Contreras M G, Warner M A, Charboneau W J, Cahill D R
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Clin Anat. 1998;11(6):372-8. doi: 10.1002/(SICI)1098-2353(1998)11:6<372::AID-CA2>3.0.CO;2-R.
Men develop perioperative ulnar neuropathies more frequently than women. To determine the role of anatomical gender differences in the development of these neuropathies, we performed several studies of the anatomy of the ulnar nerve, cubital tunnel, and elbow region. These studies included detailed dissection of male and female embalmed and unembalmed cadavers, ultrasound measurements of the tissue layers at the elbow, and measurement of various dimensions of the coronoid process of the ulna in multiple skeletal sets. No gross anatomical differences were found between genders regarding the course of the ulnar nerve through the upper limb. However, there was a strikingly larger (2-19 times greater) fat content on the medial aspect of the elbow in women compared to men, and the tubercle of the coronoid process was approximately 1.5 times larger in men (P < or = .002, rank sum test). Our finding suggest that the tubercle of the coronoid process is a likely area for external compression-induced ischemia of the ulnar nerve because the nerve and its arterial supply (the posterior ulnar recurrent artery) are covered at the tubercle only by skin, subcutaneous fat, and a very thin aponeurosis of the flexor carpi ulnaris. Importantly, this tubercle is larger and the nerve and blood vessels passing by it are less protected by subcutaneous fat in men than in women. These two anatomical differences between men and women may contribute to the increased frequency of perioperative ulnar neuropathy induced by external pressure at the medial aspect of the elbow in men.
男性围手术期尺神经病变的发生率高于女性。为了确定解剖学上的性别差异在这些神经病变发生过程中的作用，我们对尺神经、肘管和肘部区域的解剖结构进行了多项研究。这些研究包括对男性和女性防腐及未防腐尸体的详细解剖、肘部各组织层的超声测量，以及对多套骨骼标本中尺骨冠突各维度的测量。在尺神经通过上肢的走行方面，未发现两性之间存在明显的解剖学差异。然而，与男性相比，女性肘部内侧的脂肪含量显著更高（高出2至19倍），男性尺骨冠突的结节大约大1.5倍（秩和检验，P≤0.002）。我们的研究结果表明，尺骨冠突结节可能是尺神经因外部压迫导致缺血的区域，因为该神经及其动脉供应（尺侧返后动脉）在结节处仅被皮肤、皮下脂肪和尺侧腕屈肌的一层非常薄的腱膜覆盖。重要的是，男性的这个结节更大，且经过此处的神经和血管受到皮下脂肪的保护比女性更少。男性和女性之间的这两个解剖学差异可能导致男性因肘部内侧外部压力引起的围手术期尺神经病变发生率增加。
