Macchi Veronica, Tiengo Cesare, Porzionato Andrea, Stecco Carla, Sarasin Gloria, Tubbs Shane, Maffulli Nicola, De Caro Raffaele
Department of Molecular Medicine, Institute of Anatomy, University of Padova, Padova, Italy.
J Anat. 2014 Aug;225(2):262-9. doi: 10.1111/joa.12206. Epub 2014 Jun 10.
Entrapment of the ulnar nerve at the elbow is the second most common compression neuropathy in the upper limb. The present study evaluates the anatomy of the cubital tunnel. Eighteen upper limbs were analysed in unembalmed cadavers using ultrasound examination in all cases, dissection in nine cases, and microscopic study in nine cases. In all cases, thickening of the fascia at the level of the tunnel was found at dissection. From the microscopic point of view, the ulnar nerve is a multifascicular trunk (mean area of 6.0 ± 1.5 mm(2) ). The roof of the cubital tunnel showed the presence of superimposed layers, corresponding to fascial, tendineous and muscular layers, giving rise to a tri-laminar structure (mean thickness 523 ± 235 μm). This multilayered tissue was hyperechoic (mean thickness 0.9 ± 0.3 mm) on ultrasound imaging. The roof of the cubital tunnel is elastic, formed by a myofascial trilaminar retinaculum. The pathological fusion of these three layers reduces gliding of the ulnar nerve during movements of the elbow joint. This may play a role in producing the symptoms typical of cubital tunnel syndrome. Independent from the surgical technique, decompression should span the ulnar nerve from the triceps brachii muscle to the flexor carpi ulnaris fascia.
尺神经在肘部的卡压是上肢第二常见的压迫性神经病变。本研究评估了肘管的解剖结构。对18例上肢未防腐尸体进行了分析，所有病例均采用超声检查，9例进行了解剖，9例进行了显微镜研究。在所有解剖病例中，均发现肘管水平的筋膜增厚。从显微镜角度看，尺神经是一个多束状主干（平均面积为6.0±1.5平方毫米）。肘管顶部可见重叠层，分别对应筋膜层、肌腱层和肌肉层，形成了三层结构（平均厚度523±235微米）。这种多层组织在超声成像中表现为高回声（平均厚度0.9±0.3毫米）。肘管顶部具有弹性，由肌筋膜三层支持带构成。这三层的病理性融合会减少肘关节运动时尺神经的滑动。这可能在产生肘管综合征的典型症状中起作用。无论采用何种手术技术，减压都应覆盖从肱三头肌到尺侧腕屈肌筋膜的尺神经。
