肘内侧入路的临床应用解剖及其意义

Applied Anatomy and Clinical Significance in Medial Elbow Approach

目的：为肘内侧入路手术避免损伤重要结构提供解剖学基础。方法：选教学用的固定尸体标本24具（男18女6）48侧，按手术入路层次，对肘内侧入路的相关血管神经进行解剖学观测。结果：（1）臂内侧皮神经于臂中部的内侧面浅出，直径为（1．05±0．35）mm；前臂内侧皮神经于臂内侧中下1／3肱二头肌内侧沟伴贵要静脉浅出，直径为（1．50±0．55）mm。（2）尺神经干在肘部发出1～3肘关节支、1～4尺侧腕屈肌支和1～4指深屈肌支。（3）尺侧上副动脉、尺侧下副动脉和尺侧返动脉后支从肱动脉的起点处至尺神经垂直距离分别为（1．65±0．35）cm、（2．43±0．54）cm、（1．86±0．41）cm；与尺神经伴行至内上髁的距离分别为（14．38±1．82）cm、（4．51±1．16）cm、（5．91±0．67）cm。肘部附近尺侧下副动脉和尺侧返动脉后支与尺侧上副动脉在尺神经外膜相吻合。结论：（1）肘内侧入路浅层必须寻找和保护臂内侧皮神经和前臂内侧皮神经；（2）肘内侧入路保护尺神经血供及其肌支是临床手术成败的关键。

Objective：To provide anatomical basis for protecting the relative structures in operations by medial elbow approach. Methods：The vessels and nerves in medial elbow approach were studied by operative approach on 48 sides （male： 36 sides and famle： 12 sides） of adult cadaver for teaching. Results： （ 1 ）The medial brachial cutaneous nerve, which mean diameter is （ 1.05 ± 0.35）mm,origins from the medial brachial. The medial antebrachial cutaneous nerve,average of diameters is （ 1.50 ± 0.55）mm, origins from the middle inferior 1/3 of medial brachial and in the medial bicipital sulcus with the basilic vein. （2）The ulnar nerve at elbow region origins 1 - 3 branches to the elbow joint, 1 - 4 branchesto the flexor carpal joints and 1 - 4 branches to the flexor digitorum profundus. （3）The perpendicular distances from the brachial arterial originating points of the superior ulnar collateral artery,inferior ulna collateral artery and posterior ranlus of ulnar recurrent artery to ulnar nerv are （1.65±0.35）mm; （2.43 ± 0.54） nun; （ 1.86 ± 0.41 ） nun, respectively. The total lengths of these vessels traving along with the ulnar nerve to the medial epicondyle are （ 14.38 ± 1.82）cm; （4.51 ± 1.16）cm; （5.91 ± 0.67）cm respectively. Inferior ulnar collateral artery and posterior ramus of ulnar recurrent artery formed rich artery network with superior ulnar collateral artery in the ulnar epineurium. Conclusions： （ 1 ）Medial brachial cutaneous nerve and medial antebrachial cutaneous nerve must be found and be protected in this approach. （2） The protecting major arteries to the ulnar nerve and its muscular branches is the key point of the operation.