肱骨髁上短缩旋转楔形截骨联合尺神经原位松解术治疗创伤性肘外翻合并迟发性尺神经炎10例  

Combine supracondylar shortening rotary wedge osteotomy of humerus and ulnar nerve in situ release for traumatic cubitus valgus with ulnar nerve palsy:a report of 10 cases

作　　者：冉令强 李晓雅 范琛琛 RAN Lingqiang;LI Xiaoya;FAN Chenchen(Department of Emergency,Shandong Rehabilitation Hospital,Jinan,Shandong,250100,China)

机构地区：[1]山东省康复医院急诊科,山东济南250100 [2]山东省康复医院内科,山东济南250100

出　　处：《实用手外科杂志》2023年第3期384-388,共5页Journal of Practical Hand Surgery

摘　　要：目的探讨应用肱骨髁上短缩旋转楔形截骨联合尺神经原位松解治疗创伤性肘外翻合并迟发性尺神经炎的手术技术和疗效。方法回顾性分析2015年1月-2019年12月收治的10例创伤性肘外翻畸形合并迟发性尺神经炎患者病例资料。依据顾玉东推荐的肘管综合征分期标准:轻度3例,中度3例,重度4例。所有患者均行肱骨髁上短缩旋转楔形截骨联合尺神经原位松解术治疗。结果术后随访时间为12~36个月,平均24个月,10例均达到骨性愈合。术后末次随访小指两点辨别觉(4.1±1.4)mm;握力(23.6±8.9)kg;提携角11.7°±4.5°;肘关节屈曲活动度116.4°±11.6°,各项指标手术前后差异具有统计学意义(P<0.05)。术后按Yokohama City University尺神经炎评分标准,改善率85%,肘关节功能评定按HSS评分系统进行评定,优良率90%。结论采用肱骨髁上短缩旋转楔形截骨术治疗创伤性肘外翻畸形外观的同时,恢复了肘关节正常生物力学;联合尺神经原位松解术治疗创伤性肘外翻合并的迟发性尺神经炎是一种可同时矫正肘关节旋转畸形、符合解剖学特点、对患者创伤小且疗效满意的联合术式。Objective To investigate the surgical technique and effect of supracondylar shortening rotary wedge osteotomy of humerus combined with in situ release of ulnar nerve in the treatment of lated ulnar nerve palsy caused by traumatic cubitus valgus.Methods Retrospective analysis:from January 2015 to December 2019,10 patients with severe cubitus valgus combined with lated ulnar nerve palsy were admitted to our department.According to the staging standard of cubital tunnel syndrome recommended by Gu Yudong:mild in 3 cases,moderate in 3 cases and severe in 4 cases.All patients were treated with Supracondylar shortening rotary wedge osteotomy of humerus combined with ulnar nerve in situ release.Results The follow-up time was 12~36 months,with an average of 24 months.All 10 patients achieved bone healing.At the last follow-up,the two-point discrimination of little finger was(4.1±1.4)mm;Grip strength(23.6±8.9)kg;Humerus-elbow-wrist(HEW)angle 11.7°±4.5°;The postoperative elbow flexion range of motion was 116.4°±11.6°,and the difference of various indexes before and after operation was statistically significant(P<0.05).According to the scoring standard of ulnar neuritis of Yokohama City University,the improvement rate was 85%;The elbow function was evaluated according to HSS scoring system,and the excellent and good rate was 90%.Conclusion The supracondylar rotation shortening wedge osteotomy of humerus was used to treat traumatic cubitus valgus deformity,and the normal biomechanical characteristics of the affected elbow joint were restored;Combined with ulnar nerve in situ release in the treatment of lated ulnar nerve palsy caused by traumatic cubitus valgus deformity is a combined operation that can correct elbow rotation deformity,restore anatomical characteristics,have less trauma and satisfactory curative effect.

关 键 词：肘外翻 尺神经炎 短缩 旋转 楔形截骨 原位松解 

分 类 号：R687.3[医药卫生—骨科学]