肘部单切口下二氧化碳灌注内窥镜辅助下尺神经松解及前置术  

Endoscope-asslsted cubital tunnel release and ulnar nerve anterior transposition under carbon dioxide inflation within one incision

作　　者：蒋苏[1] 邱彦群[2] 徐文东[1] 沈云东[1] 陆九州[1] 徐建光[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海200040 [2]上海市静安区中心医院复旦大学附属华山医院静安分院手及上肢外科

出　　处：《中华手外科杂志》2011年第5期266-268,共3页Chinese Journal of Hand Surgery

基　　金：卫生部临床学科重点课题资助项目（2007-66-6）,上海市周围神经显微外科重点实验室课题资助项目（08D22270600）

摘　　要：目的介绍一种在单个小切口下利用二氧化碳（CO2）气泵于肘部尺神经行经处创造气腔，在内窥镜辅助下彻底松解尺神经并前置的方法。方法2005年至2008年，对12例临床确诊为肘管综合征的患者在肘内侧做单个纵行小切口，利用气腹机在肘部皮下与前臂或臂部深筋膜之间产生的CO2气腔内，采用妒角内窥镜下行尺神经松解及屈肌筋膜下前置术。采用Dellon及改良Bishop评分系统进行手术前后评估。结果术前根据Dellon评分，12例肘管综合征中轻度5例、中度5例、重度2例。肘部手术切口长（15±3）mm，CO2气腔均成功建立，尺神经松解长度为（18±2）cm，内窥镜下的神经松解及筋膜下前置手术均顺利，整个手术持续时间为（30±5）min。术后所有患者的尺神经症状均较术前有改善，无并发症发生。随访时间为12—18个月，按改良Bishop评分：优10例（占83．3％），良2例（占16．7％）。结论肘部单个小切口下，CO2灌注产生的皮下气腔可以更好地暴露尺神经，结合内窥镜肘部尺神经松解及前置术减少了对神经分支及血供的损伤。该方法简单安全，创伤小，恢复快。Objective To describe the technique of endoscopic-assisted ulnar nerve decompression and subcutaneous anterior transposition within one incision using carbon dioxide inflation. Methods From 2005 to 2008, 8 male and 4 female patients with an average age of 42 years （range, 25 to 56 years） who presented signs, symptoms and abnormal neurophysiological studies of cubital tunnel syndrome （CUTS） were recruited in the study. They were operated on using a 0~ lens endoscope. A single longitudinal small incision was made at the medial side of tile elbow. CO： was pumped between the subcutaneous layer and deep fascia to create a cavity for ulnar nerve nettrolysis and anterior transposition. Preoperatively, the cases were classified according to the Dellon scale, and the Bishop rating system was used to evaluate the postoperative outcomes. Results Preoperatively, 5 patients were rated as mild CUTS, another 5 as moderate CUTS, and the rest 2 as severe CUTS. The average length of the incision was （ 15±3） mm. The mean length of endoscopically released ulnar nerve was （18±2） cm. The endoscopic assisted cubital tunnel release under carbon dioxide inflation and subcutaneous anterior transposition surgeries in all patients were performed with no difficulty. The entire procedure lasted （30 ± 5） minutes. All the patients had improvement of symptoms. There were no complications. Postoperative follow-up ranged from 12 to 18 months. Ten of 12 patients （83.3%） scored excellent and 2 patients （ 16.7% ） scored good based on the modified Bishop rating system. Conclusion Endoscope-assisted cubital tunnel release and anterior transpasition under carbon dioxide inflation demonstrated similar results compared to conventional open surgeries. Besides, it may avoid problems such as long incision, painful scarring and have additional advantages of providing an extended endoscopic view, which is safe and minimally invasive.

关 键 词：肘管综合征 内窥镜 尺神经 神经前置 

分 类 号：R687.3[医药卫生—骨科学]