合并肘关节内翻或外翻的肘管综合征的临床疗效探讨  

Clinical efficacy of combined wedge osteotomy and ulnar nerve transposition for the treatment of cubital tunnel syndrome associated with cubitus varus or valgus

作　　者：陈宏[1] 潘佳栋[1] 王欣[1] 章伟文[1] 

机构地区：[1]宁波市第六医院手外科,315040

出　　处：《中华肩肘外科电子杂志》2014年第4期240-245,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：浙江省自然科学基金(LYI3H060008)

摘　　要：目的：探讨肱骨髁上楔型截骨联合尺神经松解前置术治疗合并肘管综合征的成人肘外翻或内翻畸形的手术指征、手术技术和疗效。方法我科于2004年2月至2013年8月，对12例合并有肘管综合征的成人肘外翻或内翻畸形患者进行肱骨髁上楔形截骨和肘部尺神经松解前置手术治疗。本组患者中肘外翻畸形9例，提携角(29.5±4.2)°(24°~38°)，其中7例伴有肱骨外髁骨不连。肘内翻畸形3例，内翻角(25.3±9.1)°(17°~35°)。12例肘关节均无法达到完全伸直，伸肘(24.8±7.9)°(16°~40°)，屈肘(116.9±11)°(100°~143°)。所有患者均有肘部尺神经卡压的症状，手部握力(17.4±6.2)kg(9~30 kg)，手部尺神经支配区两点辨别觉(7.3±3.6)mm(3~14 mm)。依据Dellon推荐的分期标准：中度3例、重度9例。结果术后随访时间为8~35个月，平均24个月。肱骨髁上截骨平均愈合时间为15.4周，术后平均提携角为11.3°。术后肘关节伸肘(20.8±9.9)°(10°~42°)，屈肘(115.2±11.4)°(95°~140°)，手部握力(23.7±8.2)kg(13~42 kg)，手部尺神经支配区皮肤两点辨别觉(4.3±1.9)mm(2~8 mm)，平均DASH 评分由术前的35分降为17分。结论肱骨髁上楔形截骨联合尺神经松解前置手术不仅能纠正肘关节的内翻或外翻畸形，而且可以使长期被牵拉或不稳定而麻痹的尺神经功能获得改善，因此是治疗成人肘外翻或内翻畸形合并肘管综合征患者的良好选择。Background The aim of this study is to evaluate the clinical efficacy of combined wedge osteotomy and ulnar nerve transposition for the treatment of cubital tunnel syndrome associated with cubitus varus or valgus.Patients with cubitus varus or cubitus valgus are subject to cubital tunnel syndrome.The consequent symptoms of ulnar nerve palsy such as hand muscle atrophy,limitation in meticulous motions and paresthesia can seriously affect hand function.The anterior transposition of the ulnar nerve alone is less effective for such patients.Methods We performed supracondylar wedge osteotomy of the humerus combined with anterior transposition of the ulnar nerve in twelve adult patients with cubitus valgus or cubitus varus with cubital tunnel syndrome from February 2004 to August 2013.This group of patients included nine cases of cubitus valgus with the carrying angle of29.5±4.2(24~38)degrees,in which seven cases were complicated with nonunion of the lateral humeral condyle.There also included three cases of cubitus varus,with the varus angle of 25.3±9.1(17~35)degrees.In all of the cases,patients were unable to reach full elbow extension,with the elbow extension of 24.8±7.9(16~40)degrees and elbow flexion of 116.9±11(100~143)degrees.They all had symptoms of ulnar nerve entrapment,with the hand-grip strength of 17.4±6.2(9~30)kg and two-point discrimination in ulnar nerve area of 7.3±3.6(3~14)mm.They were divided into moderate cases(n =3)and severe cases(n =9)according to the classification criteria recommended by Dellon.Operating techniques:Arc longitudinal incisions were performed across the posterior elbow,with the length of about 14 cm.First,the tissue was dissected by layers into the sulcus to explore ulnar nerve.The ulnar nerve ranging from 7cm above to 5cm below the medial epicondyle were explored and retracted with rubber strips.Second,a longitudinal incision was made on the muscle fiber in the central axis of the dorsal triceps muscle to expose the distal humerus.The distal osteotomy line was set approxima

关 键 词：肘关节 截骨 尺神经压迫综合征 畸形 

分 类 号：R688[医药卫生—骨科学]