内窥镜辅助下肘管减压尺神经前置术的应用解剖

Applied anatomy of endoscopic decompression and anterior transposition for cubital tunnel syndrome in cadavers

目的在尸体上模拟内窥镜辅助下肘管减压及尺神经前置术，探讨该术式的注意事项。方法在8具上肢标本上模拟内窥镜辅助下肘管减压及尺神经前置术，再对尸体进行解剖，观察尺神经松解、前置效果及有无前臂内侧皮神经损伤。结果8侧标本均顺利去除肘部尺神经卡压的因素，前置尺神经充分，固定牢靠，未形成继发卡压。在肘管减压及尺神经松解过程中前臂内侧皮神经后支均未损伤。皮下筋膜与屈肌旋前圆肌肌膜缝合固定法缝扎前臂内侧皮神经后支2例，筋膜瓣法固定未对前臂内侧皮神经造成损伤。结论在内窥镜辅助下能切除肘部尺神经卡压的常见因素，前置尺神经充分，并能有效降低前臂内侧皮神经后支的损伤，但需注意皮下筋膜与屈肌旋前圆肌肌膜缝合固定法易缝扎前臂内侧皮神经后支，而筋膜瓣法固定相对安全。

ObjeOive To simulate endoscopic decompression and anterior transposition of the ulnar nerve for treatment of eubital tunnel syndrome in cadavers and explore the technical details of this approach. Methods Simulation of endoscopic decompression of the cubital tunnel and anterior transposition of the ulnar nerve was carried out in 8 upper limb cadaver specimens. The cubital tunnel was then opened to explore the effectiveness of decompression and transposition and any signs of medial antebraehial cutaneous nerve （MACN） dmnage. Results Nerve decompression was sufficient with all the constrictions re^eased. The utnar nerve was properly anterior transposed and secured. There was no sign of secondary compression to the ulnar nerve. There was no MACN injury during cubital tunnel release and ulnar nerve decompression. MACN posterior branch was caught in 2 specimens when the superficial fascia and pronator teres sarcolemma were sutured together to make transposition tunnel. Creating a fascia tunnel did not cause MACN injury. Conclusion Endoscopic release can effectively remove the compression structures, anterior transpose the ulnar nerve and avoid MACN injury. Care should be taken not to sew the superfieial fascia to the pronator teres sareolemma. The fascia sling is a safe way to secure the transposed nerve.