Muneer Mohammed, Al-Maraghi Salwa
Hamad Medical Corporation, Doha, Qatar.
Qatar University, Doha, Qatar.
Int Orthop. 2025 Jun;49(6):1421-1425. doi: 10.1007/s00264-025-06494-4. Epub 2025 Mar 17.
understanding the concept of multiple compression neuropathy syndrome has recently evolved, leading to better clinical assessment and evaluation. However, decompression of the involved nerves might require multiple incisions. Concomitant compression neuropathy, such as Lacertus Syndrome (LS) and cubital tunnel syndrome, is not uncommon. The traditional approach for releasing both nerves encompasses two separate surgical incisions. Minimazing surgical incisions is essential for postoperative scar management and nerve gliding. In this paper we describe a single surgical incision for releasing both compressions.
To release the Lacertus Fibrosis using the classical surgical incision for cubital tunnel syndrome, an incision is made between the medial epicondyle and olecranon. After reaching the brachial fascia, the skin and subcutaneous tissue are raised as a one flap off the fascia. The lacertus fibrosis, identified as a thick rectangular or trapezoid stracture attached to the brachial fascia, is then incised to expose the median nerve beneath it.
As we advance towards the concept of multiple compression neuropathy, it is crucial to minimize surgical incisions to reduce pain, wound breakdown, scar formation, traction neuropathy, neuroma formation, and unsatisfactory aesthetic outcomes.
对多重压迫性神经病变综合征概念的理解最近有所发展，这使得临床评估和评价得到了改善。然而，对受累神经进行减压可能需要多个切口。合并压迫性神经病变，如肱二头肌肌腱膜综合征（LS）和肘管综合征，并不少见。传统的同时松解这两根神经的方法需要两个单独的手术切口。尽量减少手术切口对于术后瘢痕管理和神经滑动至关重要。在本文中，我们描述了一种用于同时松解两种压迫的单一手术切口。
为了使用治疗肘管综合征的经典手术切口来松解肱二头肌肌腱膜，在内上髁和鹰嘴之间做一个切口。到达肱筋膜后，将皮肤和皮下组织作为一个皮瓣从筋膜上掀起。肱二头肌肌腱膜被识别为附着于肱筋膜的厚矩形或梯形结构，然后切开该结构以暴露其下方的正中神经。
随着我们朝着多重压迫性神经病变的概念发展，尽量减少手术切口以减轻疼痛、伤口裂开、瘢痕形成、牵拉伤性神经病变、神经瘤形成以及不理想的美学效果至关重要。
