屈肌-旋前圆肌起点筋膜悬吊与皮下前置术治疗重度肘管综合征  

A randomized controlled trial on the treatment of severe cubital tunnel syndrome with flexor-pronator teres origin fascial sling and anterior subcutaneous transposition of ulnar nerve

作　　者：庞波涛 张天怡 邓志洋 李雪城 张成年 马信龙[1] Pang Botao;Zhang Tianyi;Deng Zhiyang;Li Xuecheng;Zhang Chengnian;Ma Xinlong(Tianjin Medical University Orthopaedic Clinical College(Tianjin Hospital),Tianjin 300221,China;Binzhou Medical University Hospital,Binzhou 256603,China)

机构地区：[1]天津医科大学骨科临床学院(天津市天津医院),天津300221 [2]滨州医学院附属医院,滨州256603

出　　处：《中华骨科杂志》2024年第24期1581-1587,共7页Chinese Journal of Orthopaedics

基　　金：滨州医学院科技计划项目(BY2021KJ38)。

摘　　要：目的探讨屈肌-旋前圆肌起点筋膜悬吊与皮下前置术治疗重度肘管综合征的临床效果。方法前瞻性收集2021年12月至2022年2月共30例于滨州医学院附属医院手术治疗重度肘管综合征患者的资料。应用随机抽签法分为:筋膜悬吊组15例,采用尺神经松解后筋膜悬吊的方法前置尺神经,男11例、女4例,平均年龄为59岁(范围51~73岁);皮下前置组15例,采用尺神经松解后皮下前置尺神经,男10例、女5例,平均年龄为56岁(范围41~72岁)。记录两组手术时间、术中出血量及切口并发症;术后6、12、24个月测量患肢小指动态两点辨别觉及握力,并比较两组术后改善情况;术后24个月进行功能评定、调查患者满意度,并进行组间比较。结果筋膜悬吊组手术时间为(46.80±1.86)min,长于皮下前置组的(43.87±2.00)min,差异有统计学意义(t=4.166,P<0.001);筋膜悬吊组术中出血量为(3.53±0.52)ml,多于皮下前置组的(2.53±0.52)ml,差异有统计学意义(t=5.303,P<0.001);两组均无未发生切口并发症。筋膜悬吊组术后6、12、24个月患肢小指动态两点辨别觉分别为(5.87±1.41)、(4.27±1.16)、(3.13±1.06)mm,皮下前置组分别为(5.73±1.98)、(4.40±1.45)、(3.20±1.15)mm,差异均无统计学意义(P>0.05)。筋膜悬吊组术后6、12个月患肢握力分别为(24.62±4.94)、(25.88±4.72)kg,皮下前置组分别为(21.94±3.76)、(23.62±4.00)kg,差异均无统计学意义(P>0.05);筋膜悬吊组术后24个月患肢握力优于皮下前置组[(27.58±4.92)kg和(23.62±4.00)kg],差异有统计学意义(t=2.425,P=0.033)。筋膜悬吊组术后24个月功能评定为优4例、良8例、可3例;皮下前置组优3例、良8例、可4例。筋膜悬吊组中1例对功能改善不满意;皮下前置组中4例因术区明显不适感同时合并功能改善不满意。结论治疗重度肘管综合征,屈肌-旋前圆肌起点筋膜悬吊在技术上容易实现,且术后患肢握力的改善及患者满意度更优于皮下Objective To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods 30 patients with severe cubital tunnel syndrome were prospectively enrolled,who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022.Randomized drawing divided the patients into two groups:the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group.In the fascial sling group,there were 11 males and 4 females,with an average age of 59 years(range 51-73 years),who underwent fascial suspension after ulnar nerve decompression.In the anterior subcutaneous transposition group,there were 10 males and 5 females,with an average age of 56 years(range 41-72 years),who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression.The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6,12,and 24 months postoperatively.The postoperative improvement between the two groups were compared.Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results Neither groups had incision-related complications.The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group(46.80±1.86 min and 43.87±2.00 min)with significant difference(t=4.166,P<0.001).Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group(3.53±0.52 ml and 2.53±0.52 ml)with significant difference(t=5.303,P<0.001).No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6,12,and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group(5.87±1.41 mm,4.27±1.16 mm,3.13±1.06 mm an

关 键 词：肘管综合征 尺神经 随机对照试验 筋膜悬吊 皮下前置 

分 类 号：R65[医药卫生—外科学]