Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow - An experimental study in human cadavera
Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow - An experimental study in human cadavera
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DOI：
10.2106/00004623-199804000-00005
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发表时间：
1998-04-01
影响因子：
5.3
通讯作者：
Silva, MJ
中科院分区：
文献类型：
--
作者：
Gelberman, RH;Yamaguchi, K;Silva, MJ
本研究的目的是利用磁共振成像和测量神经内和神经外间质压力来确定肘关节屈曲时尺神经和肘管之间的关系。研究了20例人体尸体标本，肘关节处于增量屈曲位置，利用磁共振成像在肘管的三个解剖区域分别进行了横切面成像：计算肘管和尺侧腕屈肌不同屈曲位置的横截面积，比较肘管和尺神经的横截面积，利用超声成像测量间质压力，以便在肘管内及其近端4厘米处采用微创方法放置压力导管。肘关节从0度到130度，以10度的增量屈曲。当肘关节从完全伸展到135度屈曲时，肘管三个区域的平均横截面积分别减少了30%、39%和41%，尺神经的平均面积分别减少了33%、50%和34%。这些变化在肘管的三个区域都是显著的（p < 0.05）。当肘关节屈曲135度时，最大的变化发生在肘管腱膜下区域。肘关节屈曲90度、100度、110度和130度时，肘管内平均神经内压力显著高于平均神经外压力（p < 0.05）。当肘关节屈曲130度时，平均神经内压力比平均神经外压力高45% （p < 0.001）。同样，当肘关节屈曲120度或以上时，肘管近端4厘米处的平均神经内压力显著高于平均神经外压力（p < 0.01）。相对于它们的最低值，在肘管内和近端，神经内压力在较小的屈曲角度下比神经外压力增加，根据现有的数据，我们没有发现在肘管水平或近端4厘米处测量的神经内压力有任何显著差异，在肘管腱膜顶释放后。临床意义：这些发现表明肘管在形态学上是一个动态区域。肘管和尺神经的面积变化是正常肘关节屈伸时的50%，尺神经明显变平，但没有直接、局灶性压迫的证据。这些形态学发现与间质压力的测量结果很好地吻合，表明神经内压力最初增加，但神经外压力没有相应增加。这表明尺神经牵拉是导致肘关节屈曲时神经内压力增加的主要原因。
The purpose of this study was to determine the relationship between the ulnar nerve and the cubital tunnel during flexion of the elbow with use of magnetic resonance imaging and measurements of intraneural and extraneural interstitial pressure, Twenty specimens from human cadavera were studied with the elbow in positions of incremental flexion, With use of magnetic resonance imaging, cross-sectional images were made at each of three anatomical regions of the cubital tunnel: the medial epicondyle, deep to the cubital tunnel aponeurosis, and deep to the flexor carpi ulnaris muscle, The cross-sectional areas of the cubital tunnel and the ulnar nerve were calculated and compared for different positions of elbow flexion, Interstitial pressures were measured with use of ultrasonographic imaging to allow a minimally invasive method of placement of the pressure catheter, both within the cubital tunnel and four centimeters proximal to it, at 10-degree increments from 0 to 130 degrees of elbow flexion.As the elbow was moved from full extension to 135 degrees of flexion, the mean cross-sectional area of the three regions of the cubital tunnel decreased by 30, 39, and 41 per cent and the mean area of the ulnar nerve decreased by 33, 50, and 34 per cent. These changes were significant in all three regions of the cubital tunnel (p < 0.05). The greatest changes occurred in the region beneath the aponeurosis of the cubital tunnel with the elbow at 135 degrees of flexion.The mean intraneural pressure within the cubital tunnel was significantly higher than the mean extraneural pressure when the elbow was flexed 90, 100, 110, and 130 degrees (p < 0.05). With the elbow flexed 130 degrees, the mean intraneural pressure was 45 per cent higher than the mean extraneural pressure (p < 0.001). Similarly, with the elbow flexed 120 degrees or more, the mean intraneural pressure four centimeters proximal to the cubital tunnel was significantly higher than the mean extraneural pressure (p < 0.01). Relative to their lowest values, intraneural pressure increased at smaller angles of flexion than did extraneural pressure, both within the cubital tunnel and proximal to it, With the numbers available, we could not detect any significant difference in intraneural pressure measured, either at the level of the cubital tunnel or four centimeters proximal to it, after release of the aponeurotic roof of the cubital tunnel.CLINICAL RELEVANCE: These findings demonstrate that the cubital tunnel is a dynamic region morphologically. Both the cubital tunnel and the ulnar nerve change in area by as much as 50 per cent as the normal elbow is flexed and extended, with substantial flattening of the ulnar nerve but no evidence of direct, focal compression, These morphological findings corresponded well with measurements of interstitial pressure, which demonstrated an initial increase in intraneural pressure without a corresponding increase in extraneural pressure. This indicates that traction on the ulnar nerve is a major cause of increased intraneural pressure in association with flexion of the elbow.