内窥镜治疗肘管综合征  

Treatment of cubital tunnel syndrome by endoscope

作　　者：史其林[1] 官士兵[1] 余学东[2] 孙贵新[1] 顾玉东[1] 

机构地区：[1]复旦大学华山医院手外科,上海200040 [2]重庆医科大学附属第一医院手外科

出　　处：《中华手外科杂志》2003年第3期159-161,共3页Chinese Journal of Hand Surgery

基　　金：上海市医学领先学科基金 (9930 1 5);美国中华医学基金资助项目 (MB95-61 9)

摘　　要：目的　探讨应用小切口内窥镜下作尺神经松解术治疗肘管综合征的经验和方法。方法　切口 :单纯尺神经松解术 ,沿尺神经沟作 1cm直切口 ;尺神经松解 +内上髁切除术 ,沿尺神经沟作 3cm直切口。直视下切开肘管 ,显露尺神经 ,在圆筒状透明闭锁外套管内窥镜引导下 ,用推刀沿外套管沟槽切断屈肌 旋前肌深腱膜 (deepflexor pronatoraponeurosis)和Struthers弓 ,肱骨内上髁远近端各松解减压达 10cm。术后第 2天开始肘关节即可作伸屈活动。结果　 12例患者于术后随访 3～ 2 7个月 ,以最后 1次随访结果为准。肘部瘢痕小 ,术后半年环、小指感觉恢复正常 ,无 1例复发。结论　本术式安全、简单 ,操作方便 ,皮肤切口小 ,组织创伤轻 ,术后平均 10d即恢复日常工作。Objective To introduce our methods and experiences of ulnar nerve neurolysis for treatment of cubital tunnel syndrome under the endoscope using small incision. Methods For simple neurolysis of ulnar nerve, a straight incision 1 cm in length was made along the groove of the ulnar nerve. For the neurolysis and the medial epicondylectomy, an incision 3 cm in length was made along the groove of the ulnar nerve. The cubital tunnel was transected under direct vision and the ulnar nerve was exposed. Under the guide of cylinder-shape transparent closed external tube endoscope, the deep flexor-pronator aponeurosis and Struthers arch were transected using pushing knife along with the groove of the external tube. The neurolysis was done 10 cm distal and proximal to the medial epicondyle assisted by endoscope. The patients were allowed to move the elbow joint one day after surgery. Results Twelve cases were followed up for 3-27 months(mean 18 months)after operation. The last follow-up showed small scar at the elbow joint. Normal sensation at the ring and small finger occurred half a year postoperatively without recurrence. Conclusion The procedure has advantage of safety, simpleness, convenient manipulation, small incision, gentle tissue trauma. Patients can return to work or activities of daily living 10 days after operation.

关 键 词：内窥镜 外科治疗 肘管综合征 小切口 尺神经松解术 

分 类 号：R687[医药卫生—骨科学]