肘部正中神经卡压解剖与临床研究

Anatomical and clinical study of median nerve entrapment at the elbow

目的为肘部正中神经卡压的诊断与治疗提供解剖与临床依据。方法在10侧上肢标本上观察正中神经在肘部卡压的解剖因素及正中神经的外形。同时对我科收治的14例肘部正中神经卡压患者进行病例分析。结果解剖学研究发现10侧上肢标本肱二头肌腱膜与正中神经的关系：全覆盖型2侧（20％），部分覆盖型1侧（10％），非覆盖型7侧（70％）；旋前圆肌尺骨头浅面有厚筋膜9侧（90％），肱骨头肌内有腱束2侧（20％），反转筋膜斜过正中神经前方6侧（60％）。指浅屈肌起始部分的形态结构：指浅屈肌腱束1侧（10％），纤维弓1侧（10％），联合腱弓型8侧（80％）。14例肘部正中神经卡压患者包括5例旋前圆肌综合征和9例骨间前神经综合征。5例旋前圆肌综合征的卡压点：增厚紧张的肱二头肌腱膜尺侧卡压2例，旋前圆肌深面腱弓处卡压2例，旋前圆肌两头之间卡压1例。9例骨间前神经综合征的卡压点：旋前圆肌深面腱弓处卡压2例，旋前圆肌尺骨头处卡压1例，旋前圆肌两头之间卡压1例，紧张增厚的指浅屈肌起始边缘处卡压5例。6例获得随访，平均随访时间为2年4个月，结果均良好。结论肘部正中神经卡压与肘部正中神经的外形、周围的腱膜、增厚紧张的筋膜等因素有关。

Objective To provide anatomic and clinical basis for diagnosis and treatment of median nerve entrapment at the elbow. Methods Microanatomical dissection of the median nerve was done in 10 cadaver upper limb specimens to observe the anatomical factors that cause compression of the median nerve at the elbow and shape of the median nerve. Case analysis was conducted in 14 patients with median nerve entrapment at the elbow who were treated in our department. Results Anatomic studies in the 10 dissected specimens showed three types of relationship between the bicepital aponeuresis and median nerve： complete-covering （2 specimens, 20% ）, partial-covering （ 1 specimen, 10% ） and non-covering （7 specimens, 70% ）. Thickened fascia in the superficial layer of pronator teres ulnar head was seen in 9 specimens （90%）. Intramuscular tendinous bundles in the anconens were observed in 2 specimens （20%）. The reverse fascia that traversed the median nerve was seen in 6 specimens （60%）. The structures of the origins of two heads of the flexor digitorum superficialis （FDS） had three types： intramuscular tendinous bundle （1 specimen, 10%）, fibrous arch （1 specimen, 10%）, and conjoined tendinous arch （8 specimens, 80%）. Of the 14 patients who had median nerve entrapment at the elbow, 5 were diagnosed as pronator teres syndrome while 9 were diagnosed as anterior interosseous nerve（AIN） compression. The compression points in the pronator syndrome cases were ulnar side of the thickened and taut bicepital aponeurosis （2 cases）, deep tendinous arch of pronator teres （2 cases）, and between two heads of prenator teres （ 1 case）. The compression points in the AIN compression cases were deep tendinous arch of pronator teres （2 cases）, ulnar head of pronator teres （1 case）, between two heads of pronator teres （1 case）, and thickened and taut FDS origin （5 cases）. Six patients were follow-up. The average follow-up time was 2 years and 4 months. Good to excellent recovery of motor function was achieved in these patients. Conclusion The shape of the median nerve, its surrounding tendinous structures and thickened and taut fascia are the anatomic basis of median nerve entrapment at the elbow.