摘要
目的总结尺神经沟扩大显微镜下神经束间松解术及尺神经前移显微镜下神经束间松解术治疗重度肘管综合征的疗效。方法2002年12月-2007年1月,采用尺神经沟扩大显微镜下神经束间松解治疗22例重度肘管综合征患者(治疗组),与2001年7月-2004年11月,采用尺神经前移显微镜下神经束间松解治疗的22例患者(对照组)进行比较。治疗组:男17例,女5例;年龄21～66岁,平均43.8岁。肘关节骨性关节炎17例,尺神经滑脱3例,肘外翻畸形2例。左侧8例,右侧14例。病程6～69个月。对照组:男18例,女4例;年龄20～64岁,平均42.1岁。肘关节骨性关节炎16例,尺神经滑脱4例,肘外翻畸形及肱骨内髁骨折移位畸形愈合致尺神经沟变窄变浅各1例。左侧7例,右侧15例。病程5～67个月。结果两组患者术后切口均Ⅰ期愈合。治疗组术后1d,患者小指麻木均明显减轻、消失;对照组术后3～5d,患者小指麻木明显减轻、消失。两组患者均获随访,随访时间12～45个月,平均20.1个月。肌电图检查示尺神经传导速度均正常。按照中华医学会外科学会上肢部分功能评定试用标准和Lascar分级法评价疗效,治疗组优21例,良1例,优良率100%;对照组优19例,良2例,可1例,优良率95.45%。治疗组和对照组术前评分分别为(2.89±0.15)分和(2.91±0.13)分,差异无统计学意义(P>0.05);术后分别为(11.32±1.04)分和(9.91±1.48)分,差异有统计学意义(P<0.01)。结论尺神经沟扩大神经束间松解和尺神经前移、神经束间松解均是治疗重度肘管综合征的有效方法,前者优于后者。
Objective To discuss the curative effect of expanding ulnar nerve groove and interfascicular neurolysis under microscope in treating severe cubital tunnel syndrome （Cub Ts）, and to compare with that of the forward moving of ulnar nerve and interfascicular neurolysis under microscope to find out the best way to treat severe Cub Ts. Methods From December 2002 to January 2007, 22 severe Cub Ts cases were treated with expansion of ulnar nerve groove and interfascicular neurolysis under microscope （treatment group）, and other 22 cases were treated with forward moving of ulnar nerve and interfascicular neurolysis under microscope （control group）. In treatment group, there were 17 males and 5 females, aged 21-66 years （mean 43.8 years）. Pathogenic causes were elbow arthritis in 17 cases, ulnar nerve dislocation in 3 cases and elbow ectroption in 2 cases. The locations were left elbow in 8 cases and right elbow in 14 cases. The course of disease was 6-69 months. In control group, there were 18 males and 4 females, aged 20-64 years （mean 42.1 years）. Pathogenic causes were elbow in arthritis 16 cases, ulnar nerve dislocation in 3 cases, elbow ectroption in 1 case and narrowing and shallowing of ulnar nerve groove caused by abnormal healing of medial condyle fracture in 1 case. The locations were left elbow in 7 cases and right elbow in 15 cases. The course of disease was 5-67 months. Results For all patients of both groups, the wound healed by first intention, and all were followed up for 12-45 months. In treatment group, the numbness in little finger was obviously relieved, or disappeared in 22 cases 1 day after operation. In control group, the numbness in little finger was obviously relieved or disappeared in 22 cases 3-5 days after operation. EMG showed that conduction speed of ulnar nerve was normal. Evaluated by upper 1 imbs function standard of China Medical Association, Surgery Association and Lascar grades, the results were excellent in 21 cases and good in 1 case in treatment group; whilet excellent in 19 cases, good in 2 cases and fair in 1 case in control group. There was significant difference between treatment group and control group （P 〈 0.01）. Conclusion Either expansion of ulnar nerve groove and interfascicular neurolysis or forward moving of ulnar nerve and interfascicular neurolysis is an effective method to treat severe Cub Ts, but the former is better than the latter.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第11期1314-1317,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肘管综合征
尺神经沟扩大
神经束间松解
Cubital tunnel syndrome Ulnar nerve sulcus expansion Interfascicular neurolysis
