Objective To find the proximal humeral safe zone through anatomical measurement of cadaveric shoul-ders. To provide some anatomical information for surgical approach of proximal humeral fractures for open reduction and internal fixation, and to discuss the key points of operation. Methods 48 fresh adult cadaveric shoulders were anatomized. The important vessels and nerves around the proximal humerus were investigated and the distance be-tween humeral landmarks of incision were measured. Results The distance from the undersurface of the acromion to the superior border of the nerve was 55. 4~66. 2(60. 2 ± 2. 2) mm. The distance from the lateral prominence of the great tuberosity to the superior edge of the nerve was 43. 8~51. 6 ( 46. 9 ± 1. 7 ) mm. The ratio between arm length and the distance from the lateral prominence of the great tuberosity to the superior edge of the nerve was 0. 147 ~0. 161(0. 154 ± 0. 0). The distance from the undersurface of the acromion to the superior border of the anterior hu-meral circumflex artery was 55. 8~66. 7(60. 6 ± 2. 1) mm. The distance from the lateral prominence of the great tu-berosity to the superior edge of the anterior humeral circumflex artery was 53. 1~61. 3 (56. 2 ± 1. 7) mm. The ratio between arm length and the distance from the lateral prominence of the great tuberosity to the superior edge of the an-terior humeral circumflex artery was 0. 178~0. 194(0. 185 ± 0. 0). The distance from the undersurface of the acromi-on to the superior border of the posterior humeral circumflex artery was 56. 8~68. 1(61. 3 ± 2. 1) mm. The distance from the lateral prominence of the great tuberosity to the superior edge of the posterior humeral circumflex artery was 47. 9~55. 7(51. 0 ± 1. 7) mm. The ratio between arm length and the distance from the lateral prominence of the great tuberosity to the superior edge of the posterior humeral circumflex artery was 0. 160 ~0. 176 ( 0. 167 ± 0. 0 ) . Conclusions The area of the axillary nerve is about 58. 0~62. 4 mm from acromion. The area of the anterior humer-al circumflex artery is about 54. 5~57. 9 mm from great tuberosity. The area of the posterior humeral circumflex ar-tery is about 59. 2~63. 4 mm from acromion. Operative procedure in these regions should be conducted with extra caution to avoid neurovascular injuries.%目的 通过尸体解剖测量,寻求肱骨近端手术安全区,为肱骨近端骨折切开复位内固定术的手术入路提供解剖学依据,并探讨手术注意事项. 方法 取48具肩关节新鲜尸体标本,解剖观察肱骨近端的重要血管及神经,并测量相对于手术切口的标志性骨结构之间的距离. 结果 肩峰下缘与腋神经上缘的垂直距离为55. 4~66. 2(60. 2 ± 2. 2) mm,大结节顶点至腋神经上缘的垂直距离为43. 8~51. 6(46. 9 ± 1. 7) mm. 大结节顶点至腋神经上缘的距离与肱骨长度的比值为0. 147~0. 161 ( 0. 154 ± 0. 0 ). 肩峰锁骨端下缘与旋肱前动脉上缘的垂直距离为55. 8 ~66. 7 ( 60. 6 ± 2. 1 ) mm,大结节顶点与旋肱前动脉上缘的垂直距离53. 1 ~61. 3 (56. 2 ± 1. 7) mm,大结节顶点至旋肱前动脉上缘的距离与肱骨长度的比值为0. 178~0. 194(0. 185 ± 0. 0).肩峰锁骨端下缘与旋肱后动脉上缘的垂直距离为56. 8~68. 1(61. 3 ± 2. 1) mm,大结节顶点与旋肱后动脉上缘的垂直距离47. 9 ~55. 7 ( 51. 0 ± 1. 7 ) mm,大结节顶点至旋肱后动脉上缘的距离与肱骨长度的比值为0. 160~0. 176 (0. 167 ± 0. 0). 结论 肩峰锁骨端下缘58. 0 ~62. 4 mm 为腋神经走行区域;大结节下缘54. 5~57. 9 mm为旋肱前动脉走行区域;肩峰锁骨端下缘59. 2~63. 4 mm为旋肱后动脉走行区域. 在上述3个区域手术操作时,要轻柔仔细,防止损伤神经血管.
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