带蒂筋膜瓣包裹尺神经的肘管扩大成形术治疗肘管综合征的临床疗效  

Clinical effect of expanded cubital tunnel plasty with pedicled fascial flap wrapping ulnar nerve in the treatment of cubital tunnel syndrome

作　　者：李强 宋辉 张成 LI Qiang;SONG Hui;ZHANG Cheng(Department of Orthopedics,The Orthopedics Hospital of Zibo City,Zibo,Shandong,255000,China)

机构地区：[1]淄博市骨科医院骨科,山东淄博255000 [2]淄博市职业病医院康复科,山东淄博255000

出　　处：《实用手外科杂志》2022年第4期477-479,共3页Journal of Practical Hand Surgery

摘　　要：目的探讨应用带蒂筋膜瓣包裹尺神经的肘管扩大成形术治疗肘管综合征的临床疗效。方法收集2016年9月-2020年8月应用带蒂筋膜瓣包裹尺神经的肘管扩大成形术治疗肘管综合征24例患者的临床资料。根据Dellon分级标准:中度8例,重度16例。术前根据患者的临床表现及辅助检查结果可以明确诊断,术后观察恢复情况。结果术后切口均一期愈合,无感染、皮肤坏死等并发症发生。对24例采取了门诊复查和电话随访的方式进行随访6个月~2年,平均(14.9±5.0)个月。术后第1天麻木症状较前明显缓解。术前小指末节指腹两点辨别觉为(8.3±2.7)mm,术后为(3.6±1.8)mm;术前肘部尺神经传导速度为(26.2±4.4)m/s,术后为(42.1±5.2)m/s。按顾玉东的肘管综合征功能评定标准评定:优13例,良8例,可3例,优良率87.5%。末次随访时,所有患者均未出现症状加重情况,无复发,手部爪形手畸形无明显加重,无需二次手术。结论应用带蒂筋膜瓣包裹尺神经的肘管扩大成形术治疗肘管综合征临床效果显著,带蒂筋膜瓣作为一个机械屏障,能够更好地对尺神经起到保护作用,操作简单,是一种可行的治疗方式。Objective To investigate the clinical effect of expanded cubital tunnel plasty with pedicled fascial flap wrapping ulnar nerve in the treatment of cubital tunnel syndrome.Methods From September 2016 to August 2020,24 patients with cubital tunnel syndrome treated by cubital tunnel expansion plasty with pedicled fascia flap wrapping ulnar nerve were collected.The diagnosis could be made clearly according to the clinical manifestations and auxiliary examination results before operation,and the postoperative recovery of the patients could be observed.Results The incision healed in one stage,and there were no complications such as infection and skin necrosis.24 patients were followed up for 6 months to 2 years,with an average follow-up of(14.9±5.0)months.The symptoms of numbness in the first day after operation were significantly relieved.The two-point discrimination of the distal segment of the little finger was(8.3±2.7)mm before operation and(3.6±1.8)mm after operation;the conduction velocity of ulnar nerve was(26.2±4.4)m/s before operation and(42.1±5.2)m/s after operation.According to Gu Yudong's functional evaluation standard of cubital tunnel syndrome,13 cases were excellent,8 cases were good and 3 cases were fair.The excellent and good rate was 87.5%.At the last follow-up,all patients had no aggravation of symptoms,no recurrence,no significant aggravation of claw hand deformity,and no surgical revision was required.Conclusion The expanded cubital tunnel plasty with pedicled fascia flap wrapping the ulnar nerve is effective in the treatment of cubital tunnel syndrome.As a mechanical barrier,pedicled fascia flap can better protect the ulnar nerve.The operation is simple and feasible.

关 键 词：带蒂筋膜瓣 肘管扩大成形术 肘管综合征 手术治疗 

分 类 号：R688[医药卫生—骨科学]