Applied Anatomy And Clinical Application Of Theel Bow And The Radial Head Safety Zone

Objective:To explore the tomography anatomy of the elbow joint and ligamentcombined with the operation approach simulation of the radial head fracture open reduction and internal fixation clear the operation safety zone of the elbow and radial head, lays the sectional imaging anatomy foundation for the elbow joint imaging diagnosis and surgical operation treatment。 Materialsandmethods:Select 6 elbow specimens(male 3 cases, female 3 cases), X-rays of the elbow by Japan Toshiba MRAD-D50 S digital X ray, anteroposterior, lateral, supination external rotation, in a 4 direction; and CT images by Philip Brilliance 64 slice spiral CT for elbow joint specimens were obtained by TLC scanning transverse, sagittal and coronal and the l MR images by Philips company 1.5T MRI scanner and workspace R2.6.3.1 image post-processing workstation for transverse, sagittal and coronal, then select 4 cases(male 2 cases, female 2 cases) cut into 8mm thick layer of transverse, sagittal and coronal sectional specimen with an electric band saw with equidistance method. Select 2 elbow specimens according to the radial head fracture fixation operation incision reduction and internal approach to simulate operation. Select 15 cases from The Dong’e people’s Hospital from 2010 January to 2014 January using the Kocher approach for open reduction and internal fixation of radial head fractures, male 9 cases, female 6 cases, for clinical analysis. Comparative study of the X-ray, CT, MRI image and sectional specimen of elbow joint, clarify the complex anatomy, and clear the security area of the elbow joint and radial head operation fixing. Result:There is oval radial head and the proximal ulna through the sectional of the middle of the radial head and proximal radioulnar joint; About 70% of the area around the radial head is covered with cartilage, mainly distributed in the side near the radial notch of ulna, radial head ring joint face and the radial notch of ulna constitute the proximal radioulnar joints, there is annular ligament of radius around the radial head, and lateral and attached to the radial notch of ulna, before trailing edge in the lateral of the joint, the upper end of the inner side of the ulna is the medial collateral ligament You can see radial head, lateral epicondyle of humerus, medial humeral capitellum and lateral trochea, olecranon, Wacom, trochlear notch through the coronal sectional of the radial head portion; the trochlear notch of ulna and the trochlea of humerus constitute the ulnohumeral joint, The joint concave above the radial head and capitulum of humerus constitute the humeroradial joint.ring joint face around the radial head and the radial notch of ulna constitute the proximal radioulnar joint. The outside of the humeroradial joint is the lateral collateral ligament also known as the lateral complex including the radial collateral ligament and the annular ligament.The medial of the ulnohumeral joint is the medial collateral ligament, is located medial of the articular capsule, originated from the medial epicondyle of humerus down to the ulna incisura trochlearis. Through the sagittal lateral radial head portion can see the capitulum humeral lateral part of, the radial head and neck of radius, humeral head protruding into the distal radial head is discoid, central depression, joint concave capitulum humeral and radial head above constitute the radiocapitellar joint, joint posterior to the posterior wall of elbow joint capsule, front as part of the annular ligament of radius.Around the radial neck muscle supination, it plays a key role in the forearm rotation of forearm pronation, the muscles in a relaxed state, in a state of tension when supination, so through the supinator deep branch of the radial nerve in the forearm pronation in a relaxed state, far away from the articular radial head surface distance the nerve when forearm pronation.Simulation of operation process hints in the lateral approach too forward separation of medial surface exceeds the elbow to avoid the medial cutaneous nerve of the forearm injury can not cut the skin, to identify the Kocher gap between the elbow muscle and extensor carpi ulnaris is a key step of operation, the Kaplan approach should be carefully identified and isolated extensor carpi radialis and length the common extensor muscle of neck of radius gap, more than to the more isolated proximal to protection of the radial nerve, the radial head open capsular exposure in front of the lateral collateral ligament complex open to outside complex injury, in addition the radial head implant should be placed in the radial proximal articular surface outside the region, the region is the safety zone the radial head fixation placement. Conclusion :1. The sectional radial head portion is the best level of the annular ligament of radius, supinator muscle and the radial head "security zone", the coronal sectional radial head portion is a typical level were observed in the lateral collateral ligament complex and medial collateral ligament, the sagittal lateral radial head portion is the identification of the brachioradialis joint and ligament, and the typical level of radial head safety zone.2. In the forearm pronation supination muscles in a relaxed state, the supinator muscle deep branch of the radial nerve in the relaxed state, the body position is radial proximal fractures with open reduction and internal fixation to avoid the best position for the nerve injury.3.Simulation operation results show the deep branch of the radial nerve at the level of the radial tuberosity from the front to the back of the supinator muscle, in the radial tuberosity near end operation is safe, the neck of the radius to distal incision supinator when forearm pronation has the deep branch of the radial nerve in favor of intraoperative; lateral collateral ligament complex plays a key role the elbow joint lateral stability during operation, the lateral collateral ligament complex ahead through the joint capsule and exposure of the radial head is safe, can avoid the damage of the complex operation, repair the lateral collateral ligament complex is to maintain the stabilization of the elbow and early postoperative functional rehabilitation of key, the radial head implant should be placed not part of outer radial bone forearm proximal joint arc area of about 110 degrees.