Dinh Paul T, Gupta Ranjan
Department of Orthopaedic Surgery, University of California, Irvine Irvine, CA 92868, USA.
Tech Hand Up Extrem Surg. 2005 Mar;9(1):52-9. doi: 10.1097/01.bth.0000154444.88187.46.
Ulnar nerve compression at the elbow is commonly accepted as the second most frequent compressive peripheral neuropathy. The unique anatomic location of the ulnar nerve directly posterior to the medial epicondyle at the elbow places it at risk for injury. With normal motion of the elbow, the ulnar nerve is subjected to compression, traction, and frictional forces. Compression can occur at any of the 5 sites that begin proximally at the arcade of Struthers and end distally where the nerve exits the flexor carpi ulnaris in the forearm. Initial treatment of compressive neuropathy is nonoperative, usually consisting of rest, modification, and/or restriction of elbow or wrist movement. If symptoms persist, especially when accompanied by muscle weakness, surgery is usually indicated. Surgical options include decompression in situ, medial epicondylectomy, transposition of the ulnar nerve (subcutaneous, intramuscular, or submuscular), and/or a combination of these procedures. Careful decompression with a subtotal medial epicondylectomy is a valuable procedure that allows decompression at all levels with minimal risk of devascularizing the nerve or creating elbow instability.
肘部尺神经卡压通常被认为是第二常见的压迫性周围神经病变。尺神经在肘部位于内上髁正后方的独特解剖位置使其容易受伤。随着肘部的正常活动，尺神经会受到压迫、牵拉和摩擦力。压迫可发生在从近端的Struthers弓开始到远端神经在前臂穿出尺侧腕屈肌的5个部位中的任何一处。压迫性神经病变的初始治疗是非手术治疗，通常包括休息、调整和/或限制肘部或腕部活动。如果症状持续，尤其是伴有肌肉无力时，通常需要手术治疗。手术选择包括原位减压、内上髁切除术、尺神经移位（皮下、肌内或肌下）以及/或者这些手术的联合。采用次全内上髁切除术进行仔细减压是一种有价值的手术，它能在所有层面进行减压，同时使神经缺血或导致肘部不稳定的风险降至最低。
