关节清理成形尺神经松解前置术治疗中重度肘关节骨关节炎伴肘管综合征

Treatment of moderate-severe osteoarthritis in elbow joint with cubital tunnel syndrome by joint clean arthroplasty and ulnar nerve release anterior transposition

目的探讨中重度肘关节骨关节炎伴肘管综合征的手术治疗方法与临床效果。方法 2007年2月-2016年2月,对48例中重度肘关节骨关节炎伴肘管综合征患者采用关节松解清理成形、尺神经松解皮下前置术治疗。手术取肘关节后内侧入路或联合外侧入路,清除增生骨赘,切除增生滑膜,取出关节腔内的游离体,用磨钻打磨做鹰嘴窝、冠状突窝及桡骨头窝成形,并行尺神经松解皮下前置术治疗,术后10~14 d在支具保护下行肘关节主被动伸屈及前臂旋转功能康复训练。结果术后48例随访1~8年,平均3.5年,肘关节屈伸活动度由术前平均37°至术后115°;参照Mayo肘关节功能评分标准,优良率为93.7%;采用疼痛视觉模拟评分(VAS),疼痛由术前平均5.0分改善至0.5分;电生理检查尺神经传导速度及体感诱发电位均明显恢复;采用顾玉东肘管综合征功能评定标准评价,优20例,良27例,可1例。所有病例术后疼痛获得了长期缓解,肘关节活动度得到了明显改善。结论肘关节清理成形尺神经松解皮下前置术可以改善肘关节活动度,缓解神经卡压症状,但远期随访肘关节活动范围随着活动强度的增加仍会有继发性的部分丧失。

Objective To discuss the operative method and clinical effect of moderate-severe osteoarthritis in elbow joint with cubital tunnel syndrome. Methods From February 2007 to February 2016, we used joint clean arthroplasty and ulnar nerve release anterior transposition to treat moderate-severe osteoarthritis in elbow joint with cubital tunnel syndrome. In the operation, the posterior medial approach or combination lateral approach of elbow joint was adopted, the hyperplasia of osteophyte and synovial was cleaned, and the episome of intra-articular was took out, the olecranon fossa plasty and coronoid fossa plasty and head of radius fossa plasty was polished by medical bit. And the ulnar nerve preposition was applied. At 10-14 days after operation, the patients were excised by active or passive extension and flexion of elbow joint and rotate of forearm. Under the protection of braces. Results Forty eight Patients were followed up for 1~8 years(average 3.5 years), the flexion-extension ROM of elbow joint reached 115°(37° preoperation). According to Mayo functional scoring criteria of elbow joint, the excellent rate was 93.7%. According to VSA, the pain score reached 0.5(5.0 preoperation). The ulnar nerve conduction velocity and SEP was obvious recovery by electrophysiological examination. Based on the Guyudong’function evaluation criteria for elbow joint, the results were rated as excellent in 20 cases, good in 27 cases and fair in 1 case. The pain of all cases obtained long-term relief, and the ROM of elbow joint had obviously improvement. Conclusion It can improve the ROM of elbow joint, and relieve the symptom of nerve compression, that using joint clean arthroplasty and ulnar nerve release anterior transposition. But the range of elbow joint activity has partial secondary loss with the strength increase of elbow joint activity in the long-term following up.