前内侧入路与后内侧入路尺神经松解前置术治疗肘管综合征的对比研究  

A retrospective trial of ulnar nerve neurolysis and anterior transposition through anteromedial approach versus posteromedial approach for treatment of cubital tunnel syndrome

作　　者：靳国强 赵蕾 韩宗昌 孟宪杰 JIN Guoqiang;ZHAO Lei;HAN Zongchang;MENG Xianjie(Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China)

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院

出　　处：《中医正骨》2019年第8期20-24,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教发[2014]20号)

摘　　要：目的:比较前内侧入路与后内侧入路尺神经松解前置术治疗肘管综合征的临床疗效及安全性。方法:回顾性分析46例肘管综合征患者的病例资料,其中采用前内侧入路尺神经松解前置术治疗24例(前内侧入路组),采用后内侧入路尺神经松解前置术治疗22例(后内侧入路组)。男39例,女7例。年龄45~68岁,中位数55岁。左侧21例,右侧25例。按照肘管综合征的Dellon分级标准,中度31例、重度15例。病程6~25个月,中位数13个月。比较2组患者的手术时间、切口长度、小指指腹两点辨别觉、患手握力及术后并发症发生情况。结果:前内侧入路组的手术时间与后内侧入路组比较,差异无统计学意义[(33.5±5.8)min,(33.8±4.7)min,t=0.609,P=0.546];切口长度短于后内侧入路组[(10.0±1.8)cm,(13.0±1.9)cm,t=3.872,P=0.007]。所有患者均获随访,随访时间25~37个月,中位数29个月。所有患者切口均愈合。术前2组患者的小指指腹两点辨别觉比较,差异无统计学意义(t=-0.205,P=0.838);末次随访时,2组患者的小指指腹两点辨别觉均较术前改善[(8.7±1.2)mm,(5.2±0.8)mm,t=11.190,P=0.000;(8.9±1.1)mm,(5.3±0.7)mm,t=14.674,P=0.000];2组末次随访时的小指指腹两点辨别觉比较,差异无统计学意义(t=-0.206,P=0.837)。术前2组患者的患手握力比较,差异无统计学意义(t=-1.941,P=0.060);末次随访时,2组患者的患手握力均较术前增强[(21.6±3.0)N,(31.5±2.7)N,t=-16.237,P=0.000;(21.7±2.8)N,(30.9±2.9)N,t=-11.413,P=0.000];2组末次随访时的患手握力比较,差异无统计学意义(t=1.647,P=0.107)。前内侧入路组,1例出现切口周围皮肤麻木,未进行特殊治疗,自行缓解;1例出现切口周围瘢痕组织增生,采用自粘性软聚硅酮敷料贴敷后改善。后内侧入路组,1例出现肘部和前臂背侧疼痛,采用营养神经药物治疗后改善;1例出现切口周围瘢痕组织增生,采用自粘性软聚硅酮敷料贴敷后改善。2组患者并发症发生Objective:To compare the clinical curative effects and safety of ulnar nerve neurolysis and anterior transposition through anteromedial approach versus posteromedial approach for treatment of cubital tunnel syndrome(CTS).Methods:The medical records of 46 patients with CTS were analyzed retrospectively.Twenty-four patients were treated with ulnar nerve neurolysis and anterior transposition through anteromedial approach(anteromedial approach group),while the others were treated with ulnar nerve neurolysis and anterior trans-position through posteromedial approach(posteromedial approach group).The patients consisted of 39 males and 7 females,and ranged in age from 45 to 68 years(Median=55 yrs)and in disease course from 6 to 25 months(Median=13 months).The CTS located at left elbow for 21 patients and right elbow for 25 patients.According to Dellon classification criteria,the CTS belonged to moderate-grade(31)and se-vere-grade(15).The operative time,incision length,two-point discrimination(2PD)in pulp of little finger,hand grip strength of affected side and postoperative complications were recorded and compared between the 2 groups respectively.Results:There was no statistical differ-ence in operative time between anteromedial approach group and posteromedial approach group(33.5+/-5.8 vs 33.8+/-4.7 min,t=0.609,P=0.546).The incision lengths were shorter in anteromedial approach group compared to posteromedial approach group(10.0+/-1.8 vs 13.0+/-1.9 cm,t=3.872,P=0.007).All patients in the 2 groups were followed up for 25-37 months with a median of 29 months and the operative incisions healed in all patients.There was no statistical difference in 2PD in pulp of little finger between the 2 groups before the surgery(t=-0.205,P=0.838).The 2PD in pulp of little finger was improved at the last follow-up compared to pre-surgery(8.7+/-1.2 vs 5.2+/-0.8 mm,t=11.190,P=0.000;8.9+/-1.1 vs 5.3+/-0.7 mm,t=14.674,P=0.000).There was no statisti-cal difference in 2PD in pulp of little finger between the 2 groups at the last follow-up(t=

关 键 词：肘管综合征 尺神经 手术入路 临床试验 

分 类 号：R47[医药卫生—护理学]