内窥镜下尺神经松解联合内上髁微小切除治疗伴尺神经滑脱的肘管综合征

EFFECTIVENESS OF ENDOSCOPIC ULNAR NEUROLYSIS AND MINIMAL MEDIAL EPICONDYLECTOMY IN TREATING CUBITAL TUNNEL SYNDROME WITH ULNAR NERVE SUBLUXATION

目的探讨内窥镜下尺神经松解联合内上髁微小切除治疗伴尺神经滑脱的肘管综合征效果。方法 2004年6月-2009年6月,对11例伴尺神经滑脱的肘管综合征患者行内窥镜下尺神经松解联合内上髁微小切除术。男7例,女4例;年龄18～47岁,平均36岁。均有患侧小指及环指尺侧半刺痛感减退。第1骨间背侧肌伴小鱼际肌萎缩(++～+++)9例,肌萎缩不明显2例。术前肌电图检查示尺神经于肘部传导速度为(27.0±7.5)m/s。病程3～18个月,平均7个月。结果术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间6～37个月,平均19个月。术后1个月11例感觉基本恢复正常。术后3个月7例肌力恢复至4级以上,4例为3～4级。术后3个月复查肌电图,尺神经于肘部传导速度为(43.5±9.5)m/s,与术前比较,差异有统计学意义(P<0.05)。按Amadio肘部尺神经损害疗效评价标准,获优7例,良4例。结论内窥镜下尺神经松解联合内上髁微小切除治疗伴尺神经滑脱的肘管综合征安全、简便、有效,创伤小,术后恢复快。

Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis and minimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years （range, 18-47 years）. All cases had numbness in little finger and ring finger. The disease duration varied from 3 to 18 months （7 months on average）. Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity （NCV） were slowed down at elbow, which was （27.0 ± 1.5） m/s. Results All incisions healed by first intention, and no complication occurred. Eleven cases were followed up 6-37 months （19 months on average）. All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively （grade 4 in 7 cases and grade 3-4 in 4 cases）. The postoperative electromyography showed that the NCV was obviously improved, which was （43.5 ± 9.5） m/s, showing significant difference when compared with preoperative one （P〈0.05）. According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.