尺神经原位松解术与松解皮下前移术治疗中度肘管综合征的前瞻性对比研究

Comparative study of simple decompression versus anterior subcutaneous transposition in the treatment of moderate cubital tunnel syndrome

目的本研究旨在比较尺神经原位松解术与松解皮下前移术在治疗中度肘管综合征中的临床效果。方法将2018年7月至2019年7月于河北省沧州中西医结合医院收治的中度肘管综合征患者随机分为治疗组(尺神经原位松解术)和对照组(尺神经松解皮下前移术)。记录性别、年龄、症状持续时间等一般资料。将小指单丝触觉,小指两点辨别觉作为评价患者感觉恢复的指标,将握力,拇示指侧方捏力,运动神经传导速度作为评价患者运动的指标,并记录两组的术后并发症(肘关节疼痛,尺神经半脱位,切口感染)。对两组患者均进行为期不少于12个月的随访,并进行横向组间比较及纵向组内比较(治疗前,治疗后12月)。结果本研究共纳入50例患者,治疗组25例,对照组25例。两组患者性别(χ^(2)=0.081,P=0.777),年龄(t=0.117,P=0.907),症状持续时间(t=-1.364,P=0.179),随访时间(Z=-0.865,P=0.387)一般资料未见统计学差异,具有可比性。两组小指单丝触觉(Z=-0.990,P=0.322),小指两点辨别觉(Z=-0.447,P=0.655),握力(t=0.711,P=0.481),拇示指侧方捏力(Z=-0.233,P=0.816),运动神经传导速度(Z=-1.438,P=0.150)均未见统计学差异。治疗组小指单丝触觉(Z=-4.391,P=0.000),小指两点辨别觉(Z=-4.506,P=0.000),握力(t=-41.297,P=0.000),拇示指侧方捏力(Z=-4.422,P=0.000),运动神经传导速度(Z=-4.418,P=0.000)均较治疗前有明显改善。对照组小指单丝触觉(Z=-4.430,P=0.000),小指两点辨别觉(Z=-4.526,P=0.000),握力(t=-33.597,P=0.000),拇示指侧方捏力(Z=-4.353,P=0.000),运动神经传导速度(Z=-4.449,P=0.000)均较治疗前有明显改善两组均未出现肘关节疼痛,尺神经半脱位,切口感染等术后并发症。结论尺神经原位松解术与松解皮下前移术是安全有效的两种术式,均能明显改善中度肘管综合征患者的运动及感觉,尺神经松解皮下前移术术中及术后出血更多。

Objective The purpose of this study was to compare the clinical efficacy of simple decompression versus anterior subcutaneous transposition in the treatment of moderate cubital tunnel syndrome.Methods Patients with moderate cubital tunnel syndrome admitted to Cangzhou Hospital of Integrated TCM-WM of Hebei from July 2018 to July 2019 were divided into treatment group(simple decompression group)and control group(anterior subcutaneous transposition group).General information such as gender,age,and duration of symptoms.The Semmes-Weinstein Monofilament of the little finger and twopoint discrimination of the little finger were used as the indicators to evaluate the sensory recovery of the patients,and grip strength,pinch strength of the thumb and index,and motor nerve conduction velocity were used as the indicators to evaluate the motor of the patients.The postoperative complications of the two groups were recorded(elbow joint pain,ulnar nerve supracrustal dislocation,and incision infection).Patients in both groups were followed up for at least 12 months,and cross-group and intra-group comparisons were performed(preoperative,12-month follow up).Results A total of 50 patients were included in this study,including 25 patients in the treatment group and 25 patients in the control group.There were no statistically significant differences in gender(c2=0.081,P=0.777),age(t=0.117,P=0.907),symptom duration(t=-1.364,P=0.179)and follow-up time(Z=-0.865,P=0.387)between the two groups,indicating comparability.Semmes-Weinstein Monofilament of the little finger(Z=-0.990,P=0.322),two-point discrimination of the little finger(Z=-0.447,P=0.655)grip strength(t=0.711,P=0.481),pinch strength of the thumb and index(Z=-0.233,P=0.816),and motor nerve conduction velocity(Z=-1.438,P=0.150)in treatment group were significantly improved compared with those before treatment.Semmes-Weinstein Monofilament of the little finger(Z=-4.430,P=0.000),two-point discrimination of the little finger(Z=-4.526,P=0.000),grip strength(t=-33.597,P=0.000),pinch strength of the thumb and index(Z=-4.353,P=0.000),and motor nerve conduction velocity(Z=-4.449,P=0.000)in control group were significantly improved compared with those before treatment postoperative complications such as elbow pain,ulnar nerve subluxation,and incision infection were not found in both groups.Conclusions Simple decompression and Anterior subcutaneous transposition of the ulnar nerve are safe and effective procedures,both of which can significantly improve motor and sensation in patients with moderate cubital tunnel syndrome.Anterior subcutaneous transposition of the ulnar nerve resulted in more intraoperative blood loss and postoperative drainage.