Laulan J, Daaboul J, Fassio E, Favard L
Service de Chirurgie Orthopédique et Traumatologique, CHU Trousseau, Tours.
Ann Chir Main Memb Super. 1994;13(5):366-72. doi: 10.1016/s0753-9053(05)80075-4.
Since Roles and Maudsley's publication, in 1972, it has been admitted that the entrapment of the posterior interosseous nerve (PION) is a possible cause of lateral elbow pain. In the radial tunnel, at least 4 or 5 compressive structures have been described. The arcade of Frohse is a well known compressive cause while the medial edge of the extensor radialis brevis (ECRB) muscle is less frequently incriminated. An anatomic study of 45 supper limbs from 40 cadavers was performed to analyse the relations between the medial edge of the ECRB and the PION. The medial edge of the ECRB was a real fibrous arch in 43 cases (95%). It crossed over the PION in 42 cases, 9 mm more proximally than the arcade of Frohse. So the relationships between the ECRB and PION are very close in 93% of cases. The proximal edge of the supinator muscle was fibrous in 40% of cases but always supple. These findings suggest that the ECRB is a possible cause of PION entrapment. Its role is underestimated in pathology. The frequent association between lateral epicondylitis and PION compression can be explained by the presence of this fibrous structure. Lateral elbow pain must be considered as a regional pathology. The treatment has to deal with every pathological aspect.
自罗尔斯和莫兹利在1972年发表相关内容以来,人们已承认骨间后神经(PION)卡压是外侧肘部疼痛的一个可能原因。在桡管中,至少已描述了4或5个压迫结构。弗罗泽弓是一个众所周知的压迫原因,而桡侧腕短伸肌(ECRB)的内侧缘较少被认为是病因。对40具尸体的45个上肢进行了解剖学研究,以分析ECRB内侧缘与PION之间的关系。在43例(95%)中,ECRB的内侧缘是一个真正的纤维弓。它在42例中跨过PION,比弗罗泽弓更靠近近端9毫米。因此,在93%的病例中,ECRB与PION的关系非常密切。在40%的病例中,旋后肌的近端边缘是纤维性的,但总是柔软的。这些发现表明,ECRB是PION卡压的一个可能原因。其在病理中的作用被低估了。外侧上髁炎与PION压迫之间的频繁关联可以用这种纤维结构的存在来解释。外侧肘部疼痛必须被视为一种区域性病理。治疗必须处理每一个病理方面。