单纯神经松解术与神经松解前置术治疗肘管综合征疗效的Meta分析  

Simple decompression versus anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome:A Meta-analysis

作　　者：肖万安[1] 王斌[1] 田峰[1] 田立杰[1] 

机构地区：[1]中国医科大学附属盛京医院手足显微外科,沈阳110004

出　　处：《中华临床医师杂志（电子版）》2013年第5期146-148,共3页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的应用Meta分析的方法,对单纯松解术(simpledecompression,SD)与神经前置术(anteri-ortransposition,AT)治疗肘管综合征的疗效差异进行评价,为临床选择适当术式提供依据。方法计算机检索Pubmed、EMBASE、Ovid、Cochrane图书馆和ClinicalTrials.gov网站数据库,检索相关的随机对照试验和回顾性对照研究,利用RevMan5.0软件进行异质性分析及Meta分析,绘制森林图。结果本文检索了1980～2012年间发表的591篇相关文献,经过筛选和评价,最后纳入9篇(共685例患者)随机对照试验和质量较高的回顾性对照研究,Meta分析显示SD和AT对术后肌电图运动神经传导速度[SMD=1.46,95%CI(-0.95,3.87),P=0.23]和术后优良率[RR=0.96,95%CI(-0.88,1.05),P=0.39]的影响没有差异,SD能降低术后并发症[RR=0.39,95%CI(0.22,0.68),P<0.01],两种疗法对中度以上肘管综合征患者术后评分的影响亦无差异[RR=1.09,95%CI(0.90,1.31),P=0.38]。结论对于单纯的肘管综合征,SD能降低术后并发症,是较AT更值得推荐的手术方法。Objective To evaluate the efficacy of simple decompression （SD）versus anterior transposition （AT） of the ulnar nerve in the treatment of cubital tunnel syndrome（CTS）,and provide the basis for clinical selection of proper operation method.Methods PubMed,EMBASE,Ovid,the Cochrane Central Register of Controlled Trials and database of Clinical Trials.gov were searched for randomized controlled studies and comparative studies comparing the effect of SD and AT of the ulnar nerve in CTS from January 1980 to January 2012.Included studies were assessed for quality and heterogeneity.RevMan 5.0 software was used for data analysis.Results 591 studies were retrieved for this paper.After screening and evaluation,nine studies involving 685 cases were identified in this analysis.There were no statistically significant difference between SD and AT in terms of the improvement of clinical scores[RR =0.96,95% CI（-0.88,1.05）,P =0.39],postoperative motor nerve-conduction velocities [SMD =1.46,95 % CI （-0.95,3.87）,P =0.23],and the improvement of clinical scores of medium and high-grade cases in CTS [RR =1.09,95% CI （0.90,1.31）,P =0.38].This Meta-analysis showed that compared with AT,SD could reduce the rate of complication[RR =0.39,95% CI（0.22,0.68）,P 〈0.01].Conclusions This report suggest that SD of the ulnar nerve is a reasonable alternative to AT for the surgical treatment of CTS.

关 键 词：肘管综合征 META分析 单纯松解术 神经前置术 

分 类 号：R687.3[医药卫生—骨科学]