Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini A K, Preissler P, Scheglmann K, Schwerdtfeger K, Wessels K D, Wüstner-Hofmann M
Praxis für periphere Neurochirurgie, Dossenheim.
Handchir Mikrochir Plast Chir. 2009 Feb;41(1):2-12. doi: 10.1055/s-0029-1185287. Epub 2009 Feb 17.
The cubital tunnel syndrome is one of the most widespread compression syndromes of a peripheral nerve. In German-speaking countries it is known as the sulcus ulnaris syndrome (retrocondylar groove syndrome), which is anatomically incorrect. The cubital tunnel consists of the retrocondylar groove, the cubital tunnel retinaculum (Lig. arcuatum or Osborne band), the humeroulnar arcade and the deep flexor/pronator aponeurosis. According to Sunderland it can be divided into a primary form (including the ulnar luxation and the epitrocheoanconaeus muscle) and a secondary form caused by deformation or other processes of the elbow joint. The diagnosis has to be confirmed by a thorough clinical examination and nerve conduction studies. Neurosonography and MRI are becoming more and more important with improving resolution and enable the direct identification of morphological changes. Differential diagnosis is essential in atypical cases, especially C8 syndrome and pressure palsy. Double crush (double compression syndrome) may occur. Operative treatment is more effective than conservative treatment, which consists primarily of the prevention of exposure to external noxes. According to actual randomised controlled studies the therapy of choice of the primary form in most cases is the simple in situ decompression of the ulnar nerve in the cubital tunnel. This has to be extended at least up to 5-6 cm distally of the medial epicondyle and can be performed in the open or endoscopic technique, both under local anesthesia. Simple decompression is also the therapy of choice in uncomplicated ulnar luxation and in most post-traumatic cases and other secondary forms. In cases of severe bony or tissue changes of the elbow (especially cubitus valgus) the volar transposition of the ulnar nerve may be indicated. This can be performed in a subcutaneous or submuscular technique. Risks of transposition are impairment of perfusion and, above all, kinking caused by insufficient proximal or distal mobilisation of the nerve has to be avoided. In these cases revision surgery is necessary. The epicondylectomy is not common in our country. Recurrences may occur.
肘管综合征是最常见的周围神经卡压综合征之一。在德语国家，它被称为尺神经沟综合征（髁后沟综合征），这在解剖学上是不正确的。肘管由髁后沟、肘管支持带（弓状韧带或奥斯本带）、肱尺肌弓和深层屈肌/旋前肌腱膜组成。根据桑德兰的分类，它可分为原发性形式（包括尺神经脱位和肱肌止点处病变）和由肘关节变形或其他病变引起的继发性形式。诊断必须通过全面的临床检查和神经传导研究来证实。随着分辨率的提高，神经超声和磁共振成像变得越来越重要，能够直接识别形态学变化。在非典型病例中，尤其是C8综合征和压迫性麻痹，鉴别诊断至关重要。可能会发生双重压迫（双重压迫综合征）。手术治疗比保守治疗更有效，保守治疗主要包括防止接触外部有害因素。根据实际随机对照研究，大多数情况下原发性肘管综合征的首选治疗方法是在肘管内对尺神经进行简单的原位减压。减压范围至少要延伸到内上髁远端5 - 6厘米处，可以采用开放或内镜技术，均在局部麻醉下进行。简单减压也是单纯尺神经脱位、大多数创伤后病例及其他继发性形式的首选治疗方法。在肘部出现严重骨质或组织改变（尤其是肘外翻）的情况下，可能需要进行尺神经的掌侧移位。这可以通过皮下或肌下技术进行。移位的风险包括灌注受损，最重要的是必须避免因神经近端或远端活动不足导致的扭结。在这些情况下，需要进行翻修手术。在我国，肱骨髁上切除术并不常见。可能会出现复发。
