带血管蒂尺神经肌筋膜下前置术治疗中度肘管综合征

Anterior subfascial transposition of the ulnar nerve with blood vessel for treatment of moderate cubital tunnel syndrome

[目的]评价带血管蒂尺神经肌筋膜下前置术治疗中度肘管综合征的疗效。[方法]通过对6例防腐成人上肢标本观察测量肘部尺神经血供来源和血管外径及血管长度的相关数据,对30例中度肘管综合征患者,分为两组,分别采用带血管蒂尺神经肌筋膜下前置术和单纯肌筋膜下前置术,参照中华医学会手外科学会制定的尺神经修复后功能评定试用标准,Lascar分级法和术前术后尺神经神经电生理变化,对疗效进行评价比较。[结果]尺神经的营养伴行血管有3条。伴神经走行的长度分别为尺侧上副动脉(144.0±3.3)mm、尺侧下副动脉(47.6±7.2)mm、尺侧返动脉后支(66.2±8.3)mm。带血管尺神经筋膜下前置术优良率为93.3%,单纯肌筋膜下前置术优良率为80%,两组比较差异有统计学意义。神经电生理检查:带血管尺神经肌筋膜下前置术优于单纯肌筋膜下前置术,两组比较差异有统计学意义。[结论]带血管蒂尺神经肌筋膜下前置术疗效可靠,方法简便,是治疗中度肘管综合征的有效方法。

[Objective] To evaluate the clinical outcome of anterior subfascial transposition of the ulnar nerve with blood vessel in treating moderate cubital tunnel syndrome. [Methods] The blood supply, as well as the outer diameter and length of blood vessel of the ulnar nerve were observed and measured from the elbows of 6 formaldehyde-preserved adult upper limb specimens. Thirty patients with moderate cubital tunnel syndrome were divided into two groups, where group 1 was treated by anterior subfascial transposition of the ulnar nerve with blood vessel and group 2 was treated by anterior subfascial transposition of the ulnar nerve（without blood vessel）. Treatment efficacy in patients was assessed based on the evaluation standards for restoration of ulnar nerve function by the Chinese Medical Association,Lascar classification and pre- and post-surgery electrophysiological changes. [Results] The ulnar nerve was accompanied by 3 arteries,namely the superior ulnar collateral artery,inferior ulnar collateral artery, and posterior branch of the ulnar recurrent artery,these arteries were 144.0±3.3 mm, 47.6±7.2 mm, and 66.2±8.3 mm in length, respectively. Treatment satisfaction rate was 93.3% in group 1 and 80% in group 2,with a significant difference between the two groups. Electrophysiological results indicated that anterior subfascial transposition of the ulnar nerve with blood vessel（group 1） was significantly better than the one without blood vessel（group 2）. [Conclusions] Anterior subfascial transposition of the ulnar nerve with blood vessel is a reliable, simple, and effective method for treating moderate cubital tunnel syndrome.