Variations of the ulnar nerve in Guyon's canal: in vivo demonstration using ultrasound and 3 T MRI
Variations of the ulnar nerve in Guyon's canal: in vivo demonstration using ultrasound and 3 T MRI
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DOI：
10.3109/02841851.2010.503193
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发表时间：
2010-10-01
期刊：
影响因子：
1.3
通讯作者：
Nojima, Shoko
中科院分区：
文献类型：
--
作者：
Niitsu, Mamoru;Kokubo, Naomi;Nojima, Shoko
背景：由于尺神经的不同分支模式，Guyon管的临床重要性受到重视。目的：利用高清晰度超声(US)和3T磁共振成像(MRI)技术，对15名志愿者30只手的尺神经在Guyon管内的解剖变化进行研究。材料和方法：对15名志愿者30只手进行超声成像和3 T磁共振成像。主干和分支的尺浅、尺深神经，包括神经分叉或三叉神经，在超声上被识别，并经3T磁共振图像证实。在彩色多普勒超声上追踪尺动、静脉及其分支，并在MRI上显示。结果：30只手中，21只手(70%)显示尺神经分叉，9只手(30%)显示尺神经三叉型。16只手(54%)影像显示单个神经进入管内，分成浅、深两支，然后离开管内。分叉主要发生在进入渠道入口后。典型的三叉型表现为：一支主干进入管内，分成两支，其中一支分叉，形成两浅一深的三叉型。15例受试者中，4例(27%)双侧手呈对称性分支，11例(73%)为非对称性分支。结论：US和3T MRI可在体内显示尺神经在Guyon管内的分支形态。对这一神经分支的形态学了解在术前计划和诊断中都是有用的。
Background: The clinical importance of Guyon's canal is emphasized due to the various branching patterns of the ulnar nerve. So far, the arborization pattern of the ulnar nerve in Guyon's canal has been investigated mostly by cadaveric studies.Purpose: To demonstrate anatomic variations of the ulnar nerve in Guyon's canal in vivo by using high definition ultrasound (US) and 3 T magnetic resonance imaging (MRI).Material and Methods: US imaging and 3 T MRI with an 8-channel coil was applied to 30 hands of 15 volunteers. The main trunk and the branched superficial and deep ulnar nerves, including neural bifurcation or trifurcation, were recognized on US and confirmed by 3 T MR images. The ulnar artery and vein and its branches were traced on color Doppler US and also visualized by MRI. The branching pattern of the ulnar nerve was determined from the inlet to the outlet of Guyon's canal.Results: Of 30 hands, 21 (70%) revealed bifurcation and 9 (30%) had trifurcation branching pattern of the ulnar nerve. In 16 hands (54%), imaging demonstrated that a single nerve entered the canal and divided into two trunks, one superficial and one deep, then exited the canal. The bifurcation occurred predominantly just after entering the canal inlet. The typical trifurcation pattern indicated that a single trunk entered the canal and divided into two, then one of the two bifurcated, producing a trifurcated pattern with two superficial and one deep bundle. Of 15 participants, symmetrical branching of bilateral hands was identified in 4 cases (27%), whereas 11 (73%) had asymmetrical branching.Conclusion: US and 3 T MRI readily delineated the branching pattern of the ulnar nerve in Guyon's canal in vivo. Morphological understanding about this neural branching can be informative in presurgical planning and also in diagnosis.