半开放手术松解治疗肘管综合征合并肘关节骨性关节炎35例  

Semi-open Surgical Release in the Treatment of Cubital Tunnel Syndrome Combined With Elbow Osteoarthritis: Report of 35 Cases

作　　者：李海滨[1] 王铭[1] 代娟[1] 邓广明 付洪睿 厚艳芳 马艳 刘会欣[1] Li Haibin;Wang Ming;Dai Juan(Department of Osteoarthrosis,Qingxian People’s Hospital,Qingxian 062650,China)

机构地区：[1]河北省青县人民医院骨关节科,青县062650

出　　处：《中国微创外科杂志》2022年第11期888-892,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨半开放手术松解治疗肘管综合征合并肘关节骨性关节炎(osteoarthritis,OA)的临床疗效。方法2017年1月~2021年2月我科采取关节镜结合内侧切开松解尺神经前置的半开放手术治疗35例肘管综合征合并肘关节OA。关节镜下探查并清理关节内骨赘,切除挛缩的关节囊,切开直视下切除尺骨鹰嘴后内侧骨赘,同时进行尺神经松解前置处理。采用Mayo肘关节功能评分(Mayo Elbow Performance Score,MEPS)、疼痛视觉模拟评分(Visual Analogue Scale,VAS)及尺神经功能定量评定标准评价疗效。结果35例随访12~30个月,平均17.3月,无异位骨化、肘关节失稳等。MEPS由术前(64.6±15.3)分提高到术后6个月(89.4±10.5)分(P=0.000),术后12个月(90.4±9.3)分(P=0.000)。VAS由术前中位数3.0分降至术后6个月1.0分和12个月0分(χ^(2)=66.865,P=0.000)。肘关节活动范围由术前72.3°±17.7°提高至术后6个月113.5°±9.0°和术后12个月114.3°±10.0°(均P=0.000)。术后6个月尺神经功能优9例,良24例,可2例;术后12个月尺神经功能优20例,良15例。术后6、12个月尺神经功能评分由术前(4.6±1.5)分显著提高至(10.7±2.0)、(12.8±1.8)分(均P=0.000),术后12个月明显高于术后6个月(P=0.000)。结论半开放式手术松解治疗肘管综合征合并肘关节OA同时解决尺神经卡压和肘关节僵硬,效果满意。Objective To investigate the clinical application and effect of semi-open surgical release in the treatment of cubital tunnel syndrome combined with elbow osteoarthritis.Methods From January 2017 to February 2021,35 patients with cubital tunnel syndrome combined with elbow osteoarthritis were treated by arthroscopy combined with medial incision to release the anterior ulnar nerve.The osteophytes in the joint were explored and cleaned under arthroscope,the contracture joint capsule was removed,the osteophyte on the posterior medial side of olecranon of ulna was cut under direct vision,and the ulnar nerve was released at the same time.Mayo Elbow Performance Score(MEPS),Visual Analogue Scale(VAS)and quantitative functional assessment criteria of cubital tunnel syndrome were used to evaluate the efficacy.Results All the 35 patients were followed up for 12-30 months,with an average of 17.3 months.There were no heterotopic ossification,elbow instability or other complications.The MEPS increased from(64.6±15.3)points preoperatively to(89.4±10.5)points at 6 months(P=0.000)and(90.4±9.3)points at 12 months postoperatively(P=0.000).The median VAS decreased from 3.0 points preoperatively to 1.0 point at 6 months and 0 point at 12 months postoperatively(χ^(2)=66.865,P=0.000).The range of motion of elbow was significantly improved from 72.3°±17.7°preoperatively to 113.5°±9.0°at 6 months and 114.3°±10.0°at 12 months postoperatively(all P=0.000).The ulnar nerve function was excellent in 9 cases,good in 24 cases and fair in 2 cases at 6 months after operation,and was excellent in 20 cases and good in 15 cases at 12 months after operation.The ulnar nerve function scores increased from(4.6±1.5)points preoperatively to(10.7±2.0)points at 6 months and(12.8±1.8)points at 12 months postoperatively(all P=0.000),with scores at 12 months after operation being significantly higher than 6 months after operation(P=0.000).Conclusion The semi-open surgical release for cubital tunnel syndrome combined with elbow osteoarthritis s

关 键 词：肘管综合征 肘关节骨性关节炎 尺神经松解 关节松解 

分 类 号：R688[医药卫生—骨科学] R684.3[医药卫生—外科学]