不同类型前置术治疗尺神经肘管卡压综合征

Various kinds of nerve transposition for the treatment of ulnar nerve entrapment syndrome associated with the cubital tunnel

目的对比不同类型前置术治疗尺神经肘管卡压综合征的临床疗效。方法回顾性分析278例尺神经肘管卡压综合征病人的临床资料,按McGowan法分级后,随机行尺神经皮下前置术(皮下前置术)139例,"Z"字形改良肌下前置术(肌下前置术)139例。检测尺神经横截面积(CSA)、神经运动传导速度(MCV)、感觉传导速度(SCV)、神经干动作电位(NAP)变化,比较两种术式的疗效。结果 McGowanⅠ级病人,术后CSA、MCV、SCV、NAP均较术前明显改善(P<0.05),但两种术式间各参数和术后优良率差异均无统计学意义(P>0.05)。McGowanⅡ、Ⅲ级病人术后CSA、MCV、SCV、NAP均较术前明显改善(P<0.05),且两种术式间各参数和术后优良率差异均有统计学意义(P<0.05)。结论皮下前置术适于尺神经肘管卡压综合征McGowanⅠ级病人,而肌下前置术更适用于McGowanⅡ、Ⅲ级病人。

Objective To compare the clinical efficacies of various kinds of nerve transposition for the treatment of ulnar nerve entrapment syndrome associated with cubital tunnel.Methods Clinical data of 278 patients with entrapment syndrome of the ulnar nerve were analyzed retrospectively.Ulnar nerve decompression was performed under microscope in all the patients.After classifying according to McGowan grade,the patients were randomly given subcutaneous ulnar nerve transposition（subcutaneous nerve transposition） and Z-shaped modified submuscular ulnar nerve transposition（submuscular nerve transposition） in respective 139.The cross-section area（CSA）,motor conduction velocity（MCV）,sensory conduction velocity（SCV） and nerve action potential（NAP） were detected.The therapeutic efficacy was compared between the two surgical methods.Results In the patients with McGowan grade Ⅰ,compared with preoperative parameter,the postoperative CSA,MCV,SCV and NAP improved obviously（P0.05）.But there was no statistical significance between the two surgical methods in every parameter and the rate of good to excellent outcome postoperatively（P0.05）.In the patients with McGowan grades Ⅱ and Ⅲ,the postoperative CSA,MCV,SCV and NAP improved obviously compared with preoperation（P0.05）.And there was statistical significance between the two surgical methods in every parameter and the rate of good to excellent outcome postoperatively（P0.05）.Conclusions Subcutaneous nerve transposition is suitable for the patients with grade Ⅰ elbow entrapment syndrome of the ulnar nerve,while submuscular nerve transposition is more suitable for the grades Ⅱ and Ⅲ patients with the syndrome.