주관증후군 접근 중 마주치는 내측 전완부 피부 신경 분지의 해부학적 분포 = Anatomical Distribution of Branches of the Medial Antebrachial Cutaneous Nerve during Cubital Tunnel Surgery

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this prospective study is to examine the anatomical variations of the branches of the medial antebrachial cutaneous nerve in Koreans encountered during cubital tunnel surgery.
Methods: Ninety two patients with cubital tunnel syndrome were treated with a standard approach from December 2008 to July 2012. The position of the branches of medial antebrachial cutaneous nerve was evaluated based on the medial humeral epicondyle with the elbows fully extended.
Results: At least one medial antebrachial cutaneous nerve branch was found during the surgeries in all patients. The average number of crossing medial antebrachial cutaneous nerve branches per patient was 1.6. Thirty-eight percent of the cases showed that the medial cutaneous nerve branches cross proximal to the medial humeral epicondyle within 1 cm. Eighty-two percent showed that the medial antebrachial cutaneous nerve branches cross distal to the medial humeral epicondyle within 1.9 cm.
Conclusion: When using standard approach during cubital tunnel surgery,more than one medial forearm cutaneous nerve is found. Therefore, understanding the general position of medial antebrachial cutaneous nerve branches helps avoid iatrogenic damage to this nerve during cubital tunnel surgery.

국문 초록 (Abstract)

목적: 이 연구의 목적은 한국인에 있어서 주관증후군 수술 중에 마주치게 되는 내측 전완 피부 신경 분지의 해부학적 분포에 대해서 분석하고자 하는 것이다.
대상 및 방법: 2008년 12월부터 2012년 7월까지 주관증후군으로 진단받고 전형적인 접근법을 통한 수술을 시행한 92명의 환자를 대상으로 하였다. 내측 전완 피부 신경 분지의 분포는 주관절을 신전시킨 상태에서 상완골의 내측 상과를 기준으로 평가하였다.
결과: 92명의 모든 환자에게서 최소 1개 이상의 내측 전완 피부 신경 분지가 발견되었으며, 평균 1.7개의 신경 분지가 발견되었다. 내측 상과 또는 그 근위부를 지나는 경우는 35예(38%)에서 발견되었으며, 내측 상과에서 평균 1 cm 근위부에존재하였다. 내측 전완 피부 신경 분지가 내측 상과의 원위부를 지나는 경우는 82예(89.1%)에서 발견되었으며, 내측 상과에서 평균 1.9 cm 원위부에 존재하였다.
결론: 주관증후군 환자에게 전형적인 접근법을 이용한 수술을 시행할 때 모든 예에서 최소한 한 개 이상의 내측 전완 피부 신경을 마주치게 되므로, 내측 전완 피부 신경 분지의 일반적인 위치에 대해 인지하고 있는 것은 주관증후군 수술 중에 내측 전완 피부 신경의 의인성 손상을 예방하는데 도움이 될 것으로 생각된다.

참고문헌 (Reference)

1 Mackinnon SE, "Wandering nerve graft technique for management of the recalcitrant painful neuroma in the hand : a case report" 9 : 95-102, 1988

2 Dellon AL, "Treatment of the painful neuroma by neuroma resection and muscle implantation" 77 : 427-438, 1986

3 Stahl S, "Surgical treatment of painful neuroma in medial antebrachial cutaneous nerve" 48 : 154-158, 2002

4 Masear VR, "Surgical anatomy of the medial antebrachial cutaneous nerve" 14 : 267-271, 1989

5 Siegel DB, "Submuscular transposition of the ulnar nerve" 12 : 445-448, 1996

6 Osterman AL, "Subcutaneous transposition of the ulnar nerve for treatment of cubital tunnel syndrome" 12 : 421-433, 1996

7 Wu J, "Painful neuromas : a review of treatment modalities" 43 : 661-667, 1999

8 Fernandez E, "Neurosurgery of the peripheral nervous system : cubital tunnel syndrome" 50 : 83-85, 1998

9 Gellman H, "Modified in situ decompression of the ulnar nerve at the elbow" 12 : 405-410, 1996

10 Sarris I, "Medial brachial and antebrachial cutaneous nerve injuries : effect on outcome in revision cubital tunnel surgery" 18 : 665-670, 2002

11 Dellon AL, "Injury to the medial antebrachial cutaneous nerve during cubital tunnel surgery" 10 : 33-36, 1985

12 Dellon AL, "Implantation of sensory nerve into muscle : preliminary clinical and experimental observations on neuroma formation" 12 : 30-40, 1984

13 Lowe JB 3rd, "Current approach to cubital tunnel syndrome" 12 : 267-284, 2001

14 Kuschner SH, "Cubital tunnel syndrome. Treatment by medial epicondylectomy" 12 : 411-419, 1996

15 Tetro AM, "Cubital tunnel syndrome and the painful upper extremity" 12 : 665-677, 1996

16 Jackson LC, "Complications and treatment of failures" 12 : 449-456, 1996

17 Leffert RD, "Anterior submuscular transposition of the ulnar nerves by the Learmonth technique" 7 : 147-155, 1982

18 Kleinman WB, "Anterior intramuscular transposition of the ulnar nerve" 14 : 972-979, 1989

19 Race CM, "Anatomic course of the medial cutaneous nerves of the arm" 16 : 48-52, 1991

20 Mackinnon SE, "Alteration of neuroma formation by manipulation of its microenvironment" 76 : 345-353, 1985

21 Mackinnon SE, "A technique for the treatment of neuroma in-continuity" 8 : 379-383, 1992

22 DiGiovanni AJ, "A technique for selective blockade of the medial antebrachial cutaneous nerve" 30 : 242-243, 1969