内窥镜下微创治疗肘管综合征的相关解剖学研究

Anatomical study of the treatment of cubital tunnel syndrome by endoscope

目的为内窥镜下进行肘管尺神经减压并前移术提供临床应用解剖基础。方法 10例新鲜尸体标本、20例临床病例传统手术中尺神经在臂部、前臂游离长度,尺神经第1肌支距离肱骨内上髁的距离、尺神经前移距离。在4例新鲜尸体标本上模拟手术。结果此术式尺神经前臂、臂部游离距离为（3.90±0.145）cm（3.64～4.23 cm）、（4.21±0.18）cm（3.80～4.53 cm）,前移距离（1.49±0.05）cm（1.39～1.57cm）,尺神经第1肌支距离肱骨内上髁距离（2.18±0.38）cm（1.13～2.72cm）。此术式入路点、轴线、层面：肱骨内上髁与尺骨鹰嘴间长约2 cm纵行切口;肱骨内上髁与尺骨鹰嘴之间中点与豌豆骨连线上约7cm长的轴线,肱骨内上髁与尺骨鹰嘴之间中点与肱二头肌内侧肌间隔中点连线上长8cm的轴线;奥本斯韧带、前臂尺侧腕屈肌之间纤维弓形组织表面,臂部深筋膜表面。模拟手术成功。结论研究证实此术式可行,达预期效果。

Objective To provide clinical anatomy for the way of endoscopic anterior ulnar nerve subcutaneous transposition. Methods the length of ulnar nerve free in the forearm and the upper arm,the distance from the first motor branch to the flexor carpi ulnaris muscle tothe medial epicondyle were measured in ten fresh limbs from fresh cadavers and twenty patients. Simulative surgery were performed on four limbs from cadavers. Results In this surgery ,the length of ulnar nerve free in the forearm was （3.90±0.145）cm （3.64～4.23 cm）,free in the upper arm was （4.21＋0.18）cm（3.80～4.53 cm）,the first motor branch to the flexor carpi ulnaris muscle was （2.18±0.38）cm（ 1.13～2.72 cm）away from the medial humoral epicondyle. In this surgery, the surgical incision was 2 cm longitudinal incision between the medial epicondyle and the olecranon, the forearm axis of the endoscopic operation was about 7 cm line on the line connecting the midpoint between the medial epicondyle and the olecranon to the pisiform,the upper arm axis was about an 8cm line on the line connecting the midpoint on the medial epicondyle and the olecranon to the midpoint on the medial septum of biceps;the suitable and the olecranon regional the endoscopic operation tissue level was the surface of arcuate ligament of Osborne, flexor carpi ulnaris muscle in the forearm and deep fascia in the upper arm. Simulative surgery was successful. Conclusion This study confirmed this surgical approach was feasible, and could achieve the desired results.