尺神经松解前置术治疗肘管综合征的临床疗效及预后的影响因素分析  

Clinical efficacy of ulnar nerve release anterior transposition on cubital tunnel syndrome and its influencing factors for prognosis

作　　者：张磊 王海林 刘旋 张凤军 ZHANG Lei;WANG Hai-lin;LIU Xuan;ZHANG Feng-jun(Department of Hand and Foot Surgery,Binzhou Second People’s Hospital,Binzhou Shandong 256800,China;Department of Vascular Surgery,Binzhou Second People’s Hospital,Binzhou Shandong 256800,China)

机构地区：[1]滨州市第二人民医院手足外科,山东滨州256800 [2]滨州市第二人民医院血管外科,山东滨州256800

出　　处：《局解手术学杂志》2021年第6期520-524,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探究尺神经松解前置术治疗肘管综合征的临床疗效及患者预后的影响因素。方法选取我院109例中重度肘管综合征患者,均行尺神经松解前置术治疗。术后随访18个月,比较治疗前后患者的上肢功能情况和相关临床资料,并进行单因素和多因素回归分析,构建Nomogram预测模型。结果术后手内肌萎缩、Tinel征阳性、夹纸试验阳性、Froment征阳性患者比例减少,手部握力、尺神经运动神经传导速度(MNCV)、潜伏期、波幅、两点分辨觉(2-PD)、上肢功能测定(DASH)评分等结果均有改善,差异有统计学意义(P<0.05)。多因素分析结果显示,年龄≥50岁、男性、病程≥6个月、长期屈肘工作、尺神经MNCV<35 m·s^(-1)、2-PD≥6 mm和DASH评分≥55分为肘管综合征患者预后不良的独立影响因素(P<0.05)。将以上因素纳入Nomogram预测模型,校正曲线显示该模型预测值与实际值有较高的一致性。结论尺神经松解前置术治疗中重度肘管综合征疗效显著,年龄、性别、病程、工作是否长时间屈肘、尺神经MNCV、2-PD、DASH评分是患者预后的独立影响因素。Objective To investigate the clinical efficacy of ulnar nerve release anterior transposition in the treatment of cubital tunnel syndrome and the factors influencing the prognosis of patients.Methods A total of 109 patients with moderate to severe cubital tunnel syndrome in our hospital were selected,and they all underwent ulnar nerve release anterior transposition.The patients were followed up for 18 months,the upper limb function and related clinical data of the patients before and after treatment were compared.Univariate and multivariate regression analysis were performed and the Nomogram prediction model was constructed.Results After operation,the proportion of patients with intra-hand muscle atrophy,Tinel sign positive,paper clamp test positive,and Froment sign positive was significantly reduced,and the hand grip strength,ulnar nerve motor nerve conduction velocity(MNCV),latency,wave amplitude,2-point discrimination(2-PD)and disabilities of the arm shoulder and hand(DASH)score were significantly improved,the differences were statistically significant(P<0.05).Multivariate analysis results showed that age≥50 years old,male,course of disease≥6 months,long-term elbow bend work,ulnar nerve MNCV<35 m·s^(-1),2-PD≥6 mm and DASH score≥55 point were the independent influencing factors for poor prognosis in patients with cubital tunnel syndrome(P<0.05).Incorporating the above factors into the Nomogram prediction model,the calibration curve showed that the predicted value of the model had a high consistency with the actual value.Conclusion The effect of ulnar nerve release anterior transposition in the treatment of moderate to severe cubital tunnel syndrome is significant.Age,gender,course of disease,whether the elbow bends at work for a long time,ulnar nerve MNCV,2-PD,and DASH score are the independent factors affecting the prognosis of patients.

关 键 词：肘管综合征 尺神经松解前置术 临床疗效 预后 影响因素 

分 类 号：R681.7[医药卫生—骨科学]