尺神经松解前置联合手内在肌重建治疗重度肘管综合征

ANTERIOR SUBCUTANEOUS TRANSPOSITION OF ULNAR NERVE AND HAND INTRINSIC MUSCLES FUNCTION RECONSTRUCTION FOR SEVERE CUBITAL TUNNEL SYNDROME

目的 探讨尺神经松解前置联合手内在肌重建治疗重度肘管综合征的疗效。方法 2006年3月-2015年5月,采用肘部尺神经松解前置联合手内在肌重建的方法治疗22例（23侧）重度肘管综合征患者。其中男15例,女7例;年龄45~60岁,平均55岁。病因：肘外翻12例,尺神经半脱位4例,骨性关节炎6例。病程10个月~3年,平均17个月。根据Akahori分型,4型14例,5型9例。术后观察患者环、小指麻木感,手内在肌肌萎缩及拇指内收功能恢复情况,以及爪形畸形改善情况;采用捏力计测量拇指指腹与示指侧方捏力;采用中华医学会手外科学会上肢部分功能评定试用标准评价术后手功能。结果 术后患者切口均Ⅰ期愈合。22例均获随访,随访时间8~24个月,平均14个月。术后1 d 10侧环、小指麻木感明显减轻;术后1个月12侧麻木感完全消失,11侧至术后1年2个月仍有轻度麻木感。末次随访时,1侧手内在肌肌萎缩有部分恢复（＋＋＋）,22侧仍无改善;17侧爪形畸形有明显改善,6侧无改变;拇指指腹与示指侧方捏力为（5.07±1.11）kg,较术前的（2.91±0.63）kg显著改善（t=—12.340,P=0.032）。末次随访时按中华医学会手外科学会上肢部分功能评定试用标准评价手功能,优11侧,良8侧,可3侧,差1侧,优良率82.6%。结论 尺神经松解前置联合手内在肌重建治疗重度肘管综合征操作简便,疗效可靠。

Objective To study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome. Methods Between March 2006 and May 2015, 22 cases （23 hands） of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45- 60 years （mean, 55 years）. The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years （mean, 17 months）. According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger＇s numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger＇s pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol. Results All incisions healed well and all cases were successfully followed up 8 to 24 months （mean, 14 months）. Numbness of ring/ little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in I 1 hands. At last follow-up, hand intrinsic muscle atrophy partially improved （＋＋＋） in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to （5.07±1.11） kg from preoperative （2.91±0.63） kg （t= -12.340, P=0.032）. At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%. Conclusion Anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.