腕尺管的解剖学研究

发布时间：2018-09-19 20:14

【摘要】： 背景：1908年Hunt首先描述了腕部尺神经卡压综合症(ulnar tunnel sydrome，UTS)，亦称之为腕尺管综合症，是尺神经在腕部内受到各种因素的卡压而出现的一组症状和体症。UTS临床上较少见，病因较多，临床症状和体征多样，可伴有其它疾病，使诊断更加困难，相关文献国外报道较多，国内报道较少。国内外学者不断对其进行研究，相继有一些新进展报道，有关手部尺神经和小鱼际肌的解剖关系国外报道较多，国内尚没有这方面的文献报道。国内学者对尺神经深支的走行、毗邻、分支、分布、体表投影，进行了观测。腕尺管区解剖结构复杂，有待于进一部研究，提供国人的解剖学数据。目的：研究腕尺管内不同平面管径的大小，血管、神经的大小及其伴行关系，进一步探讨腕尺管内神经的卡压因素，研究小鱼际肌变异及手部尺神经树枝状模式，观察小鱼际肌和尺神经的关系。方法：我们对30个防腐尸体手(延边大学解剖学与组织胚胎学教研部提供)进行了解剖学研究，通过4倍放大镜下解剖手的尺侧，记录腕尺管内不同平面管径的大小，血管、神经的大小，小鱼际肌肌腹的数量和它们的变异，尺神经深支裂隙处小鱼肌腱弓的组成模式，尺神经在每一个手的分支。观察小鱼际肌的变异和树枝状尺神经之间的关系。结果：腕尺管管径入口处窄而高，小鱼际腱弓下间隙的宽度大于血管神经束的横径，而纵向高度与血管神经束的纵径几乎相等，小指展肌在4个手有一个肌腹，在25个手有2个肌腹，在1个手有3个肌腹。小指短屈肌在4个手缺如，在22个手有一个肌腹，在4个手有2个肌腹。在所有小指对掌肌部有两层，尺神经深支通过两层之间，我们观察有3种尺神经深支的裂隙模式，5种尺神经树枝状分布模式，根据解剖形态特点我们把小指展肌的运动神经支配模式分为4种类型。发现3个手的尺神经深支起点有变异，起自于从尺神经远端到分支处。三个手的两个感觉支之间有一个交通支。发现两个手的尺侧感觉支有分支进入小指展肌。结论：我们总结了尺神经和小鱼际肌之间的解剖关系，，证明它们之间的关系是非常复杂的，这些解剖知识可以为腕尺管综合征的诊断和治疗提供解剖学依据。
[Abstract]:Background: Hunt first described ulnar nerve entrapment syndrome (ulnar tunnel sydrome,UTS) in 1908, also known as ulnar tunnel syndrome. There are many clinical symptoms and signs, which can be accompanied by other diseases, which make diagnosis more difficult. Scholars at home and abroad continue to study it, and there have been some new progress reports. There are many reports on the anatomical relationship between the ulnar nerve of hand and the hypothenar muscles, but there are no reports on this aspect in our country. Domestic scholars have observed the walking, adjacent, branching, distribution and surface projection of the deep branch of ulnar nerve. The anatomical structure of the ulnar carpal canal is complex, which needs to be studied to provide Chinese anatomical data. Objective: to study the size of different plane diameters, blood vessels and nerves in the ulnar carpal canal, and the relationship between them, and to study the factors of entrapment of the nerve in the ulnar carpal tunnel, the variation of the hypothenar muscle and the tree-like pattern of ulnar nerve in the hand. To observe the relationship between hypothenar muscle and ulnar nerve. Methods: we studied the anatomy of 30 embalmed cadaveric hands (provided by Department of Anatomy and Embryology, Yanbian University). The ulnar side of the hand was dissected under 4 times magnifying glass, and the sizes and vessels of the different plane diameters in the ulnar carpal canal were recorded. The size of the nerves, the number of hypothenar muscles and their variations, the pattern of the tendinous arch in the fissure of the deep branch of the ulnar nerve, the branch of the ulnar nerve in each hand. To observe the relationship between the variation of hypothenar muscle and the branch ulnar nerve. Results: the diameter of the ulnar canal was narrow and high. The width of the space under the hypothenar tendon arch was larger than the transverse diameter of the vascular nerve bundle, but the longitudinal height was almost equal to the longitudinal diameter of the vascular nerve bundle. There are 2 muscles in 25 hands and 3 in 1 hand. The flexor brevis was absent in 4 hands, one in 22 hands and two in 4 hands. There are two layers in all the palmar muscles of the lesser finger, and the deep branch of ulnar nerve passes between the two layers. We observe three fracture patterns of the deep branch of the ulnar nerve and five kinds of branches of the ulnar nerve. According to the anatomical features, we divided the motor innervation pattern of abductor muscle into four types. The origin of the deep branch of ulnar nerve in 3 hands was found to vary from the distal part of ulnar nerve to the branch. There is a traffic branch between the two sensory branches of the three hands. Branches of the ulnar sensory branches of both hands were found to enter the abductor muscle of the lesser finger. Conclusion: we summarize the anatomical relationship between ulnar nerve and hypothenar muscle and prove that the relationship between ulnar nerve and hypothenar muscle is very complicated. These anatomical knowledge can provide anatomic basis for diagnosis and treatment of ulnar carpal tunnel syndrome.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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