CAJ | 학술논문

目的评价带血管尺神经筋膜下前置术治疗重度肘管综合征的疗效.方法对5例成人尸体上肢标本进行解剖学研究,观察尺神经在肘部的血液供应来源,测量尺神经的营养血管与神经伴行的长度.对38例重度肘管综合征患者,随机分为两组,分别采用带血管尺神经筋膜下前置术和单纯筋膜下前置术,参照中华医学会手外科学会上肢部分功能评定试用标准Lascar分级法和神经电生理测定,对患者的疗效进行评价比较.结果解剖测量尺神经的营养血管与神经伴行长度:3条动脉伴神经走行的长度分别为尺侧上副动脉(145.0±4.3)mm,尺侧下副动脉(48.6±8.2)mm,尺侧返动脉后支(65.2±9.3)mm.带血管尺神经筋膜下前置术优良率为89.5％,单纯筋膜下前置术优良率为68.4％,两组比较差异有统计学意义.神经电生理检查:不带血管组术前运动神经传导速度(MNCV)平均为(23.3±3.6)m/s,术后(37.5±5.2)m/s;带血管组术前MNCV平均为(22.3±4.4)m/s,术后(45.2±6.0)m/s;两组比较差异有统计学意义.结论带血管尺神经筋膜下前置术疗效可靠,方法简便,是治疗重度肘管综合征的有效方法.
목적 평개대혈관척신경근막하전치술치료중도주관종합정적료효.방법 대5례성인시체상지표본진행해부학연구,관찰척신경재주부적혈액공응래원,측량척신경적영양혈관여신경반행적장도.대38례중도주관종합정환자,수궤분위량조,분별채용대혈관척신경근막하전치술화단순근막하전치술,삼조중화의학회수외과학회상지부분공능평정시용표준Lascar분급법화신경전생리측정,대환자적료효진행평개비교.결과 해부측량척신경적영양혈관여신경반행장도:3조동맥반신경주행적장도분별위척측상부동맥(145.0±4.3)mm,척측하부동맥(48.6±8.2)mm,척측반동맥후지(65.2±9.3)mm.대혈관척신경근막하전치술우량솔위89.5％,단순근막하전치술우량솔위68.4％,량조비교차이유통계학의의.신경전생리검사:불대혈관조술전운동신경전도속도(MNCV)평균위(23.3±3.6)m/s,술후(37.5±5.2)m/s;대혈관조술전MNCV평균위(22.3±4.4)m/s,술후(45.2±6.0)m/s;량조비교차이유통계학의의.결론 대혈관척신경근막하전치술료효가고,방법간편,시치료중도주관종합정적유효방법.
Objective To evaluate the effect of vascularized ulnar nerve sub-fascial transposition in the treatment of severe cubital tunnel syndrome.Methods Anatomical dissection of 5 embalmed adult upper limb cadaver specimens was carried out to observe the blood supply of the ulnar nerve around the elbow.The accompanying length of its feeding vessels was measured.Thirty-eight cases of severe cubital tunnel syndrome were divided into two groups.In group 1 the ulnar nerve was transposed under the fascia with its feeding blood vessel.In group 2 the ulnar nerve was transposed without the blood vessel.The treatment effect was evaluated using the upper limb function evaluation criteria issued by the Chinese Medical Association,the Lascar classification method and electmphysiologic studies.Results Them were 3 vessels that accompany the ulnar nerve around the elbow.The length of the vessel accompanying the ulnar nerve was (145.0 ± 4.3) mm for superior ulnar collateral artery,(48.6 ± 8.2) mm for inferior ulnar collateral artery,and (65.2 ± 9.3) mm for the posterior branch of ulnar recurrent artery.The excellent and good rate was 89.5％ in group 1 and 68.4％ in group 2.The difference was statistically significant.Nerve conduction study showed an increase in motor nerve conduction velocity (MNCV) from (22.3 ± 4.4) m/s preoperatively to (45.2 ± 6.0) m/s postoperatively in group 1,and from (23.3 ± 3.6) m/s preoperatively to (37.5 ± 5.2) m/s postoperatively in group 2.The difference between the two groups was statistically significant.Conclusion Vascularized ulnar nerve subfascial transposition is a reliable treatment for severe cubital tunnel syndrome.The surgical procedure is simple and effective