肘部尺神经前置术后翻修病例的回顾性分析

Aretrospective study of revision cases after ulnar nerve anterior transposition at the elbow

目的分析肘部尺神经前置术后翻修手术病例术中探查情况、术后随访治疗效果,总结尺神经前置初次手术疗效不佳的主要原因以及翻修手术的要点和治疗效果。方法对37例自2008年1月到2019年8月在我院行尺神经前置术后翻修手术的患者进行回顾性分析,收集病例一般资料、翻修手术前后体格检查、辅助检查(包括神经电生理检查和神经超声)及患者自评量表结果,记录术中探查情况。结果术后所有患者均获得随访,时间为4~18个月,平均(10.3±3.7)个月,造成尺神经前置初次手术效果不佳的原因主要包括尺神经周围瘢痕组织卡压、局部卡压因素未彻底解除以及筋膜瓣制备不当。翻修术后末次随访时,手部尺侧麻木改善25例(67.6%)、手部及肘关节尺侧疼痛缓解9例(81.8%)、手内肌萎缩缓解18例(81.8%),功能评定按照顾玉东肘管综合征功能评定标准:优2例,良23例,可10例,差2例,优良率达67.6%。影响翻修手术效果的可能相关因素包括初次手术至翻修手术时间以及翻修手术前是否出现严重疼痛。结论尺神经前置初次手术应仔细、谨慎地探查并解除所有可能造成尺神经再次卡压的因素,并恰当制备用于前置的筋膜瓣。对于术后效果不佳的患者,翻修手术能带来较为良好的治疗效果。

Objective To analyze the intraoperative exploration and postoperative follow-up of revision cases of ulnar nerve anterior transposition,to summarize the main reasons for poor initial surgical efficacy of ulnar nerve anterior transposition,as well as the key points and treatment effects of revision surgery.Methods A retrospective analysis was conducted on 37 patients who underwent revision surgery for ulnar nerve anterior transposition in our hospital from January 2008 to August 2019.The general case information,physical examination before and after revision surgery,auxiliary examinations(including neuroelectrophysiological examination and neuroultrasound),and patient self-evaluation scale results were collected,and intraoperative exploration status was recorded.Results All patients were follow-up for 4 to 18 months,with an average of(10.3±3.7)months.The main reasons for the poor initial surgical efficacy of ulnar nerve anterior transposition included the compression of scar tissue around the ulnar nerve,the incomplete removal of local compression factors,and the improper preparation of fascia flap.At the last fllow-up after the revision surgery,ulnar numbness in the hand was alleviated in 25 cases(67.6%),ulnar pain in the hand and elbow joint was alleviated in 9 cases(81.8%),and atrophy of the hand muscles was alleviated in 18 cases(81.8%).According to Gu Yudong's criteria for cubital tunnel syndrome,the functional results were evaluated as excellent in 2 cases,good in 23 cases,fair in 10 cases,and poor in 2 cases,with an excellent and good rate of 67.6%.