Fujioka H, Nakabayashi Y, Hirata S, Go G, Nishi S, Mizuno K
Department of Orthopedic Surgery, Kobe University School of Medicine, Japan.
J Orthop Trauma. 1995;9(5):435-40. doi: 10.1097/00005131-199505000-00013.
Four cases of tardy ulnar nerve palsy associated with a cubitus varus deformity of the elbow secondary to a supracondylar fracture of the humerus are presented. All patients had surgical management of their ulnar nerve palsy. In two patients, the ulnar nerve was entrapped by scar tissue at the abnormal position and the nerve developed a sharp V-shaped kink when the elbow was flexed. In one patient, the ulnar nerve displaced anteriorly with elbow flexion and spontaneously reduced into the ulnar nerve groove with elbow extension. In one patient, the ulnar nerve remained in the ulnar nerve groove; however, it was entrapped by fibrous bands arising from the flexor carpi ulnaris. It is speculated that malunion resulting in cubitus varus deformity will alter the anatomy at the elbow and that this can have a direct effect on the position and instability of the ulnar nerve. Incongruity of the elbow joint due to cubitus varus deformity also may cause osteoarthritis changes. As a result, ulnar neuropathy may develop from irritation to the ulnar nerve from the posttraumatic osteoarthritic changes at the elbow joint.
本文报告了4例因肱骨髁上骨折继发肘内翻畸形而导致的迟发性尺神经麻痹病例。所有患者均接受了尺神经麻痹的手术治疗。2例患者的尺神经在异常位置被瘢痕组织卡压，当肘关节屈曲时神经形成尖锐的V形扭曲。1例患者的尺神经在肘关节屈曲时向前移位，在肘关节伸展时自行回到尺神经沟。1例患者的尺神经仍位于尺神经沟内；然而，它被尺侧腕屈肌发出的纤维束卡压。据推测，导致肘内翻畸形的骨折不愈合会改变肘部的解剖结构，这可能直接影响尺神经的位置和稳定性。肘内翻畸形导致的肘关节不匹配也可能引起骨关节炎改变。因此，尺神经病变可能是由于肘关节创伤后骨关节炎改变对尺神经的刺激所致。
