肘管综合征135例尺神经皮下前移术疗效分析

Clinical analysis of subcutaneous anterior transposition of the ulnar nerve in 135 patients of cubital tunnel syndrome

目的随访肘管综合征135例尺神经皮下前移术治疗效果。方法分析2002年2月-2005年12月，135例肘管综合征尺神经皮下前移患者的病情特点及效果。其中男109例，女26例，男女比例为4．2：1。41岁以上占68．1％。以手指活动笨拙就诊15例（占11％）；电生理检测均有尺神经肘部段卡压征象。42例合并肘部骨折史，占病因的31％。135例均采用尺神经外膜松解，皮下前移术。结果术后92例获得2—5年随访，平均2．5年；43例失访。按中华医学会手外科学会上肢功能评定标准，本组优72例，良12例，差8例，优良率为91．3％。结论尺神经皮下前移术简单、有效，术中应保护前臂内侧皮神经、尺神经血供及分支，并确保尺神经无张力。应重视因肘部骨折和以手部活动笨拙为主要症状的早期诊治。

Objective To analyze the clinical outcomes of subcutaneous anterior transposition of the ulnar nerve in 135 patients of cubital tunnel syndrome. Methods One hundred and thirty-five cases of cubital tunnel syndrome treated with subcutaneous anterior transposition of the ulnar nerve from February 2002 to December 2005 were reviewed. The manifestations and treatment outcomes were analyzed. Among 135 patients, 26 were female and 109 male. The male to female ratio is 4.2： 1. 68.1% of patients were over 41 years old. Fifteen patients had symptoms of clumsiness of hand （11%）. Electrophysiologic examination unexceptionally showed ulnar nerve entrapment at the cubital tunnel. Forty-two cases had history of fractures at the elbow joint. This etiology accounted for 31% of the causes. All the patients were treated with neurolysis and subcutaneous anterior transposition of the ulnar nerve. Results Ninety-two patients were followed-up for 2 to 5 years with an average of 2.5 years. According to the grading system established by Chinese Medical Association, 72 cases had excellent results, while 12 patients had good results. Results were rated as poor in 8 eases. The overall good-excellent rate was 91.3%. Conclusion Subcutaneous anterior transposition of the ulnar nerve is a simple and reliable method for treatment of cuibtal tunnel syndrome. It is critical to protect the medial antebrachial nerve and motor branches of the flexor carpi ulnaris and the blood supply of the ulnar nerve, and insure tension free for the rerouted ulnar nerve. Early-diagnosis and treatment of cases with complaint of hand clumsiness and combined elbow fracture should be highlighted.