肘管综合征的解剖和病因学探讨

[目的]探讨肘管综合征的解剖特点和发病原因。[方法]对65例肘管综合征患者的临床资料和术中所见,以及其中25例患者术前肌电图检查的结果进行综合研究分析。[结果]术中见60例患者存在肘管弓状韧带的肥厚增生,卡压磨损尺神经导致炎性病变;术前肌电图检查发现25例患者的尺神经传导速度均减慢,平均传导速度为27.97m/s;运动反应波幅降低,平均电压为1.95mv;潜伏期延长,平均时间为5.41ms;65例肘管综合征患者,继发于肘部创伤25例,慢性劳损15例,慢性骨关节炎14例,占位病变5例,先天异常有6例。[结论]肘部的创伤及慢性劳损可以导致肘管弓状韧带出现肥厚增生,引起尺神经卡压磨损,这是肘管综合征最常见的病因;其他病因还包括慢性骨关节炎,占位病变和先天异常;尺神经可被机械性卡压和磨损,出现慢性缺血缺氧,导致肘管综合征的发生;详细的体格检查和术前的肌电图检查是诊断肘管综合征的主要手段,在诊断时应注意该病与其他部位迟发性尺神经麻痹的鉴别。

Discussion on anatomy and etiology of cubital tunnel syndrome

[Objective]To discuss the anatomy and etiology of cubital tunnel syndrome.[Method]The clinical data and surgical findings of sixty five cubital tunnel syndrome cases were analyzed,and the per-operative electromyogram results of twenty five cases were studied.[Result]Hypertrophy of arcuate ligament resulted in compression and abrasion of ulnar nerve in sixty patients;we found that the ulnar nerve conduct velocity decreased(the average speed was 27.97 m/s),motional amplitude also decreased(the average voltage was 1.95 mv),and latent period prolonged(the average time was 5.41 ms)after pre-operative electromyogram.[Conclusion]The major etiology of cubital tunnel syndrome is chronic injury with sustained compression of ulnar nerve around elbow joint.Careful physical examination of ulnar nerve function and pre-operative electromyogram will help us to diagnose the cubital tunnel syndrome.Cubital tunnel syndrome should be differentiated from tardy ulnar nerve palsy of other sites.