尺神经沟扩大成形术治疗外伤性肘外翻致肘管综合征16例

Treatment of cubital tunnel syndrome caused by traumatic cubitus valgus with expansion and formation of ulnar nerve sulcus:a report of 16 cases

目的探讨尺神经沟扩大成形术治疗外伤性肘外翻致肘管综合征的疗效。方法回顾性分析2013年1月-2018年12月收治的16例肘外翻畸形合并肘管综合征患者。依据顾玉东推荐的肘管综合征分期标准:轻度8例,中度5例,重度3例。患者均行尺神经沟扩大成形术,中重度患者的尺神经外膜予以松解;其中10例因提携角过大畸形严重及影响肘关节功能的患者加行肱骨髁上截骨术。结果术后随访时间为12~36个月,平均24个月。患者握力术前(21.00±7.92)kg改善为(28.38±9.89)kg、小指两点辨别觉术前(7.88±2.83)mm改善为(4.06±1.34)mm,10例术后加行肱骨髁上截骨术患者的肘关节屈曲活动度术前108.40°±16.10°改善为117.40°±11.24°、提携角术前27.06°±4.96°改善为13.03°±1.96°,差异具有统计学意义(P<0.05)。术后按Yokohama City University尺神经炎评分标准,改善率87%;肘关节功能评定按HSS评分系统进行,优良率95%。结论采用尺神经沟扩大成形术治疗外伤性肘外翻畸形导致的肘管综合征是一种符合解剖特点、操作简单、创伤小且疗效满意的手术方案。同时,对于提携角过大、畸形严重及影响肘关节功能的患者可联合髁上截骨术,可获得切实疗效,患者满意。

Objective To explore the effect of ulnar nerve sulcus expansion and formation on the treatment of cubital tunnel syndrome caused by traumatic cubitus valgus.Methods Sixteen patients with traumatic cubitus valgus deformity and cubital tunnel syndrome admitted to our department from January 2013 to December 2018 were retrospectively analyzed.According to Gu Yudong's recommended staging criteria for cubital tunnel syndrome:8 cases were mild,5 cases were moderate,and 3 cases were severe.All the patients were treated with expansion and formation of ulnar nerve sulcus and the ulnar nerve adventitia was released in moderate and severe patients.Among them,supracondylar osteotomy was performed in 10 patients with severe deformity due to excessive carrying angle and affecting elbow joint function.Results The mean follow-up time was 24 months(range,12 to 36 months).The grip strength(21.00±7.92 kg vs 28.38±9.89 kg),two-point discrimination of little finger(7.88±2.83 mm vs 4.06±1.34 mm)and elbow flexion range of motion(108.40°±16.10°vs 117.40°±11.24°)and carrying angle(27.06°±4.96°vs 13.03°±1.96°)of 10 patients with humeral supracondylar osteotomy after operation were significantly improved compared with those before operation(P<0.05).According to Yokohama City University ulnar neuritis score,the improvement rate was 87%;elbow function was evaluated according to HSS score system,the excellent and good rate was 95%.Conclusion Ulnar nerve sulcus expansion and formation for cubital tunnel syndrome caused by traumatic cubitus valgus deformity is a simple,minimally invasive and satisfactory surgical procedure.At the same time,supracondylar osteotomy can be used to correct severe cubitus valgus deformity in patients with excessive carrying,whose severe deformity affect the function of elbow joint,which can obtain practical curative effect and patients are satisfied.