带血供尺神经前置术的解剖学研究

Anatomic Study on Anterior Transposition of the Vascularized Ulnar Nerve for Cubital Tunnel Syndrome

目的观察肘管段尺神经血供,为带血供尺神经前置术治疗肘管综合征提供解剖学基础。方法在30侧动脉灌注红色乳胶并防腐固定的成人上肢标本上,解剖观察肘管段尺神经的血供来源和血管外径及血管长度的相关资料;模拟临床尺神经前置术,测量带血供尺神经所需游离长度及无张力前移距离。结果肘部尺神经血供来自尺侧上副动脉、尺侧下副动脉和尺侧返动脉背侧支,3条营养血管起始外径分别是1.6±0.4 mm、12±0.4mm和1.5±0.8 mm:与尺神经伴行长度分别是15.7±2.1cm、5.0±0.9cm和5.9±1.1 cm;至肱骨内上髁距离分别是15.0±1.3 cm、4.5±1.1cm和5.0±1.2cm。模拟临床尺神经前置术,带血供尺神经所需游离长度为12.6±1.9cm,无张力前移距离为1.8±0.6 cm。结论带血供尺神经前置术治疗肘管综合症切实可行,带血供尺神经所需游离长度平均为12.6 cm,无张力前移距离平均为1.8cm。

Objective To provide the anatomic basis for treatment of cubital syndrome in clinic with anterior trans-position keeping the blood supply of the ulnar by observations of the ulnar nerve blood supply in the tube of elbow. Methods 30 adult cadaver upper limb specimen were injected with red-colored latex：the vascularity of the ulnar nerve was observed and external diameter and length were measured;And the clinical surgical procedure was imitated to measure maximum distance of tension-free anterior transposition of the ulnar nerve keeping the blood supply. Results There are three major arteries to supply the ulnar nerve at the cubital tunnel：the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The external diameter of the arteres at the beginning spot were 1.6 ± 0. 4 ram, 1.2 ±0.4 mm and 1.5 ± 0. 8 mm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.7 ±2. 1 cm,5.0 ±0. 9 cm and 5.9 ± 1.1 cm respectively. The distances from arterial origin to the medial epicondyle were 15.0 ± 1.3 cm,4. 5 ± 1.1 cm and 5.0 ± 1.2 cm respectively. When imitating anterior transposition keeping the blood supply of the ulnar, the length of the ulnar keeping the blood supply should be 12. 6 ± 1.9 cm, and the distance of tension-free anterior transposition was 1.8 ± 0. 6 cm. Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. The average length of the ulnar keeping the blood supply should be 12. 2 cm,and the average distance of tension-free anterior transposition was 1.8 cm.