肘管及相关结构的断层解剖与三维重建

发布时间：2018-03-28 06:38

本文选题：肘管　切入点：尺神经　出处：《天津医科大学》2011年硕士论文

【摘要】：目的利用薄型化连续火棉胶切片和三维重建技术对肘管及滑车上肘肌的解剖结构进行观察研究,阐述肘管的精细解剖结构,探讨肘管综合症潜在的病因,并为原位松解术的实施提供解剖学建议,以达到治疗肘管综合症的理想效果。材料与方法①14例福尔马林固定的成年肘部标本,11例行大体解剖观察肘管的结构。3例分别置入8%的盐酸脱钙70d,并常规脱水后,将组织块浸入火棉胶中进行包埋。利用L型浸酒大脑切片机分别将标本制成1mm厚的水平、冠状和矢状位火棉胶切片。对相关的区域在体式显微镜下放大进行观察并请2位专家进行观察切片。将67张水平切片的图像输入3D-DOCTOR软件,以不同的颜色对骨、关节囊、肱三头肌、滑车上肘肌、尺神经、尺侧腕屈肌等结构标记,完成肘管及毗邻结构的三维重建。 ②收集2010年7月至9月份天津市第一中心医院13例行肘部扫描的MRI图像,所有图像显示该区域无明显病变。以便和切片进行对比观察。结果①肘管是一扁圆形通道,由底和顶共同围成,其内主要有尺神经通过,其内还有尺侧下副动静脉和尺侧返动静脉存在以营养尺神经。肘管的底由肘关节囊和尺侧副韧带前、后、横束构成。肘管的顶由肘管支持带或滑车上肘肌和尺侧腕屈肌的肱尺两头之间的筋膜构成。滑车上肘肌起自内上髁,其上部以筋膜止于鹰嘴内侧缘；中下部分直接止于鹰嘴内侧缘。对水平切片的观察发现,在尺神经沟水平,有一神经蒂将尺神经连于底的后外部。在大体标本上表现为较多的结缔组织将尺神经连于底。三维重建可见EA是一不规则的肌肉,起自内上髁止于鹰嘴。其上部以较长的筋膜止于鹰嘴,中下部则直接止于鹰嘴。在尺神经沟水平,有一神经蒂将尺神经连于底的后外侧部分。 ②肘关节的各个结构在切片上显示良好,分界明显,边界清楚,易于辨认。MRI对肘关节显示较好。较小的结构可在MRI显示,虽然其边界稍微不清晰,断层解剖的切片与MRI图像对肘关节的表现基本一致。结论①肘管的底由关节囊和尺侧副韧带的前束、后束和横束构成,内上髁和鹰嘴不参与底的构成。肘管的顶是由肘管支持带(或滑车上肘肌)和尺侧腕屈肌两头之间的筋膜构成。②掌握滑车上肘肌的解剖结构有助于我们精确并合理地将其切除以治疗肘管综合症。③神经蒂有防止尺神经过度运动以及半脱位的作用。对于不同病因引起的肘管综合症,对此结构的处理方式应该有所不同。④进行切片与MRI的对比,有助于以后在临床中工作中可以通过MRI的影像推测出更加精确的解剖特点。做出精确诊断。
[Abstract]:Objective to observe and study the anatomical structure of cubital tunnel and superior cubital muscle of trochlear by thin continuous sponge section and 3D reconstruction technique, to elucidate the fine anatomical structure of cubital tunnel, and to explore the potential etiology of cubital tunnel syndrome. It also provides anatomical advice for the implementation of in situ release in order to achieve an ideal effect in the treatment of cubital tunnel syndrome. Materials and methods 11 cases of formalin fixed adult elbow specimens were observed by gross anatomy. The structure of cubital canal was observed in 3 cases (8% decalcification for 70 days) and after routine dehydration. The tissue block was immersed in the sponge gum for embedding. The specimens were made into the level of 1mm thickness by the L-type soaking brain machine. Coronal and sagittal sponge sections. The related areas were magnified under a pose microscope and two experts were asked to observe the sections. The images of 67 horizontal slices were input into the 3D-DOCTOR software, and the bone and articular bursa were aligned with different colors. The three dimensional reconstruction of the cubital tunnel and adjacent structures was completed by labeling the triceps brachii, the superior cubital muscle, the ulnar nerve and the flexor muscle of the ulnar wrist. 2 MRI images of 13 cases of elbow scan in Tianjin first Central Hospital from July to September 2010 were collected. All the images showed that there was no obvious lesion in the area. The ulnar nerve passes through the ulnar nerve, and the inferior ulnar collateral arteriovenous and the recurrent ulnar arteriovenous exist to nourish the ulnar nerve. The bottom of the cubital tunnel consists of the anterior part of the elbow joint capsule and the ulnar collateral ligament. The top of the cubital tunnel consists of a fascia between the upper cubital muscle of the cubital tunnel or the upper cubital muscle of the trochlear and the fascia between the two ends of the ulnar flexor muscle. The upper part of the cubital muscle starts from the medial epicondyle and ends with the fascia at the medial edge of the olecranon. The middle and lower part stops directly at the medial edge of the olecranon. At the level of ulnar nerve sulcus, there is a nerve pedicle that connects the ulnar nerve to the back and exterior of the bottom. On the gross specimen, there is more connective tissue to connect the ulnar nerve to the bottom. The three-dimensional reconstruction shows that EA is an irregular muscle. From the medial epicondyle to the olecranon, the upper part ends with a longer fascia and the middle and lower part directly from the olecranon. At the level of ulnar nerve sulcus, a nerve pedicle connects the ulnar nerve to the posterolateral part of the base. 2 each structure of elbow joint showed well on the slice, the boundary was obvious, the boundary was clear and easy to recognize. The smaller structure could be displayed in MRI, although the boundary was slightly unclear. The sectional anatomy was consistent with MRI images in the diagnosis of elbow joint. Conclusion 1 the bottom of the cubital tunnel consists of the anterior bundle, the posterior bundle and the transverse bundle of the articular capsule and the ulnar collateral ligament. The medial epicondyle and the olecranon do not participate in the formation of the bottom. The top of the cubital tunnel consists of a fascia between the cubital supporting band (or the superior cubital muscle of the trochlear) and the ulnar flexor muscle. 2. Mastering the anatomical structure of the superior cubital muscle of the trochlear helps us to merge precisely. Resected to treat cubital tunnel syndrome. 3 nerve pedicle can prevent ulnar nerve overmovement and subluxation. For cubital tunnel syndrome caused by different etiology, The processing mode of this structure should be different from that of MRI, which would be helpful to infer more accurate anatomical features and make accurate diagnosis through MRI images in clinical work in the future.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R323.7

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