肘部尺神经筋膜瓣下前置的几点体会

Pearls and pitfalls in anterior transposition of the ulnar nerve at the elbow

目的观察肘部尺神经筋膜瓣下前置术治疗肘管综合征的临床效果。方法对35例(37侧)肘管综合征的患者进行手术治疗,其中采用传统尺神经前置术式20侧(A组),筋膜瓣下尺神经前置术式17侧(B组)。检测术前、术后尺神经运动传导速度(MCV)的变化,并进行随访观察。结果术后随访6个月～3年,参照张高孟等分级标准计算优良率,A组优良率为80%,B组优良率为94.12%。B组手术前、后MCV变化与A组比较差异有统计学意义(P<0.05)。结论采用带血管蒂尺神经筋膜瓣下前置术式治疗肘管综合征的疗效明显优于传统术式。

Objective To investigate the clinical outcomes of treating eubital tunnel syndrome by ulnar nerve anterior transposition under a fascial flap. Methods Thirty-five cases （37 nerves） of cubital tunnel syndrome were surgically treated. In group A （20 nerves） the ulnar nerve was anterior transposed with conventional method. In group B （ 17 nerves） the nerve was transposed anterior to the elbow under a fascial flap. Nerve conduction study was done preoperatively and postoperatively. The patients were followed-up to compare the changes of ulnar nerve conduction velocity between the two groups. Results The patients were followed-up for an average of 1.Seventy-five years after the surgery, ranging from 6 to 12 months. According to Zhang GM score, the excellent and good rate was 80% in group A and 94.13% in group B. The increment of ulnar nerve conduction velocity in group B was significantly higher than that of group A （ P 〈 0.05）. Conclusion Anterior transposition of the ulnar nerve under a fascial flap can achieve better long-term result than conventional procedure for treatment of cubital tunnel syndrome.