尺神经不对称前置术治疗肘管综合征

Asymmetric anterior transposition of ulnar nerve in the treatment of cubital tunnel syndrome

目的探讨尺神经不对称前置术治疗中、重度肘管综合征的手术方法及临床疗效。方法对48例中、重度肘管综合征患者行尺神经不对称前置术（A组），术后随访包括麻痛症状、感觉、握力、肌萎缩及爪形手恢复情况，测量手术前后小指末节指腹皮肤两点分辨觉、肘上5cm至肘下5cm段尺神经运动神经传导速度（MNCV）；并以同一时期行传统尺神经皮下前置术的114例患者（B组）随访作为对照，统计分析两种术式疗效的差异。结果术后随访时间为12～35个月，平均24．8个月，中度肘管综合征两种术式疗效差异无统计学意义（P〉0．05）；重度肘管综合征术后优良率、两点分辨觉、MNCV两组差异均有统计学意义（P〈0．05）。结论对于重度肘管综合征，尺神经不对称前置术的疗效优于传统皮下前置术。

Objective To explore the surgical method and clinical efficacy of asymmetric anterior transposition of ulnar nerve in the treatment of moderate and severe cnbital tunnel syndrome. Methods Asymmetric anterior transposition of uinar nerve was performed in 48 cases of moderate or severe cubital tunnel syndrome （group A）. The postoperative follow-up included the symptoms of pain, sensation, grip, muscle atrophy and the recovery of claw hand. The two-point discrimination of distal finger pulp and the ulnar nerve motor nerve conduction velocity （MNCV） from 5 cm above the elbow to 5 cm below the elbow were measured before and after the operation. The follow-up results from 114 patients （group B） performed traditional subcutaneous transposition of the ulnar nerve were served as control. The difference of the clinical efficacy between the two methods was statistically analyzed. Results The postoperative follow-up period ranged from 12 to 35 months with an average of 24.8 months. For moderate cubital tunnel syndrome, there was no significant difference between the two kinds of surgical treatment （P〉0.05）. For severe cubital tunnel syndrome, the differences of the postoperative excellent and good rate, two-point discrimination and MNCV between the two groups were statistically significant （P〈0.05）. Conclusion For severe cubital tunnel syndrome, the clinical efficacy of asymmetric anterior transoosition of ulnar nerve is better than traditional subcutaneous anterior transoosition.