经平均69.8 mm。结论 经皮微创钢板内固定治疗肱骨近端骨折是一种安全、有效的术式，术中可安全的经皮置入除E和F孔以外的所有螺钉孔。当需要固定E或F孔时需扩大切口，显露腋神经及螺钉孔，直视下置钉，可有效避免损伤腋神经。
      【关键词】 肱骨近端骨折；经皮微创钢板内固定；腋神经
      【中图分类号】 R683.41 【文献标识码】 A 【文章编号】 1003—6350（2018）13—1808—03

An anatomical study of minimally invasive percutaneous plate osteosynthesis in the treatment of proximalhumerus fracture.
WANG Yan-song, WANG Xiao-dong, LI Hong-bin. Department of Orthopedics, Nantong Third People'sHospital Affiliated to Nantong University, Nantong 226000, Jiangsu, CHINA
【Abstract】 Objective To investigate the relationship between the axillary nerve and the percutaneously insert-ed proximal humeral locking plate and to evaluate the risk of axillary nerve injury during minimally invasive percutane-ous plate osteosynthesis (MIPPO). Methods Twelve upper limb specimens were implanted with a proximal humeruslocking plate (PHILOS plate, Synthes). The distance between axillary nerve and the screws, lateral acromion and axillarynerve, lateral acromion and the top of plate was measured. Results The seven superior holes (A1-D) and the inferiorfour holes (G to J) were all situated superior or inferior to the axillary nerve with their average distance being at least 10 mmfrom the nerve. Screw hole E was located in the course of the axillary nerve. Screw hole F was on average 6 mm fromthe axillary nerve but within 2 mm in two specimens. The average distance from the lateral acromion to the top of theplate was 32.1 mm, and that from the lateral acromion to the axillary nerve was 69.8 mm. Conclusion MIPPO is a safeand effective procedure for proximal humerus fracture. All screw holes except E and F can be safely inserted intraopera-tively. When the E or F holes need to be fixed, the axillary nerve and screw foramen should be exposed by expanding in-cision to avoid axillary nerve injury.
      【Key words】 Proximal humerus fracture; Minimally invasive percutaneous plate osteosynthesis (MIPPO); Axil-lary nerve·论 著·doi:10.3969/j.issn.1003-6350.2018.13.010