肘管综合征合并肘关节骨关节炎——尺神经皮下前移还是肌下前移?  

Cubital tunnel syndrome complicated with elbow osteoarthritis--subcutaneous or submuscular transposition of the ulnar nerve?

作　　者：王鹏飞[1,2] 梁文杰 姜亚兵 王骁 张万魁 赵天云 Wang Pengfei;Liang Wenjie;Jiang Yabing;Wang Xiao;Zhang Wankui;Zhao Tianyun(The First Clinical College,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Orthopedics,Department of Sports Medicine,The First Hospital of Tianshui City,Tianshui 741000,China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730000 [2]天水市第一人民医院骨科、运动医学科,天水741000

出　　处：《中华创伤骨科杂志》2024年第8期728-731,共4页Chinese Journal of Orthopaedic Trauma

基　　金：甘肃省民生科技项目(1603FCME013)。

摘　　要：关于肘管综合征(CuTS)的治疗,目前绝大多数外科医生采取尺神经松解、皮下前移的方式进行手术,当合并肘关节骨关节炎(EOA)时,临床发现尺神经皮下前移疗效欠佳且有着较高的复发率。EOA合并CuTS患者经保守治疗症状未缓解者,应早期选择适当术式手术治疗,不同术式前置尺神经得到的生理环境不同,导致预后不同,伴有EOA患者行皮下前移复发率更高。尺神经松解肌下前置,肘关节屈曲时可明显减小对神经的卡压成角,为尺神经提供更优越的生物环境,有利于受损神经的血管重建和神经再生,减少了形成尺神经二次卡压的机会,为尺神经提供了更佳解剖位置,具有更好的预后及更低的复发率。本文通过文献综述的方式对CuTS合并EOA患者的手术方式进行评估,为其治疗提供有用的参考意见。At present,most surgeons use release and subcutaneous transposition of the ulnar nerve to treat cubital tunnel syndrome(CuTS).However,subcutaneous transposition of the ulnar nerve is not effective enough and leads to a high rate of recurrence in clinic when CuTS is complicated with elbow osteoarthritis(EOA).Therefore,an appropriate surgical treatment should be adopted as early as possible if the symptoms are not relieved by a conservative treatment in cases of EOA complicated with CuTS.Different surgical methods lead to different physiological environments of the ulnar nerve,resulting in different outcomes.As a result,the recurrence rate of subcutaneous transposition motion is higher in patients with EOA.Surgical submuscular transposition of the ulnar nerve under the muscle significantly reduces its angular formation during elbow flexion,provides it with a more favorable biological environment and a better anatomical position,benefits the vascular reconstruction and regeneration of the injured nerve,and reduces its chance of secondary entrapment,leading to a better prognosis and a lower recurrence rate.This literature review evaluates the surgical methods for patients with CuTS plus EOA in an attempt to provide helpful references for their treatment.

关 键 词：肘管综合征 骨关节炎 尺神经 肘外翻 

分 类 号：R688[医药卫生—骨科学]