尺神经皮下前置与肌内前置治疗肘管综合征的疗效比较

EFFICACY COMPARISON BETWEEN ANTERIOR SUBCUTANEOUS AND SUBMUSCULAR TRANSPOSITION OF ULNAR NERVE TO TREAT CUBITAL TUNNEL SYNDROME

目的比较尺神经皮下前置与肌内前置两种手术方式治疗肘管综合征的疗效。方法2006年8月-2008年8月,收治66例肘管综合征患者,分别采用尺神经皮下前置(24例)或尺神经肌内前置(42例)治疗。患者按McGowan分级均为2级或3级,伴手部尺神经分布区麻木。尺神经皮下前置组3例伴骨间肌萎缩,尺神经肌内前置组8例伴骨间肌萎缩。两组性别构成、年龄、病程、并发症比较,差异均无统计学意义(P>0.05)。术后比较两组手术特点、术后1年Bishop评分、两点辨别觉、肌力和并发症等疗效评价指标。结果尺神经皮下前置组手术时间(28.4±5.2)min,尺神经肌内前置组为(43.8±5.6)min,两组比较差异有统计学意义(P<0.01);尺神经皮下前置组手术切口长(12.2±2.5)cm,尺神经肌内前置组为(13.6±2.8)cm,两组比较差异有统计学意义(P<0.05)。术后获随访1～3年。术后1年Bishop评分尺神经皮下前置组获优18例,良4例,差2例;尺神经肌内前置组获优36例,良3例,差3例;两组比较差异无统计学意义(P>0.05)。两组术后6个月,环指尺侧半和小指指端两点辨别觉及手部内在肌握力,均较术前明显改善(P<0.05),但两组间术后差异均无统计学意义(P>0.05)。尺神经皮下前置组1例手术切口处疼痛和麻木;尺神经肌内前置组3例手术切口处疼痛和麻木;两组均无感染和血肿等相关并发症发生,无再次手术患者。结论尺神经皮下前置与肌内前置两种手术方式均是治疗肘管综合征的有效措施,尺神经皮下前置损伤少,对部分老年患者是较好选择。

Objective To evaluate and compare the efficacy of anterior subcutaneous and submuscular transposition of the ulnar nerve in treating cubital tunnel syndrome. Methods From August 2006 to August 2008,66 patients with cubital tunnel syndrome were treated with anterior subcutaneous transposition （subcutaneous group,24 cases） and with anterior submuscular transposition （submuscular group,42 cases）. According to McGowan stages,all patients were at Stage 2 or 3 entrapment neuropathy with paresthesia in the ring and small fingers. Respectively,3 cases and 8 cases complicated by interosseous muscle atrophy in subcutaneous group and in submuscular group. No significant difference was found in gender,age,duration of the disease,and complication between two groups （P 〈0.05）. The surgical features,distribution of Bishop rates,two-point discrimination test,muscular strength,and complications were recorded. Results The operation time was （28.4 ± 5.2） minutes in subcutaneous group and （43.8 ± 5.6） minutes in submuscular group,showing signifi cant difference （P〈 0.01）. The incision length was （12.2 ± 2.5） cm in subcutaneous group and （13.6 ± 2.8） cm in submuscular group,showing signifi cant difference （P〈 0.05）. All patients were followed up 1-3 years. According to Bishop scoring system,the results were excellent in 18 cases,good in 4 cases,and poor in 2 cases in subcutaneous group; excellent in 36 cases,good in 3 cases,and poor in 3 cases in submuscular group; and showing no significant difference between two groups （P 〉0.05）. At 6 months postoperatively,two-point discrimination and grip strength were improved when compared with that of preoperation （P 〈0.05）,but there was no significant difference between two groups （P 〉0.05）. Pain and dysesthesia of the scar were noted in 1 patient of the subcutaneous group and 3 patients of the submuscular group. No infection or hematoma was found and no patient needed reoperation.Conclusion Both operative methods are effective alternative for treating cubital tunnel syndrome. The anterior subcutaneous anterior transposition of the ulnar nerve has fewer traumas,and it is a better choice for some old patients.