Nagle Daniel J, Patel Ronak M, Paisley Sonya
Chicago Center for Surgery of the Hand, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave #700, Chicago, IL 60611 USA.
Hand (N Y). 2012 Mar;7(1):103-7. doi: 10.1007/s11552-011-9377-x. Epub 2011 Nov 17.
The aim of this study is to endoscopically evaluate the ulnar nerve proximal and distal to the cubital tunnel after in situ decompression to identify and eventually release fascial bands capable of compressing the ulnar nerve.
We performed a retrospective review of 16 ulnar nerve compression cases in 12 patients. Eight men and four women with a mean age of 52 years (range, 23-77 years) were clinically diagnosed and confirmed with neurophysiologic studies. A 4-6-cm curvilinear incision was made at the medial elbow, and the ulnar nerve was identified and decompressed at the cubital tunnel. Then, a 2.7-mm endoscope was passed 8 to 10 cm proximal and distal to the medial epicondyle allowing for visualization of the ulnar nerve and its surrounding soft tissues.
The endoscopic evaluation of the 16 ulnar nerves demonstrated no compressive bands outside of the cubital tunnel. All patients had satisfactory outcomes.
The good results reported after in situ ulnar nerve decompression have questioned the need for endoscopically assisted decompression of the ulnar nerve proximal and distal to the cubital tunnel. Some authors suggest the existence of fascial bands within the flexor carpi ulnaris (FCU) capable of compressing the ulnar nerve. This study would suggest that fibrous bands deep in the FCU capable of compressing the ulnar nerve do not exist. Our satisfactory outcomes would support the perception that extensive decompression of the ulnar nerve beyond the cubital tunnel is not routinely needed.
本研究的目的是在内镜下评估原位减压术后肘管近端和远端的尺神经，以识别并最终松解可能压迫尺神经的筋膜束带。
我们对12例患者的16例尺神经卡压病例进行了回顾性研究。8名男性和4名女性，平均年龄52岁（范围23 - 77岁），经临床诊断并通过神经生理学检查得以确诊。在内侧肘部做一个4 - 6厘米的曲线切口，识别尺神经并在肘管处进行减压。然后，将一根2.7毫米的内窥镜插入到内上髁近端和远端8至10厘米处，以观察尺神经及其周围软组织。
对16条尺神经的内镜评估显示肘管外没有压迫束带。所有患者均取得了满意的结果。
原位尺神经减压术后报告的良好结果引发了对于是否需要在内镜辅助下对肘管近端和远端的尺神经进行减压的质疑。一些作者认为尺侧腕屈肌（FCU）内存在能够压迫尺神经的筋膜束带。本研究表明，尺侧腕屈肌深部不存在能够压迫尺神经的纤维束带。我们满意的结果支持了这样一种观点，即通常不需要对肘管以外的尺神经进行广泛减压。
