Gelberman R H, Yamaguchi K, Hollstien S B, Winn S S, Heidenreich F P, Bindra R R, Hsieh P, Silva M J
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Bone Joint Surg Am. 1998 Apr;80(4):492-501. doi: 10.2106/00004623-199804000-00005.
The purpose of this study was to determine the relationship between the ulnar nerve and the cubital tunnel during flexion of the elbow with use of magnetic resonance imaging and measurements of intraneural and extraneural interstitial pressure. Twenty specimens from human cadavera were studied with the elbow in positions of incremental flexion. With use of magnetic resonance imaging, cross-sectional images were made at each of three anatomical regions of the cubital tunnel: the medial epicondyle, deep to the cubital tunnel aponeurosis, and deep to the flexor carpi ulnaris muscle. The cross-sectional areas of the cubital tunnel and the ulnar nerve were calculated and compared for different positions of elbow flexion. Interstitial pressures were measured with use of ultrasonographic imaging to allow a minimally invasive method of placement of the pressure catheter, both within the cubital tunnel and four centimeters proximal to it, at 10-degree increments from 0 to 130 degrees of elbow flexion. As the elbow was moved from full extension to 135 degrees of flexion, the mean cross-sectional area of the three regions of the cubital tunnel decreased by 30, 39, and 41 per cent and the mean area of the ulnar nerve decreased by 33, 50, and 34 per cent. These changes were significant in all three regions of the cubital tunnel (p < 0.05). The greatest changes occurred in the region beneath the aponeurosis of the cubital tunnel with the elbow at 135 degrees of flexion. The mean intraneural pressure within the cubital tunnel was significantly higher than the mean extraneural pressure when the elbow was flexed 90, 100, 110, and 130 degrees (p < 0.05). With the elbow flexed 130 degrees, the mean intraneural pressure was 45 per cent higher than the mean extraneural pressure (p < 0.001). Similarly, with the elbow flexed 120 degrees or more, the mean intraneural pressure four centimeters proximal to the cubital tunnel was significantly higher than the mean extraneural pressure (p < 0.01). Relative to their lowest values, intraneural pressure increased at smaller angles of flexion than did extraneural pressure, both within the cubital tunnel and proximal to it. With the numbers available, we could not detect any significant difference in intraneural pressure measured, either at the level of the cubital tunnel or four centimeters proximal to it, after release of the aponeurotic roof of the cubital tunnel.
本研究的目的是利用磁共振成像以及神经内和神经外组织间隙压力测量，来确定肘关节屈曲时尺神经与肘管之间的关系。对20例人体尸体标本进行研究，使肘关节处于逐渐增加的屈曲位置。利用磁共振成像，在肘管的三个解剖区域（内侧髁、肘管腱膜深面、尺侧腕屈肌深面）的每一处制作横断面图像。计算并比较肘管和尺神经在肘关节不同屈曲位置时的横截面积。利用超声成像测量组织间隙压力，以便采用微创方法将压力导管放置在肘管内及其近端4厘米处，肘关节从0度到130度以10度的增量进行测量。当肘关节从完全伸展位移动到135度屈曲位时，肘管三个区域的平均横截面积分别减少了30%、39%和41%，尺神经的平均面积减少了33%、50%和34%。这些变化在肘管的所有三个区域均具有显著性（p < 0.05）。最大的变化发生在肘管腱膜下方区域，此时肘关节处于135度屈曲位。当肘关节屈曲90度、100度、110度和130度时，肘管内的平均神经内压力显著高于平均神经外压力（p < 0.05）。当肘关节屈曲130度时，平均神经内压力比平均神经外压力高45%（p < 0.001）。同样，当肘关节屈曲120度或更大角度时，肘管近端4厘米处的平均神经内压力显著高于平均神经外压力（p < 0.01）。相对于其最低值，在肘管内及其近端，神经内压力在较小的屈曲角度时就比神经外压力增加得更多。就现有的数据而言，在松开肘管腱膜顶后，我们未能检测到在肘管水平或其近端4厘米处测量的神经内压力有任何显著差异。
