Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan.
Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan.
J Shoulder Elbow Surg. 2022 Nov;31(11):2322-2327. doi: 10.1016/j.jse.2022.05.026. Epub 2022 Jul 9.
The causes of ulnar neuropathy at the elbow are unclear. The authors hypothesized that the humeral trochlea protrudes into the cubital tunnel during elbow flexion and causes a dynamic morphologic change of the ulnar nerve in the cubital tunnel.
An ultrasonic probe was fixed to the ulnar shafts of 10 fresh cadavers with an external fixator, and dynamic morphology of the cubital tunnel and ulnar nerve was observed. The distance from the Osborne band to the trochlea (OTD), distance from ulnar nerve center to the trochlea (UTD), and the short- and long-axis diameters of the nerve at 30°, 60°, 90°, and 120° of elbow flexion were recorded. We compared the OTD, UTD, and the flattening of the ulnar nerve at the different angles of flexion using single-factor analysis of variance. Correlation between the ulnar nerve flattering, OTD, and UTD was examined using Spearman correlation coefficient. A P value less than .05 was used to denote statistical significance.
Flattening of the ulnar nerve progressed with increasing elbow flexion and was significantly different between 0° and 60°, 90°, and 120° (P = .03 at 60°, P < .01 at 90° and 120°). OTD decreased with elbow flexion, and there was a significant difference at all elbow flexion angles (all P < .01). UTD decreased significantly from 0° flexion to 90° flexion (P = .03). Flattening of the nerve was significantly correlated with the OTD (r = 0.66, P < .01).
A positive correlation was found between the protrusion of the humeral trochlea into the cubital tunnel during elbow flexion and ulnar nerve flattening using cadaveric elbow and ultrasonography.
肘管尺神经病变的病因尚不清楚。作者假设，在肘弯曲时，肱骨滑车突入肘管，导致尺神经在肘管内的动态形态发生变化。
用外固定器将超声探头固定在 10 个新鲜尸体的尺骨上，观察肘管和尺神经的动态形态。记录从 Osborne 带至滑车（OTD）的距离、尺神经中心至滑车（UTD）的距离以及在肘弯曲 30°、60°、90°和 120°时神经的短轴和长轴直径。我们使用单因素方差分析比较了不同弯曲角度的 OTD、UTD 和尺神经变平。使用 Spearman 相关系数检查尺神经变平、OTD 和 UTD 之间的相关性。P 值小于 0.05 表示有统计学意义。
尺神经变平随肘弯曲增加而进展，在 0°和 60°、90°和 120°之间差异显著（60°时 P=0.03，90°和 120°时 P<0.01）。OTD 随肘弯曲而减小，在所有肘弯曲角度均有显著差异（均 P<0.01）。UTD 从 0°弯曲显著减少到 90°弯曲（P=0.03）。神经变平与 OTD 显著相关（r=0.66，P<0.01）。
使用尸体肘部和超声检查发现，在肘弯曲时肱骨滑车突入肘管与尺神经变平之间存在正相关。
