【摘要】： 目的 本研究對造成肘管綜合征的因素進(jìn)行了相關(guān)的解剖學(xué)研究,為臨床治療肘管綜合征提供詳盡的解剖學(xué)依據(jù)。 材料方法 32塊干性肱骨標(biāo)本,其中左16塊、右16塊。10%福爾馬林固定的完整正常成人胸上肢標(biāo)本20例,其中男12例,女8例。新鮮成年上肢標(biāo)本9例,其中男5例,女4例。 1.測量干性肱骨標(biāo)本尺神經(jīng)溝的長度、寬度、深度和肱骨內(nèi)上髁的寬度。 2.將29例成人胸上肢標(biāo)本(男17、女12)進(jìn)行大體解剖,分層切開皮膚、淺筋膜、深筋膜和肌肉,解剖出尺神經(jīng)。測量肘管的長度、寬度和尺神經(jīng)肘管中段的深度。 3.觀測20側(cè)成人胸上肢標(biāo)本肘部尺神經(jīng)的位置及被動(dòng)屈肘時(shí)尺神經(jīng)的伸長長度。 4.對成人胸上肢標(biāo)本20例(男12例,女8例)解剖觀察測量肘管后壁長度,切開肘管后壁,將尺神經(jīng)前移,測量其前移的最大距離。 5. 29例防腐成人胸上肢標(biāo)本觀察測量肘部尺神經(jīng)血供來源和血管外徑及血管長度的相關(guān)數(shù)據(jù),2個(gè)新鮮胸上肢標(biāo)本模擬臨床尺神經(jīng)前移術(shù)。 結(jié)果 1.干性肱骨標(biāo)本尺神經(jīng)溝的長度為:左側(cè)23.34±3.52mm,右側(cè)23.18±3.72mm;干性肱骨標(biāo)本尺神經(jīng)溝的寬度為:左側(cè)13.14±2.56mm,右側(cè)為13.18±2.74mm;干性肱骨標(biāo)本尺神經(jīng)溝的深度為:左側(cè)7.95±0.76mm,右側(cè)為7.92±0.86m。 2.尸體標(biāo)本肘管的長度為男性24.00±4.12 mm,女性22.10±4.41mm;肘管的寬度為男性6.12±0.82 mm,女性6.08±0.96 mm;肘管中段的深度為男性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),尺神經(jīng)可拉長6.6%土0.3%( X±s,自身對照);屈曲度大于90度后,伸展性明顯減少,為0.8%士0.1%。 4.肘管后壁長度:男性為18.74±2.52mm,女性為18.48±2.72mm;切開肘管后壁將尺神經(jīng)前移至肱骨內(nèi)上髁前方皮下,最大前移的距離:男性為15.50±3.00mm,女性為14.20±3.90mm。 5.肘部尺神經(jīng)血供有3個(gè)來源:尺側(cè)上副動(dòng)脈、尺側(cè)下副動(dòng)脈和尺側(cè)返動(dòng)脈后支,三條動(dòng)脈的起始外徑分別是1.8±0.5mm、1.4±0.3mm和1.8±0.4mm;到尺神經(jīng)的垂直距離分別是15.1±4.2mm、24.6±7.2mm和17.8±5.6mm;三條動(dòng)脈從起始處至肱骨內(nèi)上髁的距離分別是141.0±26.0 mm、45.2±1.4mm和62.0±4.2mm;其主干發(fā)出的部位到入尺神經(jīng)部位的距離分別是145.0±4.3mm、48.6±8.2mm和65.2±9.3mm。尺神經(jīng)于肘部發(fā)出關(guān)節(jié)支和肌支分別為1~3支。 結(jié)論 1.尺神經(jīng)肘管段全部嵌人尺神經(jīng)溝內(nèi),嵌合得越緊,發(fā)生肘管綜合癥的可能性越大。肘關(guān)節(jié)反復(fù)屈伸時(shí)尺神經(jīng)不斷被牽拉和壓迫是造成肘部尺神經(jīng)卡壓的解剖學(xué)基礎(chǔ)。 2.臨床手術(shù)治療肘管綜合癥,切開肘管后壁進(jìn)行時(shí),可切開長度在15.7~21.8 mm,肘管內(nèi)尺神經(jīng)前移距離在14.2~15.5mm之間,不會(huì)產(chǎn)生術(shù)后神經(jīng)張力增加。 3.將肘部尺神經(jīng)從肘管內(nèi)移位到肘前部治療肘管綜合征時(shí),保護(hù)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 鹵3.52 mm on the left side and 23.18 鹵3.72 mm on the right side, 13.14 鹵2.56 mm on the left side and 13.18 鹵2.74 mm on the right side, and the depth of the ulnar nerve sulcus on the dry humerus specimen was 7.95 鹵0.76 mm on the left side and 7.92 鹵0.86 m2 on the right side. The length of cubital tunnel was 24.00 鹵4.12 mm, in male and 22.10 鹵4.41 mm in female, and the width of cubital tunnel was 6.12 鹵0.82 mm, in male and 5.24 鹵1.12 mm in female and 5.18 鹵1.42 mm in female. The extensibility of ulnar nerve was significantly decreased from 0 degree to 135 degree of elbow flexion (X 鹵s, X 鹵s) and 0.8% 鹵0.1% (P < 0.05) after flexion was more than 90 degrees, and the extensibility of ulnar nerve was significantly reduced to 0.8% 鹵0.1% (X 鹵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 鹵2.52mm in male and 18.48 鹵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 鹵3.00mm for male and 14.20 鹵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 鹵0.5 mm,45.2 鹵1.4 鹵0.3mm and 1.8 鹵0.4 mm, respectively; the vertical distances to the ulnar nerve were 15.1 鹵4.2 mm, 24.6 鹵7.2mm and 17.8 鹵5.6 mm, respectively; the distances from the origin of the three arteries to the medial epicondyle of humerus were 141.0 鹵26.0 mm,45.2 鹵1.4mm and 62.0 鹵4.2 mm, respectively. The distances were 48.6 鹵8.2mm and 65.2 鹵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.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R322

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