带血管蒂尺神经肌筋膜下前置术  

Vascularized ulnar nerve transposition under myofascia for cubital tunnel syndrome

作　　者：孙良智[1] 栾素娴[1] 苏保辉[1] 王瑞泓 刘伟强[1] 朱从浩 于明东[1] 姚汝瞻 SUN Liang-zhi;LUAN Su-xian;SU Bao-hui;WANG Rui-hong;LIU Wei-qiang;ZHU Cong-hao;YU Ming-dong;YAO Ru-zhan(Department of Orthopedics,People's Hospital of Weifang City,Weifang 261041,China)

机构地区：[1]潍坊市人民医院骨科,山东潍坊261041

出　　处：《中国矫形外科杂志》2023年第13期1228-1231,共4页Orthopedic Journal of China

摘　　要：[目的]介绍带血管蒂尺神经肌筋膜下前置术的手术技术和初步临床效果。[方法] 6例成人上肢标本,采用动脉红色乳胶灌注的方法,解剖后对神经伴行营养血管行长度测量,设计手术。20例轻度肘管综合征患者,分为两组,分别采用带血管蒂尺神经肌筋膜下前置术和传统前置术。带血管蒂组术中保护好尺神经及其伴行血管,将尺神经及其伴行血管移至肌筋膜下。[结果]所有患者手术均在30~45 min完成,切口均一期愈合。所有患者均获随访6个月以上,术后感觉和运动平均恢复时间为3.6个月,手内在肌平均恢复时间为4.2个月。术后6个月与术前神经电生理检测比较,两组感觉神经传导速度(sensory nerve conduction velocity, SCV)及运动神经传导速度(motor nerve conduction velocity, MCV)均显著改善(P<0.05)。术前两组间SCV和MCV的差异无统计学意义(P>0.05),术后6个月,带蒂组的SCV [(50.7±6.7) m/s vs (47.6±5.3) m/s, P=0.049]和MCV [(52.5±3.8) m/s vs(48.4±3.1) m/s, P<0.001]均显著优于传统组。[结论]带血管蒂尺神经肌筋膜下前置术的手术技术简单可行,可改善临床疗效。[Objective]To introduce the surgical technique and preliminary clinical results of vascularized ulnar nerve transposition un⁃der myofascia for cubital tunnel syndrome.[Methods]The nutritional vessels and the length of the ulnar nerve were measured on 6 adult up⁃per limbs with red latex perfusion in the artery,and then the operation was designed.A total of 20 patients with mild cubital tunnel syndrome were divided into two groups with 10 cases in each group.The patients in the two groups received vascularized ulnar nerve transposition un⁃der myofascia,or traditional ulnar nerve transposition,respectively.In the vascularized group,the ulnar nerve and its associated vessels were freed and protected during the operation,and the ulnar nerve with associated vessels were moved to the anterior position under myofascial.[Results]All the patients had operation performed in 30~45 min,with good incisions healing.All patients were followed up for more than 6 months,with a mean of recovery of sensation about 3.6 months,while a mean of recovery of hand muscle strength about 4.2 months.Regard⁃ing electrophysiological tests,the sensory nerve conduction velocity(SCV)and motor nerve conduction velocity(MCV)significantly im⁃proved in both groups 6 months postoperatively compared with those preoperatively(P<0.05).Although there was no significant difference in SCV and MCV between the two groups before surgery(P>0.05),the vascularized group proved significantly superior to the traditional group in terms of SCV[(50.7±6.7)m/s vs(47.6±5.3)m/s,P=0.049]and the MCV[(52.5±3.8)m/s vs(48.4±3.1)m/s,P<0.001].[Conclusion]The technique of vascularized ulnar nerve transposition under myofascia is simple and feasible,which can improve the clinical outcomes.

关 键 词：肘管综合征 尺神经 带血管蒂 肌筋膜 

分 类 号：R681.7[医药卫生—骨科学]