尺神经肘管段的解剖学研究及临床意义
发布时间：2018-10-20 11:14
【摘要】： 目的 本研究对造成肘管综合征的因素进行了相关的解剖学研究,为临床治疗肘管综合征提供详尽的解剖学依据。 材料方法 32块干性肱骨标本,其中左16块、右16块。10%福尔马林固定的完整正常成人胸上肢标本20例,其中男12例,女8例。新鲜成年上肢标本9例,其中男5例,女4例。 1.测量干性肱骨标本尺神经沟的长度、宽度、深度和肱骨内上髁的宽度。 2.将29例成人胸上肢标本(男17、女12)进行大体解剖,分层切开皮肤、浅筋膜、深筋膜和肌肉,解剖出尺神经。测量肘管的长度、宽度和尺神经肘管中段的深度。 3.观测20侧成人胸上肢标本肘部尺神经的位置及被动屈肘时尺神经的伸长长度。 4.对成人胸上肢标本20例(男12例,女8例)解剖观察测量肘管后壁长度,切开肘管后壁,将尺神经前移,测量其前移的最大距离。 5. 29例防腐成人胸上肢标本观察测量肘部尺神经血供来源和血管外径及血管长度的相关数据,2个新鲜胸上肢标本模拟临床尺神经前移术。 结果 1.干性肱骨标本尺神经沟的长度为:左侧23.34±3.52mm,右侧23.18±3.72mm;干性肱骨标本尺神经沟的宽度为:左侧13.14±2.56mm,右侧为13.18±2.74mm;干性肱骨标本尺神经沟的深度为:左侧7.95±0.76mm,右侧为7.92±0.86m。 2.尸体标本肘管的长度为男性24.00±4.12 mm,女性22.10±4.41mm;肘管的宽度为男性6.12±0.82 mm,女性6.08±0.96 mm;肘管中段的深度为男性5.24±1.12mm,女性5.18±1.42mm。 3.自肘部伸直位(0度)至完全屈肘位(135度),尺神经可拉长6.6%土0.3%( X±s,自身对照);屈曲度大于90度后,伸展性明显减少,为0.8%士0.1%。 4.肘管后壁长度:男性为18.74±2.52mm,女性为18.48±2.72mm;切开肘管后壁将尺神经前移至肱骨内上髁前方皮下,最大前移的距离:男性为15.50±3.00mm,女性为14.20±3.90mm。 5.肘部尺神经血供有3个来源:尺侧上副动脉、尺侧下副动脉和尺侧返动脉后支,三条动脉的起始外径分别是1.8±0.5mm、1.4±0.3mm和1.8±0.4mm;到尺神经的垂直距离分别是15.1±4.2mm、24.6±7.2mm和17.8±5.6mm;三条动脉从起始处至肱骨内上髁的距离分别是141.0±26.0 mm、45.2±1.4mm和62.0±4.2mm;其主干发出的部位到入尺神经部位的距离分别是145.0±4.3mm、48.6±8.2mm和65.2±9.3mm。尺神经于肘部发出关节支和肌支分别为1~3支。 结论 1.尺神经肘管段全部嵌人尺神经沟内,嵌合得越紧,发生肘管综合症的可能性越大。肘关节反复屈伸时尺神经不断被牵拉和压迫是造成肘部尺神经卡压的解剖学基础。 2.临床手术治疗肘管综合症,切开肘管后壁进行时,可切开长度在15.7~21.8 mm,肘管内尺神经前移距离在14.2~15.5mm之间,不会产生术后神经张力增加。 3.将肘部尺神经从肘管内移位到肘前部治疗肘管综合征时,保护其血供是完全可能的。
[Abstract]:Objective to provide anatomic basis for clinical treatment of cubital tunnel syndrome. Methods Thirty two dry humeral specimens, including 16 left, 16 right, 10% formalin fixation, were performed in 20 normal adults, including 12 males and 8 females. There were 9 fresh adult upper limb specimens, including 5 males and 4 females. 1. The length, width, depth of ulnar nerve sulcus and width of medial epicondyle of humerus were measured. The ulnar nerve was dissected from 29 adult thoracic upper limb specimens (17 males and 12 females). The ulnar nerve was dissected by laminar incision of skin, superficial fascia, deep fascia and muscle. Measure the length and width of the cubital tunnel and the depth of the middle part of the ulnar nerve. The position of ulnar nerve in elbow and the extension length of ulnar nerve during passive elbow flexion were observed in 20 adult thoracic upper limb specimens. The length of the posterior wall of the cubital tunnel was observed and measured in 20 adult thoracic upper limb specimens (12 males and 8 females). The posterior wall of the cubital tunnel was cut open and the ulnar nerve was moved forward. The blood supply of ulnar nerve of elbow, the diameter of blood vessel and the length of blood vessel were observed and measured in 29 cases of anticorrosive adult thoracic upper limb. Two fresh chest and upper limb specimens were used to simulate clinical ulnar nerve forward transfer. Result 1. The length of ulnar nerve sulcus in dry humerus was 23.34 卤3.52 mm on the left side and 23.18 卤3.72 mm on the right side, 13.14 卤2.56 mm on the left side and 13.18 卤2.74 mm on the right side, and the depth of the ulnar nerve sulcus on the dry humerus specimen was 7.95 卤0.76 mm on the left side and 7.92 卤0.86 m2 on the right side. The length of cubital tunnel was 24.00 卤4.12 mm, in male and 22.10 卤4.41 mm in female, and the width of cubital tunnel was 6.12 卤0.82 mm, in male and 5.24 卤1.12 mm in female and 5.18 卤1.42 mm in female. The extensibility of ulnar nerve was significantly decreased from 0 degree to 135 degree of elbow flexion (X 卤s, X 卤s) and 0.8% 卤0.1% (P < 0.05) after flexion was more than 90 degrees, and the extensibility of ulnar nerve was significantly reduced to 0.8% 卤0.1% (X 卤s, self-control), and the extensibility of ulnar nerve was significantly decreased when flexion was greater than 90 degrees. The length of posterior wall of cubital tunnel was 18.74 卤2.52mm in male and 18.48 卤2.72mm in female. The posterior wall of cubital tunnel was removed from the posterior wall of cubital tunnel to the subcutaneous front of the medial epicondyle of humerus. The maximum distance was 15.50 卤3.00mm for male and 14.20 卤3.90mm. 5mm for female. The blood supply of the ulnar nerve of the elbow was derived from three sources: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior branch of the recurrent ulnar artery. The initial external diameters of the three arteries were 1.8 卤0.5 mm,45.2 卤1.4 卤0.3mm and 1.8 卤0.4 mm, respectively; the vertical distances to the ulnar nerve were 15.1 卤4.2 mm, 24.6 卤7.2mm and 17.8 卤5.6 mm, respectively; the distances from the origin of the three arteries to the medial epicondyle of humerus were 141.0 卤26.0 mm,45.2 卤1.4mm and 62.0 卤4.2 mm, respectively. The distances were 48.6 卤8.2mm and 65.2 卤9.3 mm. respectively. The articular and muscular branches of ulnar nerve in the elbow were 1 and 3, respectively. Conclusion 1. The cubital segment of ulnar nerve is completely embedded in the sulcus of human ulnar nerve. The compression of ulnar nerve is the anatomic basis of ulnar nerve compression in elbow joint. 2. In the treatment of cubital tunnel syndrome, when the posterior wall of cubital tunnel was incised, the length of incision was 15. 7 ~ 21. 8 mm,. The distance of ulnar nerve forward movement within the cubital tunnel was between 14.2~15.5mm and the nerve tension would not increase after operation. It is possible to protect the blood supply of cubital tunnel syndrome by transferring ulnar nerve from cubital tunnel to anterior cubital canal.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322
本文编号：2282986
[Abstract]:Objective to provide anatomic basis for clinical treatment of cubital tunnel syndrome. Methods Thirty two dry humeral specimens, including 16 left, 16 right, 10% formalin fixation, were performed in 20 normal adults, including 12 males and 8 females. There were 9 fresh adult upper limb specimens, including 5 males and 4 females. 1. The length, width, depth of ulnar nerve sulcus and width of medial epicondyle of humerus were measured. The ulnar nerve was dissected from 29 adult thoracic upper limb specimens (17 males and 12 females). The ulnar nerve was dissected by laminar incision of skin, superficial fascia, deep fascia and muscle. Measure the length and width of the cubital tunnel and the depth of the middle part of the ulnar nerve. The position of ulnar nerve in elbow and the extension length of ulnar nerve during passive elbow flexion were observed in 20 adult thoracic upper limb specimens. The length of the posterior wall of the cubital tunnel was observed and measured in 20 adult thoracic upper limb specimens (12 males and 8 females). The posterior wall of the cubital tunnel was cut open and the ulnar nerve was moved forward. The blood supply of ulnar nerve of elbow, the diameter of blood vessel and the length of blood vessel were observed and measured in 29 cases of anticorrosive adult thoracic upper limb. Two fresh chest and upper limb specimens were used to simulate clinical ulnar nerve forward transfer. Result 1. The length of ulnar nerve sulcus in dry humerus was 23.34 卤3.52 mm on the left side and 23.18 卤3.72 mm on the right side, 13.14 卤2.56 mm on the left side and 13.18 卤2.74 mm on the right side, and the depth of the ulnar nerve sulcus on the dry humerus specimen was 7.95 卤0.76 mm on the left side and 7.92 卤0.86 m2 on the right side. The length of cubital tunnel was 24.00 卤4.12 mm, in male and 22.10 卤4.41 mm in female, and the width of cubital tunnel was 6.12 卤0.82 mm, in male and 5.24 卤1.12 mm in female and 5.18 卤1.42 mm in female. The extensibility of ulnar nerve was significantly decreased from 0 degree to 135 degree of elbow flexion (X 卤s, X 卤s) and 0.8% 卤0.1% (P < 0.05) after flexion was more than 90 degrees, and the extensibility of ulnar nerve was significantly reduced to 0.8% 卤0.1% (X 卤s, self-control), and the extensibility of ulnar nerve was significantly decreased when flexion was greater than 90 degrees. The length of posterior wall of cubital tunnel was 18.74 卤2.52mm in male and 18.48 卤2.72mm in female. The posterior wall of cubital tunnel was removed from the posterior wall of cubital tunnel to the subcutaneous front of the medial epicondyle of humerus. The maximum distance was 15.50 卤3.00mm for male and 14.20 卤3.90mm. 5mm for female. The blood supply of the ulnar nerve of the elbow was derived from three sources: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior branch of the recurrent ulnar artery. The initial external diameters of the three arteries were 1.8 卤0.5 mm,45.2 卤1.4 卤0.3mm and 1.8 卤0.4 mm, respectively; the vertical distances to the ulnar nerve were 15.1 卤4.2 mm, 24.6 卤7.2mm and 17.8 卤5.6 mm, respectively; the distances from the origin of the three arteries to the medial epicondyle of humerus were 141.0 卤26.0 mm,45.2 卤1.4mm and 62.0 卤4.2 mm, respectively. The distances were 48.6 卤8.2mm and 65.2 卤9.3 mm. respectively. The articular and muscular branches of ulnar nerve in the elbow were 1 and 3, respectively. Conclusion 1. The cubital segment of ulnar nerve is completely embedded in the sulcus of human ulnar nerve. The compression of ulnar nerve is the anatomic basis of ulnar nerve compression in elbow joint. 2. In the treatment of cubital tunnel syndrome, when the posterior wall of cubital tunnel was incised, the length of incision was 15. 7 ~ 21. 8 mm,. The distance of ulnar nerve forward movement within the cubital tunnel was between 14.2~15.5mm and the nerve tension would not increase after operation. It is possible to protect the blood supply of cubital tunnel syndrome by transferring ulnar nerve from cubital tunnel to anterior cubital canal.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322
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