Mahan Mark A, Gasco Jaime, Mokhtee David B, Brown Justin M
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
Division of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas;
J Neurosurg. 2015 Nov;123(5):1216-22. doi: 10.3171/2014.10.JNS141379. Epub 2015 Apr 24.
Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve.
The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region.
An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle.
The common aponeurosis encountered between the FDS and FCU muscles represents a potential site of posttransposition entrapment, which may account for a subset of failed anterior transpositions. Exploration of this region with release of this structure is recommended to provide an unconstrained distal course for a transposed ulnar nerve.
通过手术将尺神经移位以缓解卡压，可能会使原本正常的结构成为新的神经受压源。尺神经前移位术后复发或持续存在的神经病变通常归因于新出现的远端卡压。作者旨在阐明尺神经前移位后，其与尺侧腕屈肌（FCU）和指浅屈肌（FDS）肱骨头共同腱膜的解剖关系。
在26个新鲜尸体标本中探查前臂近端的肌间隔。评估屈肌 - 旋前肌团的纤维间隔和共同腱膜附着点与尺神经的关系，特别关注移位对该区域神经的影响。
所有标本中均存在与FCU和FDS肌肉相关的肌间隔腱膜。当不松解该筋膜间隔时，移位始终会导致肘关节屈曲时神经成角。发现神经开始穿过该筋膜结构的近端部位距内上髁平均为3.9 cm（标准差0.7 cm）。
在FDS和FCU肌肉之间遇到的共同腱膜是移位后潜在的卡压部位，这可能是一部分尺神经前移位失败的原因。建议探查该区域并松解此结构，为移位的尺神经提供无阻碍的远端行程。
