THOMPSON入路 | 一文详解桡骨后侧入路（英文版）

POSTERIOR APPROACH TO THE RADIUS (THOMPSON)

桡骨后侧入路(汤普森)

• Indications

Fracture, tumor, and infection when access to posterior radius desired. 

适用于：骨折，肿瘤，感染，当需要暴露桡骨后侧时。

• Note

This approach is not commonly employed but may be used to expose either the proximal, mid or distal radius but is most effective for the proximal and middle thirds. 

注意：这种入路不常用，但可用于暴露桡骨近端、中端或远端，但对近端和中三分之一最有效。

• Position

The patient is supine with arm across the chest or on arm/elbow table.

体位：患者仰卧位，手臂横放于胸前或放在臂/肘台上。

• Landmarks

Lateral epicondyle to radial styloid.

体表标记：肱骨外上髁到桡骨茎突（Lister 结节）。

• Technique

1. Incision: straight from the lateral epicondyle to the radial styloid. With the forearm pronated the line of the incision is a straight line. Use all or any portion (Fig. 2-1A).

2. Expose the interval between the anterior border of the extensor digitorum communis and the posterior or radial border of the extensor carpi radialis brevis.

3. Distally palpate the bare portion of the radius distally that superficially demarcates the natural interval between these two muscle groups (Fig. 2-1B). Deep to these muscles the bare area identifies the distal aspect of the supinator and proximal attachment of the pronator teres tendon.

4. The forearm fascia is split proximally and distally allowing the extensor digitorum communis to be retracted posteriorly and extensor carpi radialis brevis to be retracted anteriorly to the ulnar side of the radius (Fig. 2-1C). The bare shaft of the radius between the supinator and pronator attachments is well defined (Fig. 2-1D).

5. Proximally with the forearm in supination, the supinator muscle is noted and the posterior interosseous nerve observed and may or may not be exposed.6. The supinator muscle is then released either in its mid-portion exposing the posterior interosseous nerve or, more commonly, is released from the shaft of the radius (Fig. 2-1E).

手术技术：

1. 切口:从外侧上髁直入桡骨茎突。前臂内旋时，切口为一条直线。使用全部或任何部分(图2-1A)。

2. 暴露指伸肌前缘和桡侧腕短伸肌后缘或桡侧缘之间的间隔。

3.远端触诊桡骨远端的裸露部分，它表面上划分了这两个肌群之间的自然间隔(图2-1B)。在这些肌肉的深处裸露的区域确定了旋后肌的远端和旋前圆肌腱的近端附着。

4. 前臂筋膜向近端和远端分裂，使指联合伸肌向后缩回，桡腕短伸肌向前缩回至桡骨尺侧(图2-1C)。旋后肌和旋前肌附件之间的桡骨清晰可见(图2-1D)。

5.旋后时前臂近端可见旋后肌和骨间后神经，可以暴露也可以不暴露。然后将旋后肌从露出骨间后神经的中间部分离断，或更常见的从桡骨干离断(图2-1E)。

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