带伴行血管尺神经前置术的解剖学研究

ANATOMICAL STUDY ON ANTERIOR TRANSPOSITION OF ULNAR NERVE ACCOMPANIED WITH ARTERIES FOR CUBITAL TUNNEL SYNDROME

目的观察肘部尺神经的血液供应,设计带伴行血管尺神经前置的手术方法。方法取20侧防腐成人上肢标本,观测肘部尺神经血供来源和血管起始处外径、血管起始处至肱骨内上髁距离、血管起始处至尺神经垂直距离及尺神经伴行长度。另采用3侧防腐成人上肢标本模拟临床手术,设计带伴行血管尺神经前置术。结果肘部尺神经血供有3个来源,分别是尺侧上副动脉、尺侧下副动脉和尺侧返动脉后支。3条动脉从起始处至肱骨内上髁的距离分别是14.2±0.9、4.2±0.6和4.8±1.1cm;尺神经伴行长度分别是15.0±1.3、5.1±0.3和5.6±0.9cm;血管起始处外径分别是1.5±0.5、1.2±0.3和1.4±0.5mm;血管起始处至尺神经垂直距离分别是1.2±0.5、2.7±0.9和1.3±0.5cm。结论带伴行血管尺神经前置术治疗肘管综合征是可行的,且最大程度保留了肘部尺神经血供。

Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome. Methods The vascularity of the ulnar nerve was observed and measured in 20 adult cadaver upper llmb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region： the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2± 0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0± 1.3,5. l!0. 3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7± 0.9 and 1.3± 0.5 cm respectively. Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.