肘管的解剖特点对原位松解术治疗肘管综合征的疗效影响

The anatomical features of cubital tunnel influence on the outcomes of in situ decompression treatment for cubital tunnel syndrome

目的探讨肘管的解剖特点,为肘管综合征的手术方式的选择提供参考意义。方法选取81例肘管综合征患者,依据其肘管的解剖构造特点分为A、B两组,A组:肘管支持带的厚度≥1.4 mm者,或者肘管支持带被滑车上肘肌取代者,共39例,B组:肘管支持带的厚度<1.4 mm者,共42例,均实施尺神经原位松解术,术后随访12个月,我们将两组的有效率进行比较。结果两组的有效率具有显著差异(P<0.05),A组的有效率为92.31%,B组的有效率为76.19%。结论对于肘管支持带较厚者,或者直接被滑车上肘肌的患者,引发肘管综合征的病因考虑为被增厚的弓状韧带或者被滑车上肘肌卡压,故实施尺神经原位松解术的效果好,而肘管支持带相对较薄者,实施尺神经原位松解术治疗效果较差,考虑这类肘管综合征患者为尺神经完全屈肘时遭到牵拉引起,而非卡压造成。

Objective To explore anatomic feature of cubital tunnel, and to provide reference for the decompression treatment of cubital tunnel syndrome. Methods We selected 81 patients with cubital tunnel syndrome, and divided these patients into two groups, in accordance with the feature of cubtial tunnel. Group A： It included the patients whose thickness of cubital tunnel retinaculum was ≥1.40 mm, or the cubital tunnel retinaculum was replaced by epitrochleo-anconeus. There were 39 cases in all. Group B： It included the patients whose thickness of cubital tunnel retinaculum was〈1.40 mm, there were 42 cases. Two groups were treated by in situ decompression treatment. The patients were followed up for 12 months. We compared the efficacy rate of two groups. Results There was statistical significance of the effective rate of two groups （P〈0.05）. The effective rate of group A was 92.31%. The efficacy rate of group B was 76.19%. Conclusions For the patients whose cubital tunnel retinaculum was thicken or is replaced by epitrochleo-anconeus, the origin of cubital tunnel syndrome was that the ulnar nerve was compressed by the thickened cubital tunnel retinaculum or the epitrochleo-anconeus. Therefore, the result of in situ decompression treatment was better, however, for those with a thinner cubital tunnel retinaculum, the result of in situ decompression treatment is poor. For these cases, we consider that the cubital tunnel syndrome is caused by the excessive stretch of the ulnar nerve when the elbow full flexion rather than it being compressed.