有鉤骨体部骨折偽関節によるGuyon管症候群の1例

Guyon's Canal Syndrome Caused by Nonunion of a Hamate Body Fracture. Case Report

　症例は48歳の男性でモーターボートのレース中に左手をハンドルで打って受傷した．左環指・小指掌側のしびれ，左手の脱力があり．受傷後3カ月で当科を受診した．母指内転筋，骨間筋の萎縮を認め，単純X線正面像で有鉤骨体部近位部に骨折を認めた．術中所見で有鉤骨は偽関節となっており，尺骨神経は有鉤骨偽関節の骨性隆起部により持ち上げられ，豆状骨・有鉤骨間のtendinous archにより圧迫されていた．Tendinous archを切離し，膨隆部を削って，尺骨神経を除圧した．術後4カ月で母指内転筋，骨間筋の萎縮は改善し，環指・小指掌側の知覚障害も改善を認めた．

　A 48-year-old man who had kept his left hand pressed against the handlebar while motorboat racing presented with a 3-month history of hypesthesia and progressive weakness of the left hand.　Examination revealed weakness of the adductor pollicis and the intrinsic muscles of the hand.　Plain radiographs revealed a fracture of the body of the hamate bone.　Intraoperatively, the ulnar nerve was observed to be constricted by a tendinous arch that extended from the pisiform to the hamate, and the bony prominence of the hamate body had raised the ulnar nerve.　The bony prominence and tendinous arch were excised to decompress the ulnar nerve.　Four months postoperatively the symptoms had improved, and recovery of motor weakness and sensation had been achieved.