Degeorges R, Masquelet A-C
Service de Chirugie Orthopédique et Traumatologique, Hospital Avicenne, France.
Surg Radiol Anat. 2002 Aug-Sep;24(3-4):169-76. doi: 10.1007/s00276-002-0032-7. Epub 2002 Jul 12.
Different levels of ulnar nerve compression have been reported (the medial intermuscular septum, the posterior compartment of the arm, soft tissue or bony abnormalities of the cubital tunnel). In some rare cases, compression can lie in a 10-cm long tunnel, distal to Osborne's ligament, between the humeral head of the ulnar flexor muscle of wrist (FCU) and the medial epicondylar muscles. Only few publications mention this fact as a factor of residual or recurrent symptoms after common surgical procedures. However, a distal pathology of the cubital tunnel has proved to be the only factor of nerve entrapment in our clinical practice. Specific anatomical dissection of this area was carried out to find and classify the anatomical structures that may play a role in ulnar nerve distal compression. Twenty-four embalmed limbs from 13 cadavers were dissected. The purpose of this study was to find anatomical fibrous structures at an average of 10 cm from the medial epicondyle. Anatomical structures were classified into five types: no aponeurosis between the FCU and the medial epicondylar muscles (54.2% of cases), a fibrous band taut between the FCU and the fourth- and fifth-finger ulnar insertions of the flexor digitorum superficialis (FDS) (8.3%), a thin (20.8%) or thick (4.2%) partial aponeurosis between the FCU and the medial epicondylar muscles, and total aponeurosis (12.5%). Anatomical variations of the distal cubital tunnel were divided in five types, but their clinical significance remains unclear.
已有报道称尺神经受压存在不同水平（内侧肌间隔、臂后室、肘管的软组织或骨异常）。在一些罕见病例中，压迫可位于腕部尺侧屈肌（FCU）肱骨头与内侧上髁肌之间、距奥斯本韧带远端10厘米长的隧道内。仅有少数出版物提及这一情况是常见外科手术后残留或复发症状的一个因素。然而，在我们的临床实践中，肘管远端病变已被证明是神经卡压的唯一因素。对该区域进行了特定的解剖，以找出并分类可能在尺神经远端压迫中起作用的解剖结构。对来自13具尸体的24条防腐处理后的肢体进行了解剖。本研究的目的是在距内侧上髁平均10厘米处寻找解剖纤维结构。解剖结构分为五种类型：FCU与内侧上髁肌之间无腱膜（54.2%的病例）、FCU与指浅屈肌（FDS）第四和五指尺侧附着点之间有一条紧绷的纤维带（8.3%）、FCU与内侧上髁肌之间有薄（20.8%）或厚（4.2%）的部分腱膜以及完全腱膜（12.5%）。肘管远端的解剖变异分为五种类型，但其临床意义仍不明确。
