肘管综合征治疗策略

The treatment strategies of cubital tunnel syndrome

目的比较治疗肘管综合征的两种术式及疗效，提出更加合理的手术治疗方案。方法回顾我院2005年8月至2011年1月收治的并获得完整随访资料的重度肘管综合征患者77例，随机行尺神经松解后筋膜瓣下前置术或皮下前置术两种术式，其中尺神经松解后筋膜瓣下前置42例、皮下前置35例。病例分级采用顾玉东建议的肘管综合征临床分型评定标准，随访采用肘管综合征功能评定标准，对术后疗效进行比较。结果术后随访3个月至6年，平均2．5年。多数患者在术后3～4个月症状得以缓解，术后时间再长并无更好的恢复。根据肘管综合征功能评定标准进行评价：优42例，良25例，可8例，差2例；优秀率54．5％，优良率87．0％。筋膜瓣下前置术及皮下前置术之间的差异有统计学意义（P〈0．05）。结论筋膜瓣下前置术为治疗肘管综合征的首选术式。

Objective To compare the efficacy of two surgical procedures for cubital tunnel syndrome and propose a more rational surgical treatment option. Methods A retrospective review of 77 cases with severe cubital tunnel syndrome treated in our hospital from August 2005 to January 2011 was conducted. They were treated with one of the two methods： neurolysis and subfascial anterior transposition of the ulnar nerve or neurolysis and subcutaneous anterior transposition of the ulnar nerve. 42 cases were treated with the former and 35 cases with the latter. Preoperatively the severity of the cases was assessed using GU＇ s classification. During postoperative follow-up the functions were evaluated by the cubital tunnel syndrome evaluation criteria. Results Postoperative follow-up period ranged from 3 months to 6 years, with an average of 2.5 years. The majority of cases were in remission after 3 to 4 months. No further improvement was observed thereafter. According to the cubital tunnel syndrome evaluation criteria, functional recovery was excellent in 42 cases, good in 25 cases, fair in 8 cases and poor in 2 cases. The excellent rate was 54.5%, while the overall satisfactory rate was 87.0%. The results of subfascial anterior transposition cases were significantly better than those of subcutaneous anterior transposition cases （ P 〈 0.05）. Conclusion Anterior transposition of the ulnar nerve under a fascial flap is a preferred surgical technique for treatment of cubital tunnel syndrome.