尺神经手背支卡压所致腕尺侧痛的解剖和临床研究

目的 对尺神经手背支卡压引起腕尺侧痛的机理进行研究并探讨尺神经手背支卡压症的诊断和治疗。方法 对40侧福尔马林固定的成人尸体前臂部和腕部进行大体解剖和显微解剖。在临床上诊治了13例尺神经手背支卡压的病例并进行分析。结果 尺神经手背支在尺骨茎突以近5.6-6.8cm处尺侧腕屈肌（腱）深面内侧缘穿出,紧贴尺骨行走,在尺骨小头内侧分成2－3大支,其中的横支紧贴骨膜,横跨尺骨小头或绕经尺骨小头远端斜行向桡侧,腕关节活动和尺骨小头的位置改变极易对其造成损伤。临床发现患该症的患者尺骨小头远端或尺侧缘有一显著而局限的压痛点,其周围有局部的皮肤感觉改变。13个病例中,7例局部封闭,6例手术,其中9例随访4个月－1年,未见复发。结论 腕关节反复屈伸时尺神经手背支尤其是横支被牵拉和压迫是造成尺神经手背支卡压的解剖学基础。临床上对腕尺侧痛并有皮肤感觉改变的病例,应考虑尺神经手背支卡压的可能性。

Ulnar-side wrist pain unduced by the compression of the dorsal branch of the ulnar nerve: anatomical and clinical study

OBJECTIVES: To investigate anatomical mechanism of the ulnar wrist pain caused by the compression of the dorsal branch of the ulnar nerve, and discuss the diagnosis and treatment of the compression. METHODS: 40 sides of the upper extremities of adult cadavers were studied anatomically. The dorsal branch of the ulnar nerve and its relationship to the surroundings was dissected and observed grossly and microscopically. 13 cases of the compression of the dorsal branch of the ulnar nerve were treated and followed up. RESULTS: The dorsal branch of the ulnar nerve was penetrated from the deep of the flexor carpi ulnaris muscle 5.6 approximately 6.8 cm proximally from the styloid process of the ulna, then ran along the ulna and divided into 2 approximately 3 big branches at the medial side of the head of the ulna. The transverse branch was apt to injury during wrist movement as it crossed or rounded the head of the ulna where it was close to the peristeam. Seven of 13 cases of the compression of the dorsal branch of the ulnar nerve were treated by local block, and 6 by surgical neurolysis. Nine cases of this group got showed good effect without recurrence after 4 months to 1 year follow-up. CONCLUSION: The anatomical basis of the compression of the dorsal branch of the ulnar nerve is repetitive traction to this nerve during wrist movement, and the compression of the transverse branch is the main cause of ulnar wrist pain. The compression of the dorsal branch of the ulnar nerve should be considered to the patients with ulnar wrist pain and abnormal sensation along the dorsal ulnar side of hand.