| 【Objective】Anatomical specimens were used to observe the neurovascular running characteristics of the modified anterior approach of the elbow joint,to explore the safety zone of the modified anterior approach of the elbow joint to expose the coronoid process of the ulna and to evaluate its efficacy through preliminary clinical application.【Methods】1.20（10 male,10 female,20 left and 20 right）complete adult upper limb specimens soaked using 10% formalin solution were dissected.with the line of the internal and external epicondyle of the humerus as the X-axis,the midpoint of the line as the origin,and the X-axis perpendicular to the midpoint as the Y-axis,establish a coordinate system on the specimen（Above the medial epicondyle of the humerus,above the lateral epicondyle of the humerus,below the lateral epicondyle of the humerus,and below the medial epicondyle of the humerus as the first,second,third,and fourth quadrant,respectively）;and the neurovascular characteristics of the modified anterior elbow approach were observed and measured.2.Based on the anatomical results,10 cases of coronoid fractures were fixed by the modified anterior approach of the elbow joint,and the curative effect was evaluated.【Results】1.The main trunk of the lateral forearm cutaneous nerve penetrates the deep fascia from the lateral edge of the biceps brachii below the lateral epicondyle of the humerus and then continues down the anterolateral aspect of the elbow;the projection point of its main trunk deep fascia penetrating point on the plane of the X and Y axes is located in the third quadrant on the coordinate axis,and the specific（x,y）coordinate point is（-12.44 ± 1.52,-18.52 ± 1.56）mm.The projection point of the medial branch deep fascia penetrating point on the plane of the X and Y axes is located in the third quadrant on the coordinate axis,and the specific（x,y）coordinate point is（-8.72±1.22,-36.16±2.18）mm.The medial cutaneous nerve of the forearm penetrates the deep fascia above the medial epicondyle of the humerus and gives off anterolateral and posterior medial branches.Similarly,the projection point of its main trunk deep fascia penetrating point on the plane of the X and Y axes is located in the first quadrant on the coordinate axis,and the specific（x,y）coordinate point is（29.68 ± 6.32,41.24 ± 11.04）mm,the projection point of the posterior medial branch deep fascia penetrating point on the plane of the X and Y axes are located in the first quadrant on the coordinate axis,and the specific（x,y）coordinate point is（30.66±2.02,30.16±2.28）mm2.In the medial branch of the brachial artery,the distance between the inferior ulnar collateral artery and the ulnar recurrent artery was（56.69±12.42）mm;on the left side（56.54±12.18）mm and the right side（56.85±12.96）mm,when comparing the two sides,there was no statistically significant difference（P>0.05）.3.Preliminary Clinical application in 10 cases,postoperative follow-up was（14.4±1.7）months.At the last follow-up,the elbow of the affected limb extension/flexion activities were（4.5±3.7）°/（129.5±4.4）°;forearm pronation/supination activities were（83±4.8）°/（77.5°±4.2）°;The Mayo elbow performance score（MEPS）was（95±6.2）points;the visual analogue scale score（VAS）was（1.0±1.2）points;the Disability of the Arm,Shoulder,and Hand（DASH）score was（2.8±2.7）points;all patients recovered well after surgery.【Conclusion】Anatomical studies and clinical applications have confirmed that the modified anterior approach of the elbow joint is to make a straight skin incision about 5 cm long distal to the elbow flexion crease in the medial 1cm of the middle of the elbow.Avoid the penetrating point of the deep fascia of the medial and lateral cutaneous nerves of the forearm,and it is not easy to damage the medial and lateral cutaneous nerves of the forearm.and Its longitudinal operation range is between the inferior ulnar collateral artery and the ulnar recurrent artery,which has the characteristics of sufficient exposure,high safety,and excellent clinical effect.which has a high clinical application value.In addition,this study found that the exposure range of the inferior ulnar collateral artery and the ulnar recurrent artery is limited.and if the injury and expanded range of treatment,it remains to be further studied whether the modified approach can be applied. |
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