Patel V V, Heidenreich F P, Bindra R R, Yamaguchi K, Gelberman R H
Washington University School of Medicine, Department of Orthopaedic Surgery, St Louis, Mo. 63110, USA.
J Shoulder Elbow Surg. 1998 Jul-Aug;7(4):368-74. doi: 10.1016/s1058-2746(98)90025-8.
We evaluated the morphology of the ulnar nerve and cubital tunnel with noninvasive magnetic resonance imaging (MRI). We used fresh human cadavers with the elbow in full extension, 90 degrees of flexion, and full flexion. For each elbow, 1-mm slices were imaged interpolated, and reconstructed into 3-dimensional data volumes, and then manually segmented before they were examined with sequential transverse sections, curved sections, and 3-dimensional images. The ulnar nerve follows a tortuous course in full extension, becomes progressively linear with incremental elbow flexion, shifts anteriorly in the cubital tunnel, and flattens against the medial epicondyle. The proximal and midportions of the cubital tunnel also change with flexion from round to elliptical. In addition, successive increases occur in the cross-sectional diameter of the mediolateral plane. The nerve is surrounded by fat throughout the cubital tunnel except adjacent to the medial epicondyle. These observations suggest that the ulnar nerve progressively stretch over the medial epicondyle occurs when the normal elbow is flexed. Direct compression areas of the ulnar nerve were not seen in our study of normal human elbows.
我们采用无创磁共振成像（MRI）评估尺神经和肘管的形态。我们使用新鲜人体尸体，使肘部处于完全伸展、90度屈曲和完全屈曲状态。对于每个肘部，对1毫米厚的切片进行成像、插值处理，并重建为三维数据体，然后在通过连续横切面、曲面和三维图像检查之前进行手动分割。尺神经在完全伸展时走行迂曲，随着肘部逐渐屈曲变得越来越直，在肘管内向前移位，并贴靠在内上髁上变平。肘管的近端和中部也随着屈曲从圆形变为椭圆形。此外，内外侧平面的横截面积也连续增加。除了在内上髁附近，尺神经在整个肘管内都被脂肪包围。这些观察结果表明，正常肘部屈曲时，尺神经会在内上髁上方逐渐受到牵拉。在我们对正常人体肘部的研究中未发现尺神经的直接受压区域。
