Hoffmann法内镜尺神经松解术治疗特发性肘管综合征

Endoscopic ulnar nerve decompression for idiopathic cubital tunnel syndrome

目的初步探讨Hoffmann法内镜尺神经松解术治疗特发性肘管综合征的安全性和有效性。方法回顾性分析北京大学第一医院神经外科自2016年6月至2020年9月行内镜手术治疗的13例肘管综合征患者的临床资料。手术器械采用肘管手术套件,采用Hoffmann法进行手术。术前应用McGowan分级对患者进行分类。术后对患者进行电话和门诊随访,采用改良Bishop评分对患者术后恢复程度进行评价。结果13例患者中11例行单纯尺神经减压,2例合并小囊肿压迫者同时行囊肿切除,术后病理报告1例为肘关节滑膜囊肿、1例为腱鞘囊肿。术后2~5 d出院,1例患者出现切口裂开,予以重新缝合后愈合良好,余患者无并发症发生。术后第2天所有患者均有麻木症状的缓解。随访5~56个月,改良Bishop评分优5例、良5例、中3例、差0例。其中术前McGowan分级1级组术后改良Bishop评分优良率100%(6/6),McGowan分级2级组改良Bishop评分优良率57%(4/7)。术后14~21 d恢复正常生活工作。结论内镜肘管减压术是微创手术,神经减压效果与开放手术相当,术后短期并发症少、恢复工作快,尤其适用于原发性肘管综合征。

Objective To investigate the efficacy and safety of Hoffmann’s endoscopic ulnar neurolysis in the treatment of cubital tunnel syndrome.Methods The clinical data of 13 patients with cubital tunnel syndrome who underwent endoscopic ulnar neurolysis from June 2016 to September 2020 in the First Hospital of Peking University were analyzed retrospectively.The surgical instrument was the cubital release kit,and Professor Hoffmann’s method was used in the operation.McGowan classification was used to classify the patients before operation.The patients were followed up by telephone and outpatient department after operation and evaluated by modified Bishop score.Results Among the 13 cases,11 cases underwent ulnar nerve decompression alone,2 cases with small cyst compression underwent cyst resection at the same time.Postoperative pathology showed that 1 case was synovial cyst of elbow joint and 1 case was ganglion cyst.All patients were discharged from the hospital 2-5 d postoperatively.One patient had incision dehiscence and healed well after suturing again.The other patients had no complications.Numbness was relieved in all patients on the second day after operation.After 5-56 months of follow-up,the modified Bishop score was excellent in 5 cases,good in 5 cases,fair in 3 cases and poor in 0 case.The excellent and good rate of modified Bishop score was 100%(6/6)in McGowan grade 1 group and 57%(4/7)in McGowan grade 2 group.All the patients returned to work in 14-21 d after surgery.Conclusion Endoscopic cubital tunnel decompression is a minimally invasive surgery,the effect of nerve decompression is equivalent to that of open surgery,with less postoperative short-term complications and quick recovery,especially suitable for patients with primary cubital tunnel syndrome.