腕部尺神经卡压的解剖学研究及其临床意义

Anatomical study on the entrapment of the ulnar nerve at the wrist and its clinical applications

目的:为腕部尺神经卡压的诊断和治疗提供解剖学依据。方法:对20例新鲜成人上肢标本的腕部进行解剖,观测尺神经行径中可能存在的卡压因素。结果:尺神经在腕尺管内分成浅、深两支,浅支于小鱼际肌腱弓浅面出腕尺管;深支在小鱼际肌腱弓深面穿出腕尺管后,走行于小指对掌肌浅、深两头腱性起点和钩骨钩之间的间隙,小指对掌肌浅头腱性起点近侧缘锐利成腱弓样,存在率100%。腕尺管内尺神经和尺动脉之间存在3种交叉伴行关系:尺动脉发出的小鱼际肌营养血管和尺神经深支交叉占10%,尺动脉深支和尺神经浅支交叉占20%,尺动脉深支和尺神经深、浅支分别交叉占70%。结论:尺神经在腕部的行程分为腕尺管段和小鱼际肌段,小指对掌肌腱弓可以卡压尺神经深支,尺动脉和尺神经之间的多种交叉伴行关系是尺动脉卡压尺神经的基础。

Objective： To explore the relationship between the ulnar nerve and the adjacent tissues at the wrist, and provide anatomic data for the diagnosis and treatment of Guyon＇s canal syndrome. Mothods： The wrist of 20 fresh upper limbs were dissected under the loupe（5 x） and recorded the factors concerning with the entrapment of the ulnar nerve along its course. Results： The ulnar nerve was divided within the ulnar canal carpus into the superficial and deep branches. The former run distally over the fascial arch of the hypothenar muscles, while the deep one went distally below the fascial arch of the hypothenar muscles and entered the hiatus between opponens digiti minimi and hamular process of unciform bone. Proximal edge of the superficial head of the opponens digiti minimi was tendious （emergence of 100%）. There were three types of crossing relationships between the ulnar artery and the ulnar nerve： for 10% cases, nutrient vessels of muscle of hypothenar originated from ulnar artery crossed over profundus nervi ulnaris; 20% the deep branch of the ulnar artery crossed over the superficial branch of the ulnar nerve, 70% the deep branch of the ulnar artery over the superficial and deep branch of the ulnar nerve. Conclusions： There are two portions along the course of the ulnar nerve： the portion of Guyon＇s canal and the portion of hypothenar muscle. The fascial arch of the opponens digiti minimi may press the deep branch of the ulnar nerve. The complicated crossing relationship between the ulnar nerve and the ulnar artery is the main reasons for the occurring of Guyon＇s canal syndrome.