旋前方肌肌支移位治疗重度肘管综合征  

Motor branch of pronator quadratus transfer for treatment of severe cubital tunnel syndrome

作　　者：王立[1] 谢晴 吕莉[1] 段文旭[1] 王丰羽 邵新中[1] 张哲敏[1] Wang Li;Xie Qing;Lu Li;Duan Wenxu;Wang Fengyu;Shao Xinzhong;Zhang Zhemin(Department of Hand Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Hand Surgery,Longgang District Orthopedic Hospital Affiliated to Shenzhen University,Shenzhen 518172,China)

机构地区：[1]河北医科大学第三医院手外科,石家庄050051 [2]深圳大学附属龙岗区骨科医院手外科,深圳518172

出　　处：《中华手外科杂志》2022年第6期483-486,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨腕部正中神经旋前方肌肌支移位至尺神经深支联合肘部尺神经减压前置治疗重度肘管综合征的手术方法和临床疗效。方法自2013年1月至2016年10月,我院采用腕部正中神经旋前方肌肌支移位至尺神经深支联合肘部尺神经减压前置的方法,治疗47例重度肘管综合征患者:术中在肘部行尺神经减压+筋膜下前置,在前臂做5cm切口,将旋前方肌肌支端侧移位至尺神经深支。采用顾玉东肘管综合征评定标准评定术后功能恢复情况,评估患侧肘部尺神经传导速度、第一背侧骨间肌CMAP波幅,小指末节指腹两点分辨觉(2PD)及拇示指捏力。结果47例患者中45例获得随访,平均随访时间37.7个月。按顾玉东肘管综合征评定标准评定:优24例,良14例,可7例;优良率84.4%。术后24个月,肘部尺神经传导速度恢复为(45.05±7.21)m/s,第一骨间背肌CMAP波幅为(17.17±5.84)mV,小指末节指腹两点分辨觉恢复到(4.7±1.3)mm,拇示指捏力平均为对侧的(75.13±7.65)%。结果与术前相比差异均有统计学意义(P<0.01)。结论腕部正中神经旋前方肌肌支移位至尺神经深支联合肘部尺神经减压前置的方法治疗重度肘管综合征,有利于手内在肌的恢复,改善手功能。ObjectiveTTo investigate the surgical procedure and clinical efficacy of motor branch of pronator quadratus transfer to the deep branch of ulnar nerve combined with decompression and anterior subcutaneous transposition of the ulnar nerve for the treatment of severe cubital tunnel syndrome.Methods From January 2013 to October 2016,47 patients with serve cubital tunnel syndrome underwent motor branch of pronator quadratus transfer to the deep branch of ulnar nerve combined with decompression and anterior subcutaneous transposition of the ulnar nerve.The decompression and anterior subcutaneous transposition of the ulnar nerve were conducted at the elbow.A 5 cm incision was made in the forearm,and the motor branch of pronator quadratus was transferred to the deep branch of ulnar nerve with end-to-side nerve coaptation.The functional recovery after operation was evaluated by Gu Yudong cubital tunnel syndrome evaluation standard,and the conduction velocity of ulnar nerve at the affected elbow,CMAP amplitude of the first dorsal interosseous muscle,two-point discrimination of the distal phalanx pulp of the little finger and the pinch strength of the thumb and index finger were evaluated.ResultsForty-five cases of the 47 patients obtained follow-up,with an average follow-up time of 37.7 months.According to the evaluation standard of Gu Yudong cubital tunnel syndrome,the results rated as excellent in 24 cases,good in 14 cases,fair in 7 cases.The excellent and good rate was 84.4%.At 24 months after operation,the conduction velocity of ulnar nerve at elbow was restored to(45.05±7.21)m/s,the CMAP amplitude of the first dorsal interosseous muscle was(17.17±5.84)mV,the two-point discrimination of the distal phalanx pulp of the little finger was restored to(4.7±1.3)mm,and the average pinch strength of the thumb and index finger was(75.13±7.65)%of the healthy side.The results were statistically significant compared with those before surgery(P<0.01).ConclusionThe treatment of severe cubital tunnel syndrome by transferring the

关 键 词：肘管综合征 神经移位 旋前方肌肌支 神经端侧吻合 

分 类 号：R687.3[医药卫生—骨科学]