肘管与滑车上肘肌的解剖学研究及其临床意义  

The anatomy and clinical significance of the cubital tunnel and epitrochleo-anconeus

作　　者：贾科锋[1] 丁实[1] 翟丽东[1] 袁武[1] 刘庚辰[1] 李云生[1] 

机构地区：[1]天津医科大学解剖学教研室,天津300070

出　　处：《中国临床解剖学杂志》2011年第2期140-144,共5页Chinese Journal of Clinical Anatomy

基　　金：天津医科大学重点学科项目(NO.052-200010)

摘　　要：目的为治疗肘管综合症的原位松解术提供解剖学依据。方法 14例福尔马林固定的成年肘部标本,11例行大体解剖观察肘管特点,3例分别制成1mm厚的水平、冠状和矢状位火棉胶切片。并利用水平切片的图像对肘管等结构进行三维重建。结果肘管的底由肘关节囊和尺侧副韧带前、后及横束构成,顶由肘管支持带或滑车上肘肌和尺侧腕屈肌的肱尺两头之间的筋膜构成。滑车上肘肌起自内上髁,其上部以筋膜止于鹰嘴内侧缘;中下部分直接止于鹰嘴内侧缘。在尺神经沟水平,有一筋膜蒂将尺神经连于底的后外侧部分。结论对于滑车上肘肌引起的尺神经卡压者,合理切除此肌肉可以达到理想的治疗效果。筋膜蒂可能有防止尺神经过度运动以及半脱位的作用。Objective To explore anatomic features of cubital tunnel,and provide reference for the decompression treatment of the cubital tunnel syndrome.Methods 14 formalin-fixed adult elbow specimens were used in this study.11 of them were dissected to reveal anatomic features of the cubital tunnel,other 3 were embedded by celloidin and performed successive horizontal,coronal and sagittal section with the thickness of 1mm,followed by the cubital tunnel reconstruction adopting successive horizontal sectional images.Results The floor of cubital tunnel was formed by the capsule of elbow and all the three bundles of medial collateral ligament（MCL）.The roof of this tunnel was composed of cubital tunnel retinaculum or epitrochleo-anconeus（EA） and the fascia between the two heads of flexor carpi ulnaris muscle.Epitrochleo-anconeus originated from the medial epicondyle.The upper portion of this muscle inserted to the medial margin of the olecranon through a fascia while the lower 2/3 portion directly to it.A fascial pedicle was identified at the level of the retrocondylar groove.It connected the ulnar nerve to the posterolateral portion of the floor.Conclusions Reasonable excision of EA is efficiently for the ulnar nerve suffered compression by epitrochleo-anconeus.The fascial pedicle has the function to prevent the ulnar nerve from subluxation.

关 键 词：肘管 尺神经 滑车上肘肌 火棉胶 

分 类 号：R323.71[医药卫生—人体解剖和组织胚胎学]