带血管尺神经前置术治疗重度肘管综合征

Anterior transposition of vascularized ulnar nerve for the treatment of severe cubital tunnel syndrome

目的评价带血管尺神经筋膜下前置术治疗重度肘管综合征的疗效。方法对5例成人尸体上肢标本进行解剖学研究，观察尺神经在肘部的血液供应来源，测量尺神经的营养血管与神经伴行的长度。对38例重度肘管综合征患者，随机分为两组，分别采用带血管尺神经筋膜下前置术和单纯筋膜下前置术，参照中华医学会手外科学会上肢部分功能评定试用标准Lascar分级法和神经电生理测定，对患者的疗效进行评价比较。结果解剖测量尺神经的营养血管与神经伴行长度：3条动脉伴神经走行的长度分别为尺侧上副动脉（145．0±4．3）mm，尺侧下副动脉（48．6±8．2）mm，尺侧返动脉后支（65．2±9．3）mm。带血管尺神经筋膜下前置术优良率为89．5％，单纯筋膜下前置术优良率为68．4％，两组比较差异有统计学意义。神经电生理检查：不带血管组术前运动神经传导速度（MNCV）平均为（23．3±3．6）m／s，术后（37．5±5．2）m／s；带血管组术前MNCV平均为（22．3±4．4）m／s，术后（45．2±6．0）m／s；两组比较差异有统计学意义。结论带血管尺神经筋膜下前置术疗效可靠，方法简便，是治疗重度肘管综合征的有效方法。

Objective To evaluate the^effect of vascularized ulnar nerve sub-fascial transposition in the treatment of severe cubital tunnel syndrome. Methods Anatomical dissection of 5 embalmed adult upper limb cadaver specimens was carried out to observe the blood supply of the ulnar nerve around the elbow. The accompanying length of its feeding vessels was measured. Thirty-eight cases of severe cubital tunnel syndrome were divided into two groups. In group 1 the ulnar nerve was transposed under the fascia with its feeding blood vessel. In group 2 the ulnar nerve was transposed without the blood vessel. The treatment effect was evaluated using the upper limb function evaluation criteria issued by the Chinese Medical Association, the Lascar classification method and electrophysiologic studies. Results There were 3 vessels that accompany the ulnar nerve around the elbow. The length of the vessel accompanying the ulnar nerve was （ 145.0± 4.3） mm for superior ulnar collateral artery, （48.6 ±8.2） mm for inferior ulnar collateral artery, and （65.2 ± 9.3） mm for the posterior branch of ulnar recurrent artery. The excellent and good rate was 89.5% in group 1 and 68.4% in group 2. The difference was statistically significant. Nerve conduction study showed an increase in motor nerve conduction velocity （MNCV） from （22.3 ± 4.4） m/s preoperatively to （45.2 ± 6.0） m/s postoperatively in group 1, and from （23.3 ± 3.6） rn/s preoperatively to （37.5 ± 5.2）m/s postoperatively in group 2. The difference between the two groups was statistically significant. Conclusion Vaseularized ulrkar nerve sub- faseial transposition is a reliable treatment for severe cubital tunnel syndrome. The surgical procedure is simple and effective.