本文選題：肘管　切入點：尺神經(jīng)　出處：《天津醫(yī)科大學》2011年碩士論文

【摘要】：目的利用薄型化連續(xù)火棉膠切片和三維重建技術對肘管及滑車上肘肌的解剖結構進行觀察研究,闡述肘管的精細解剖結構,探討肘管綜合癥潛在的病因,并為原位松解術的實施提供解剖學建議,以達到治療肘管綜合癥的理想效果。 材料與方法①14例福爾馬林固定的成年肘部標本,11例行大體解剖觀察肘管的結構。3例分別置入8%的鹽酸脫鈣70d,并常規(guī)脫水后,將組織塊浸入火棉膠中進行包埋。利用L型浸酒大腦切片機分別將標本制成1mm厚的水平、冠狀和矢狀位火棉膠切片。對相關的區(qū)域在體式顯微鏡下放大進行觀察并請2位專家進行觀察切片。將67張水平切片的圖像輸入3D-DOCTOR軟件,以不同的顏色對骨、關節(jié)囊、肱三頭肌、滑車上肘肌、尺神經(jīng)、尺側腕屈肌等結構標記,完成肘管及毗鄰結構的三維重建。 ②收集2010年7月至9月份天津市第一中心醫(yī)院13例行肘部掃描的MRI圖像,所有圖像顯示該區(qū)域無明顯病變。以便和切片進行對比觀察。結果①肘管是一扁圓形通道,由底和頂共同圍成,其內(nèi)主要有尺神經(jīng)通過,其內(nèi)還有尺側下副動靜脈和尺側返動靜脈存在以營養(yǎng)尺神經(jīng)。肘管的底由肘關節(jié)囊和尺側副韌帶前、后、橫束構成。肘管的頂由肘管支持帶或滑車上肘肌和尺側腕屈肌的肱尺兩頭之間的筋膜構成。滑車上肘肌起自內(nèi)上髁,其上部以筋膜止于鷹嘴內(nèi)側緣；中下部分直接止于鷹嘴內(nèi)側緣。 對水平切片的觀察發(fā)現(xiàn),在尺神經(jīng)溝水平,有一神經(jīng)蒂將尺神經(jīng)連于底的后外部。在大體標本上表現(xiàn)為較多的結締組織將尺神經(jīng)連于底。三維重建可見EA是一不規(guī)則的肌肉,起自內(nèi)上髁止于鷹嘴。其上部以較長的筋膜止于鷹嘴,中下部則直接止于鷹嘴。在尺神經(jīng)溝水平,有一神經(jīng)蒂將尺神經(jīng)連于底的后外側部分。 ②肘關節(jié)的各個結構在切片上顯示良好,分界明顯,邊界清楚,易于辨認。MRI對肘關節(jié)顯示較好。較小的結構可在MRI顯示,雖然其邊界稍微不清晰,斷層解剖的切片與MRI圖像對肘關節(jié)的表現(xiàn)基本一致。 結論①肘管的底由關節(jié)囊和尺側副韌帶的前束、后束和橫束構成,內(nèi)上髁和鷹嘴不參與底的構成。肘管的頂是由肘管支持帶(或滑車上肘肌)和尺側腕屈肌兩頭之間的筋膜構成。②掌握滑車上肘肌的解剖結構有助于我們精確并合理地將其切除以治療肘管綜合癥。③神經(jīng)蒂有防止尺神經(jīng)過度運動以及半脫位的作用。對于不同病因引起的肘管綜合癥,對此結構的處理方式應該有所不同。④進行切片與MRI的對比,有助于以后在臨床中工作中可以通過MRI的影像推測出更加精確的解剖特點。做出精確診斷。
[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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R323.7

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