肘部における絞扼性尺骨神経障害の解剖学的病態と手術方法の選択

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  • Selection an Operative Method Based upon Ulnar Nerve Anatomy at the Elbow

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<p>  Various procedures have been recommended for the surgical treatment of cubital tunnel syndrome. They are basically divided into ulnar neurolysis and anterior transposition with or without epicondylectomy.</p><p>  We report 51 operations to treat cubital tunnel syndrome among the 636 operations of the peripheral nerve during three years between 2005 and 2007. We analyzed our procedures in relation to the more detailed anatomical differences in the nature and location of the entrapment.</p><p>  There were five areas which had caused ulnar nerve entrapment at the elbow. From the distal side, they were ① the flexor carpi ulnaris muscle, ② cubital tunnel, ③ epicondyle, ④ intermuscular septum, and ⑤ arcade of Struthers. In addition, there were other areas ⑥ where the ulnar nerve entrapment was caused by unusual structures, such as ganglion and others.</p><p>  Our surgical cases were classified based upon the location ( ① to ⑤ ) and the nature of the pathology ⑥ of the entrapment as follow : ① 40 cases, ② 38 cases, ③ 8 cases, ④ 1 cases, ⑤ 1 cases, and ⑥ 7 cases. Cases of ① and ② made up the majority.</p><p>  The neurolysis was performed in 8 cases and anterior transposition either submuscular or epicondylectomy was added in the rest. There was no difference in the postoperative course between these two groups.</p><p>  Either neurolysis or anterior transposition were performed at ①, ② and ⑥. Anterior transposition was performed in all of the cases of ③, ④, ⑤ and epicondylectomy was added to the 28 cases where the ulnar nerve dislocated to anteriorly of the epicondyle by flexion of the elbow. Postoperative results were excellent in all of the cases.</p><p>  Although the location of entrapment can be presumed by the presence of Tinel-like sign and nerve conduction velocity study, we found that intraoperative findings were most important. We need to be aware of the anatomical differences in entrapment location, and it is important to choose the operative method suitable for each different scenario.</p>

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  • 脊髄外科

    脊髄外科 23 (1), 19-23, 2009

    日本脊髄外科学会

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