尺神经手背支卡压症的解剖与临床研究

Anatomy and Clinic of the Dorsal Branch of Ulnar Nerve Compression

目的通过对尺神经手背支的解剖学特点的观察，探讨尺神经手背支卡压症引起腕尺侧痛的机制和治疗。方法对20例成人尸体前臂部和腕部进行大体解剖和显微解剖，观测了尺神经手背支的发出部位、走行、分支及其支配区域，研究了被动活动腕关节对手背支各终末支的影响。在临床上诊治27例尺神经手背支卡压的病例并进行分析。结果尺神经手背支在尺骨茎突近侧5.2-6.6 cm处，于尺侧腕屈肌的深面自尺神经主干发出，斜向下方走行，紧贴尺骨头尺侧浅出，并转向手背。尺神经手背支在尺骨头水平分成2-3支，每支均能找到进入骨关节和韧带的终末支。腕关节活动引起尺骨头相对位置的改变，极易对手背造成牵拉，尤以横支明显。临床发现患该症的病人尺骨头远端或尺侧缘有一显著而局限的压痛点，其周围有局部的皮肤感觉改变。27例病例全部首次进行了封闭治疗，其中有9例局部封闭后治愈，18例因封闭后效果不佳而行手术治疗。对18例病例随访3个月-1年，未见复发。结论腕关节反复屈伸收展时，尺神经手背支被牵拉和压迫是造成尺神经手背支卡压症的解剖学基础，横支的卡压很可能是引起腕尺侧痛的主要原因。临床上对有腕尺侧痛和皮肤感觉改变的病例，应考虑尺神经手背支卡压的可能性。

Objective To investigate the mechanism of ulnar sided wrist pain induced by compression of the dorsal branch of ulnar nerve. Methods Anatomical studies were done on 20 sides of dorsal branch of ulnar nerve in adult cadavers. The anatomy of this branch and its relation to the surrounding was observed. 27 patients with dorsal branch of ulnar nerve compression were treated clinically. Results The dorsal branch of ulnar nerve ran along the ulnar after leaving from the ulnar sided of the muscle flexor carpi ulnaris, then gave off 2 to 3 branch by ulnar sided of the ulna capitulure. The transverse branch is very closed to the peristeam when it crossing the ulna capitulum or distal side of the ulna capitulum. Repeated movements of wrist and alterment of ulna capitulum is easy to injure this branch. Local injection and surgery is effective to decrease the symptoms. Conclusion The repetitive traction and compression on the dorsal branch of ulnar nerve during wrist flexion and extension is the anatomical foundation of the dorsal branch of ulnar nerve compression. The compression of dorsal branch of ulnar nerve should be considered when we treating a patient whose have ulnar side wrist pain and abnormal sense.