内窥镜及显微镜辅助下三切口治疗肘管综合征  

ENDOSCOPE AND MICROSCOPE ASSISTED THREE SMALL INCISIONS FOR TREATMENT OF CUBITAL TUNNEL SYNDROME

作　　者：胡继超[1] 崔岩[1] 李钧[1] 陈波[1] 潘跃[1] 柳杰[2] 

机构地区：[1]武警浙江省总队医院骨三科浙江嘉兴,314000 [2]武警浙江省总队卫生处

出　　处：《中国修复重建外科杂志》2011年第2期216-219,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结在内窥镜及显微镜辅助下采用三切口行尺神经松解并皮下前置术治疗肘管综合征的手术方法和疗效。方法 2008年5月-2009年8月,在内窥镜及显微镜辅助下采用三切口行尺神经松解并皮下前置术治疗13例肘管综合征患者。其中男4例,女9例;年龄32～60岁,平均47.5岁。致病原因:外伤性肱骨内侧髁陈旧性骨折畸形1例,无明显外伤、长时间屈肘作业10例,尺神经滑脱2例。左侧6例,右侧7例。病程4～30个月。发病至手术时间3～20个月,平均8.5个月。10例伴手内肌萎缩。结果手术均顺利完成,手术时间45～60 min。术后切口Ⅰ期愈合,无感染等并发症发生。术后患者均获随访,随访时间12～18个月,平均14个月。术后第1天,患者环、小指及掌、尺侧皮肤麻木感明显减轻。术后2周肌电图检查示前臂尺神经运动传导速度增快,波幅改善,手内肌募集反应增强。术后3个月,10例伴手内肌萎缩患者中7例肌力恢复正常,余3例肌力大部分恢复。术后12个月,患者肘管综合征临床症状消失,肘关节功能恢复正常。按照中华医学会外科学会上肢部分功能评定试用标准和Lascar等分级法评价疗效,获优10例,良3例,优良率100%。患者术后12～16 d(平均14 d)恢复日常工作。随访期内均无复发。结论内窥镜及显微镜辅助下采用三切口治疗肘管综合征具有手术切口小,组织创伤轻,尺神经松解及减压彻底等优点,患者术后能早期恢复日常工作,是一种治疗肘管综合征安全有效的微创手术方法。Objective To evaluate the surgical method and the results of endoscopic decompression and anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome.Methods Between May 2008 and August 2009,13 cases of cubital tunnel syndrome were treated with endoscopic decompression and anterior transposition of the ulnar nerve.There were 4 males and 9 females with an average age of 47.5 years（range,32-60 years）.The injury was caused by fractures of the humeral medial condyle in 1 case,by long working in elbow flexion position with no obvious injury in 10 cases,and subluxafion of ulnar nerve in 2 cases.The locations were the left side in 6 cases and the right side in 7 cases.The disease duration was 4-30 months.The time from onset to operation was 3-20 months（mean,8.5 months）.Ten patients complicated by intrinsic muscle atrophy.Results The operation was successfully performed in 13 cases,and the operation time was 45-60 minutes.All the wounds gained primary healing.All patients were followed up 12-18 months（mean,14 months）.The numbness of ring finger,little finger,and the ulnar side of hand were decreased obviously on the first day after operation.The examination of electromyogram showed that the ulnar nerve conduction increased at 2 weeks,the amplitude was improved,and recruitment of the intrinsic muscles of hand enhanced.In 10 cases complicated by intrinsic muscle atrophy,myodynamia was recovered to the normal in 7 cases and was mostly recovered in 3 cases at 3 months after operation.The symptom of cubital tunnel syndrome disappeared and gained a normal function at 12 months after operation.According to the assessment of Chinese Medical Association and Lascar et al.grading criteria,the clinical results were excellent in 10 cases and good in 3;the excellent and good rate was 100%.Patients recovered to work 12-16 days（mean,14 days） after operation.No recurrence occurred during follow-up.Conclusion The surgical method of endoscope and microscope assisted three small incisions for treatment

关 键 词：肘管综合征 内窥镜 显微技术 尺神经松解术 尺神经前置术 微创技术 

分 类 号：R687.3[医药卫生—骨科学]