肘管综合征的应用解剖学研究

Applied anatomical study of cubitai tunnel syndrome

目的研究肘管综合征中尺神经的卡压因素，为临床手术提供解剖学依据。方法采用解剖学方法对16具（32侧）成人尸体上肢标本进行解剖，观测造成尺神经卡压的Strathers弓形组织、内侧肌间隔和肘管，测量肘管内尺神经的面积、肘管的面积和肘管的长度，测量弓状韧带的长、宽和厚度，观测尺神经的营养血管及伴行长度，观测尺神经的尺侧腕屈肌肌支。结果32侧上肢标本中12侧存在腱性Struthers弓形组织，10侧有肌性Strathers弓形组织，存在率为68．8％。尺神经在内上髁上方[（11．02±1．16）cm，x±s，下同]处穿内侧肌间隔，尺神经肘管内面积与肘管面积之比为1：3．86，肘管长度为（1．96±0．18）cm。尺神经伴行血管有尺侧上副动脉和尺侧返动脉后支，尺神经在内上髁下方1cm左右发出尺侧腕屈肌肌支。结论尺神经在肘管处最容易受压，手术治疗肘管综合征时向上的切口长度约为11．02cm，同时切除Strathers弓形组织和内侧肌间隔；尺神经前置手术时，注意保留与神经伴行的尺侧返动脉后支。

Objective To investigate the anatomical elements of ulnar nerve compression at elbow, and provide guideline for surgical decompression. Methods Thirty-two upper limb specimens of 16 adult cadavers were dissected. Structures that can cause potential compression to the ulnar nerve at the elbow including arcade of Struthers, the medial intermuscular septum and cubital tunnel were measured observed. The cross-section area of the ulnar nerve at the cubital tunnel level and the cross-section area and length of the cubital tunnel were measured. Dimensions of the arcade ligament, the concomitant blood vessel of the ulnar nerve and the flexor carpi ulnaris branch of the ulnar nerve were also measured. Results Tendinous arcade of Struthers was seem in 12 limbs while muscular arcade of Struthers was found in 10 limbs. The incidence of arcade of Struthers was 68.8%. The ulnar nerve pierced the medial intermuscular septum （11. 02 ± 1. 16） cm proximal to the medial epicondyle. The ratio of ulnar nerve cross-section area to cubital tunnel crosssection area was 1： 3.86. The length of the cubital tunnel was （ 1. 96 ± 0. 18） cm. The concomitant blood vessels of the ulnar nerve included superior ulnar collateral artery （SUCA） and posterior ulnar recurrent artery （PURA）. The flexor carpi ulnaris branch of the ulnar nerve was diverged lcm distal to the medial epicondyle. Conclusion Cubital tunnel was the most common compression site of the ulnar nerve. The incision of surgical decompression should be extended 11. 02 cm proximal to the medial epicondyle. Caution should be used to preserve PURA transposing the ulnar nerve anteriorly.