Lee Won Seok, Yang Hee-Jin, Park Sung Bae, Son Young Je, Hong Noah, Lee Sang Hyung
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2023 Jan;66(1):90-94. doi: 10.3340/jkns.2022.0128. Epub 2022 Sep 8.
Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications.
A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle.
There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation.
In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.
肘管综合征是最常见的尺神经卡压性神经病，通常通过单纯减压或前移术进行治疗。前移术中的一个担忧是对肘部周围神经分支的损伤。在本研究中，在肘管综合征手术过程中评估尺神经至尺侧腕屈肌（FCU）分支的位置，以提供信息减少手术相关并发症。
回顾了一组（HJY）个人进行的肘管综合征手术病例。选择接受前移术且有至FCU分支位置信息的病例进行分析。通过术中神经刺激确认分支的功能，并通过与内上髁中心的距离评估分支的位置。
共有61例肘管综合征病例，其中31例接受了前移术治疗。分析了21例有分支位置信息的病例。肘部周围尺神经分支的平均数量为1.8（0至3），仅1例无分支。大多数病例有一支至内侧头，另一支至FCU外侧头。有2例分支无FCU反应（1例有1支，另1例有3支）。至内侧头分支的位置在内上髁远端16.3±8.6mm处（16支；范围0至35mm），至外侧头分支的位置在内上髁远端19.5±9.5mm处（19支；范围-5至30mm）。无FCU反应的分支在内侧髁近端20mm至内上髁远端15mm处（5支）。大多数至内侧头的分支在15至20mm（50%的病例），大多数至外侧头的分支在15至25mm（58%的病例）。术后无FCU明显无力的病例。
在大多数肘管综合征病例中，肘部周围存在尺神经分支。虽然可能有一些分支无FCU反应的病例，但大多数分支至FCU，应予以保留。手术者应警惕在内上髁远端约15至25mm处的分支，大多数分支在此处发出。
Zotero 插件