两种尺神经前置方法治疗肘管综合征的疗效比较

EFFECTIVENESS COMPARISON BETWEEN TWO DIFFERENT METHODS OF ANTERIOR TRANSPOSITION OF THE ULNAR NERVE IN TREATMENT OF CUBITAL TUNNEL SYNDROME

目的比较尺神经皮下前置及肌下前置两种方法治疗肘管综合征的疗效,为临床选择恰当的治疗术式提供依据。方法 2006年6月-2008年10月收治39例肘管综合征患者,其中20例采用尺神经皮下前置(皮下前置组),19例采用尺神经肌下前置(肌下前置组)。两组患者性别、年龄、病程及临床分型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果两组患者术后切口均Ⅰ期愈合。术后肌下前置组17例(89.5%)发生尺神经卡压症状缓解后突然加重,1例(5.3%)肘部瘢痕增生;皮下前置组10例(50.0%)出现触碰肘前内侧皮肤时手部尺侧麻木;两组并发症发生情况比较,差异有统计学意义(χ2=9.632,P=0.002)。患者均获随访,随访时间24～36个月,平均28个月。末次随访时,两组手部握力,拇、环指及拇、小指捏力,以及小指末节两点辨别觉比较,差异均无统计学意义(P>0.05);但均较术前显著改善,差异均有统计学意义(P<0.05)。按中华医学会手外科学会上肢部分功能评定试用标准评定:皮下前置组获优5例,良12例,可1例,差2例;肌下前置组获优6例,良10例,可2例,差1例;两组比较差异无统计学意义(u=0.346,P=0.734)。参照患者源性功能调查表上肢功能评定表评定:皮下前置组为(22±7)分,肌下前置组为(19±6)分,差异无统计学意义(t=1.434,P=0.161)。结论尺神经皮下前置及肌下前置两种方法治疗肘管综合征均可达到良好疗效,其中尺神经肌下前置法并发症较少。

Objective To compare the effectiveness of anterior subcutaneous transposition and anterior submuscular transposition of the ulnar nerve in the treatment of cubital tunnel syndrome.Methods Between June 2006 and October 2008,39 patients with cubital tunnel syndrome were treated separately by anterior subcutaneous transposition（anterior subcutaneous transposition group,n=20） and anterior submuscular transposition（anterior submuscular transposition group,n=19）.There was no significant difference in gender,age,duration,and clinical classification between 2 groups（P 0.05）.Results All incisions healed by first intention in 2 groups.In anterior submuscular transposition group,17 patients（89.5%） had abruptly deteriorated symptoms after the symptom of ulnar nerve compression was abated,and 1 patient（5.3%） had cicatrix at elbow;in the anterior subcutaneous transposition group,10 patients（50.0%） had disesthesia at cubital anterointernal skin after operation;and there was significant difference in the complication between 2 groups（χ2=9.632,P=0.002）.The patients were followed up 24 to 36 months,28 months on average.There was no significant difference in grip strength,pinch power of thumb-to-ring finger and thumb-to-little finger,or two-point discrimination of distal little fingers between 2 groups（P 0.05）,but significant differences were found between before operation and after operation in 2 groups（P 0.05）.According to the Chinese Medical Society of Hand Surgery Trial upper part of the standard evaluation function assessment,the results were excellent in 5 cases,good in 12 cases,fair in 1 case,and poor in 2 cases in the anterior subcutaneous transposition group;the results were excellent in 6 cases,good in 10 cases,fair in 2 cases,and poor in 1 case in the anterior submuscular transposition group;and there was no significant difference between 2 groups（u=0.346,P=0.734）.According to disability of arm-shoulder-hand（DASH） questionnaires,the score was 22 ± 7 in anterior subcutaneous transposition group and was 19 ± 6 in anterior submuscular transposition group,showing no significant difference（t=1.434,P=0.161）.Conclusion Both anterior subcutaneous transposition and anterior submuscular transposition have good effectiveness in treating cubital tunnel syndrome;and anterior submuscular transposition has less complication than that of submuscular transposition.