肘管综合征术后翻修的病因及疗效分析  

Etiology and curative effect of revision of cubital tunnel syndrome after operation

作　　者：苏登 熊敏 余晓军 李磊[1] 张旭林 SU Deng;XIONG Min;YU Xiaojun;LI Lei;ZHANG Xuin(Department of Orthopedics,Suining Central Hospital,Sichuan,Suining 629000,China;Outpatient Department,Suining Central Hospital,Sichuan,Suining 629000,China)

机构地区：[1]四川省遂宁市中心医院骨科,四川遂宁629000 [2]四川省遂宁市中心医院门诊部,四川遂宁629000

出　　处：《中国医药科学》2023年第22期179-182,共4页China Medicine And Pharmacy

基　　金：四川省医学科研课题(S19041)。

摘　　要：目的探讨肘管综合征术后翻修的病因,并评估肘管翻修术的临床疗效。方法选取2017年1月至2021年4月遂宁市中心医院骨科收治16例单侧肘管综合征术后复发患者,进行肘管翻修术。术中观察尺神经的卡压及走行情况,总结翻修手术的病因。术后随访10~22个月,平均(13.1±2.3)个月。测量翻修术前及术后肘段尺神经运动传导速度(MNCV)、小指远节指腹两点辨别觉(2-PD)、疼痛视觉模拟评分法(VAS)评分;采用顾玉东肘管综合征功能标准,评估翻修术后功能优良率。结果肘管综合征术后翻修的病因有:尺神经常见卡压点遗漏未完全解除(其中Struthers弓6例、内侧肌间隔5例、屈肌-旋前圆肌深层腱膜9例);尺神经周围瘢痕形成(11例);损伤前臂内侧皮神经,形成痛性神经瘤(7例);尺神经肌肉间前置术后继发卡压(3例);尺神经固定不稳,向后脱位回移致重新卡压(5例);尺神经原位松解术适应证选择不当(4例);缝线悬吊前置尺神经形成卡压(1例)。翻修术后尺神经MNCV、2-PD、VAS评分均有改善,差异有统计学意义(P<0.05)。术后功能优良率为75.0%。结论肘管综合征术后复发为多个因素同时存在所致。失败主要原因是遗漏尺神经卡压点的松解、尺神经周围瘢痕形成、损伤前臂内侧皮神经、手术适应证选择不当等。肘管翻修术后功能有明显改善。Objective To explore the causes of postoperative revision of cubital tunnel syndrome and evaluate the clinical efficacy of cubital tunnel revision surgery.Methods From January 2017 to April 2021,a total of 16 patients with recurrent unilateral cubital tunnel syndrome were admitted to the Department of Orthopaedics of Suining Central Hospital and underwent cubital tunnel revision surgery.The entrapment and routing of the ulnar nerve during surgery were observed,and the etiology of the revision surgery was summarized.The postoperative follow-up was 10-22 months,with an average of(13.1±2.3)months.The motor nerve conductive velocity(MNCV)of the ulnar nerve in the elbow segment before and after the revision surgery,2-point discrimination(2-PD)of the distal phalanx of the little finger,and visual analogue scale(VAS)for pain were measured;The functional criteria of cubital tunnel syndrome of Gu Yudong was used to evaluate the excellent and good rate of postoperative function after revision surgery.Results The causes of postoperative revision of cubital tunnel syndrome were as follows:the missing common entrapment points of the ulnar nerve were not completely relieved(including 6 cases of Struthers arch,5 cases of the medial muscular septum,9 cases of the deep aponeurosis of flexor-pronator teres).Scar formation around the ulnar nerve(11 cases).Injury of the medial cutaneous nerve of the forearm,resulting in painful neuroma(7 cases).Secondary entrapment after anterior transposition of the ulnar nerve muscles(3 cases).Unstable fixation of the ulnar nerve,resulting in posterior dislocation and re-entrapment(5 cases).Improper selection of indications for in situ release of the ulnar nerve(4 cases).Suture suspension caused entrapment of the anterior ulnar nerve(1 case).After revision surgery,the MNCV of the ulnar nerve,2-PD,and VAS score for pain all improved,with statistically significant differences(P<0.05).The excellent and good postoperative function rate was 75.0%.Conclusion Postoperative recurrence of cubital tunnel s

关 键 词：肘管综合征 并发症 翻修术 尺神经松解术 

分 类 号：R688[医药卫生—骨科学]