CAJ | 학술논문

目的为肘部正中神经卡压的诊断与治疗提供解剖与临床依据.方法在10侧上肢标本上观察正中神经在肘部卡压的解剖因素及正中神经的外形.同时对我科收治的14例肘部正中神经卡压患者进行病例分析.结果解剖学研究发现10侧上肢标本肱二头肌腱膜与正中神经的关系:全覆盖型2侧(20％),部分覆盖型1侧(10％),非覆盖型7侧(70％);旋前圆肌尺骨头浅面有厚筋膜9侧(90％),肱骨头肌内有腱束2侧(20％),反转筋膜斜过正中神经前方6侧(60％).指浅屈肌起始部分的形态结构:指浅屈肌腱束1侧(10％),纤维弓1侧(10％),联合腱弓型8侧(80％).14例肘部正中神经卡压患者包括5例旋前圆肌综合征和9例骨间前神经综合征.5例旋前圆肌综合征的卡压点:增厚紧张的肱二头肌腱膜尺侧卡压2例,旋前圆肌深面腱弓处卡压2例,旋前圆肌两头之间卡压1例.9例骨间前神经综合征的卡压点:旋前圆肌深面腱弓处卡压2例,旋前圆肌尺骨头处卡压1例,旋前圆肌两头之间卡压1例,紧张增厚的指浅屈肌起始边缘处卡压5例.6例获得随访,平均随访时间为2年4个月,结果均良好.结论肘部正中神经卡压与肘部正中神经的外形、周围的腱膜、增厚紧张的筋膜等因素有关.
목적 위주부정중신경잡압적진단여치료제공해부여림상의거.방법 재10측상지표본상관찰정중신경재주부잡압적해부인소급정중신경적외형.동시대아과수치적14례주부정중신경잡압환자진행병례분석.결과 해부학연구발현10측상지표본굉이두기건막여정중신경적관계:전복개형2측(20％),부분복개형1측(10％),비복개형7측(70％);선전원기척골두천면유후근막9측(90％),굉골두기내유건속2측(20％),반전근막사과정중신경전방6측(60％).지천굴기기시부분적형태결구:지천굴기건속1측(10％),섬유궁1측(10％),연합건궁형8측(80％).14례주부정중신경잡압환자포괄5례선전원기종합정화9례골간전신경종합정.5례선전원기종합정적잡압점:증후긴장적굉이두기건막척측잡압2례,선전원기심면건궁처잡압2례,선전원기량두지간잡압1례.9례골간전신경종합정적잡압점:선전원기심면건궁처잡압2례,선전원기척골두처잡압1례,선전원기량두지간잡압1례,긴장증후적지천굴기기시변연처잡압5례.6례획득수방,평균수방시간위2년4개월,결과균량호.결론 주부정중신경잡압여주부정중신경적외형、주위적건막、증후긴장적근막등인소유관.
Objective To provide anatomic and clinical basis for diagnosis and treatment of median nerve entrapment at the elbow.Methods Microanatomical dissection of the median nerve was done in 10 cadaver upper limb specimens to observe the anatomical factors that cause compression of the median nerve at the elbow and shape of the median nerve.Case analysis was conducted in 14 patients with median nerve entrapment at the elbow who were treated in our department.Results Anatomic studies in the 10 dissected specimens showed three types of relationship between the bicepital aponeurosis and median nerve:complete-covering (2 specimens,20％),partial-covering (1 specimen,10％) and non-covering (7 specimens,70％).Thickened fascia in the superficial layer of pronator teres ulnar head was seen in 9 specimem (90％).Intramuscular tendinous bundles in the anconeus were observed in 2 specimem (20％).The reverse fascia that traversed the median nerve was seen in 6 specimens (60％).The structures of the origins of two heads of the flexor digitorum superficialis (FDS) had three types:intramuscular tendinous bundle (1 specimen,10％),fibrous arch (1 specimen,10％),and conjoined tendinous arch (8 specimens,80％).Of the 14 patients who had median nerve entrapment at the elbow,5 were diagnosed as pronator teres syndrome while 9 were diagnosed as anterior interosseous nerve(AIN) compression.The compression points in the pronator syndrome cases were ulnar side of the thickened and taut bicepital aponeurosis (2 cases),deep tendinous arch of pronator teres (2 cases),and between two heads of pronator teres (1 case).The compression points in the AIN compression cases were deep tendinous arch of pronator teres (2 cases),ulnar head of pronator teres (1 case),between two heads of pronator teres (1 case),and thickened and taut FDS origin (5 cases).Six patients were follow-up.The average follow-up time was 2 years and 4 months.Good to excellent recovery of motor function was achieved in these patients.Condusion The shape of the median nerve,its surroanding tendinous structures and thickened and taut fascia are the anatomic basis of median nerve entrapment at the elbow.