内窥镜下单孔微创治疗肘管综合征的临床应用研究

Clinical application of endoscopic single hole minimally invasive treatment of cubital tunnel syndrome

目的报告内窥镜下单孔微创治疗肘管综合征的手术方法及治疗效果。方法前期对肘管及肘部尺神经结构进行解剖学研究及测量,确定内窥镜下单孔微创治疗肘管综合征术式的入路、操作标志线及手术操作层面。根据前期解剖研究,实施临床手术,治疗中、重型肘管综合征患者78例,术后随访患者恢复情况,与同期行传统开放手术治疗的75例患者进行疗效对比。结果解剖研究表明内窥镜下单孔微创治疗肘管综合征安全有效。术后随访时间为6~12个月,平均9.5个月。按顾玉东的肘管综合征术后功能评定标准评定:内窥镜组综合评分优41例,良20例,可16例,差1例,优良率为78.2%。内窥镜组术后患者的麻痛症状.感觉检查,肌肉萎缩.、握力,爪形手,综合评分与传统手术组比较差异无统计学意义(P>0.05),内窥镜组与传统手术组具有相同的手术效果,但术后瘢痕较小,瘢痕痛发生率低,较传统手术具有优点。结论内窥镜下单孔微创治疗肘管综合征,该术式具有临床解剖基础,能解除尺神经卡压并完成神经前置,是一种有效治疗肘管综合征的微创方法。

Objective To report the clinical application and clinical efficacy of endoscopic single hole minimally invasive treatment of cubital tunnel syndrome.Methods ln the early stage,the anatomic study and measurement of cubital tunnel and ulnar nerve structure were carried out to determine the approach,operation mark line and operation level of single hole minimally invasive treatment for cubital tunnel syndrome.According to the preliminary anatomic study,78 patients with moderate and severe cubital tunnel syndrome were treated by clinical operation.The recovery of patients was followed up after operation,and the clinical efficacy was compared with 75 patients who underwent traditional open surgery at the same time.Results Anatomic study showed that endoscopic single hole minimally invasive treatment of cubital tunnel syndrome is safe and effective.The mean follow-up time was 9.5 months(range,6 to 12 months).According to Gu Yudong's evaluation standard of postoperatlive function of cubital tunnel syndrome,the comprehensive score of endoscopic group was excellent in 41 cases,good in 20 cases,fair in 16 cases and poor in 1 case.The excellent and good rate was 78.2%.There were no statistically significant differences in postoperative numbness,sensory examination,muscle atrophy,grip strength,claw hand and comprehensive score between the endoscopic group and the traditional operation group(P>0.05).The endoscopic group and the traditional operation group had the same surgical efficacy,but the postoperative scar was smaller and the incidence of scar pain was lower in the endoscopic group,which had advantages over the traditional operation group.Conclusion The endoscopic single hole minimally invasive treatment of cubital tunnel syndrome,which has clinical anatomical basis,can relieve ulnar nerve compression and complete nerve preposition.It is an effective minimally invasive method for cubital tunnel syndrome.