尺神经骨膜外前置术治疗肘管综合症的临床应用研究

Periosteum ulnar nerve in the treatment of cubital tunnel syndrome pre-clinical study

目的通过对尺神经骨膜外前置术临床应用效果的观察,为肘管综合症的治疗提供理论依据和最佳的治疗方案。方法应用经确诊的32例肘管综合征临床病例资料,其中男22例,女10例,年龄17～73岁。左肘12例,右肘20例。病史3个月～5年,平均7.1个月。参照Machinnon等推荐的分期系统,中度13例,重度19例。观测尺神经病变的部位、范围、粗细等情况;术后随访,观察患者恢复情况,包括感觉恢复情况,肌萎缩恢复情况,爪型手恢复情况,手指内收外展功能恢复情况,肌电图变化等。结论尺侧上副动脉的伴行前置,使尺神经在前置后能获得良好的血供,有利于神经功能的恢复。尺神经骨膜外前置术将尺神经前置于肘前骨膜下,较好地解决了尺神经肘部压迫及屈肘受牵拉的问题。新肘管宽松,对神经无卡压。尺神经松解加尺侧上副动脉的共同骨膜外前置术符合生物力学及神经生理要求,为治疗中、重度肘管综合征可选择的最佳术式。

Objective： To provide the theoretical basis and the best therapeutic regimen for treatment of cubital tunnel syndrome,by observing the clinical results of the extra periosteal anterior transposition for ulnar nerves.Methods： The clinical information of 32 cases of cubital tunnel syndrome whose diagnoses had been confirmed was used.These patients included 22 men and 10 women at the age of 17~73,among whom 12 suffered from this illness in their left elbows and 20 in their right ones;the case history ranged from 3 months to 5 years,7.1 months on an average.There were 13 moderate cases and 19 severe ones,according to the staging system recommended by Machinnon and others.The parts,scopes,thickness,etc of ulnar nerve pathological changes were observed and surveyed;after the operation we followed up these cases by regular visits to them,watching the conditions of their recovery in terms of feel,muscular atrophy,claw-type hands,finger adduction and abduction,EMG changes,etc.Conclusion： The concomitant anterior transposition of the superior ulnar collateral artery can provide ulnar nerves with better blood supply after the anterior transposition,which is beneficial to the recovery of neurological functions.The extra periosteal anterior transposition for ulnar nerves can put ulnar nerves below the antecubital periosteum and has better solved the problem that ulnar nerves suffer from elbow compression and are pulled when elbows are bent.The new cubital tunnels are loose,without entrapment to nerves.The ulnar nerve neurolysis and the common periosteum anterior transposition for the superior ulnar collateral artery,which accords with the demands of biomechanics and neurophysiology,is the best operation type optional in treating moderate and severe cases of cubital tunnel syndrome.