CAJ | 학술논문

目的探讨尺神经松解肌下前置肱骨内上髁肌群经骨道原位重建治疗中、重度肘管综合征的疗效.方法对2005年1月至2012年10月确诊的45例中、重度肘管综合征患者临床资料进行分析.术中显微镜视下观察尺侧上副动脉对尺神经的灌注情况,直视下行肱骨内上髁肌群经骨道原位重建,观察新的尺神经隧道大小、尺神经活动度.术后随访观察患者恢复情况.结果 45例经过6～18个月的随访,术中显微镜视下观察到尺侧上副动脉对前置尺神经保持良好的灌注,术中肱骨内上髁肌群经骨道原位重建,固定牢固确切,新肘管隧道肘关节伸直位可无张力通过直径8mm的扩张器,屈伸活动时尺神经移动度良好.术后恢复情况采用顾玉东建议的肘管综合征功能评定标准评定:优20例,良17例,可8例;优良率为82.22％.所有患者术后3个月屈腕、旋前肌力均恢复至术前水平.结论尺侧上副动脉的伴行前置使尺神经在前置后获得良好的血供,这有利于神经功能的恢复.同时尺神经肌下前置术并且肱骨内上髁肌群经骨道原位重建,将尺神经前置于尺侧腕屈肌、旋前圆肌下,新肘管隧道足够大,对神经无卡压,周围组织疏松,能较好地解决尺神经肘部受压及屈肘受牵拉等问题.经骨道原位固定牢固、确切,术后无需石膏固定,可早期进行保护性活动,尽早恢复正常生活与工作.
목적 탐토척신경송해기하전치굉골내상과기군경골도원위중건치료중、중도주관종합정적료효.방법 대2005년1월지2012년10월학진적45례중、중도주관종합정환자림상자료진행분석.술중현미경시하관찰척측상부동맥대척신경적관주정황,직시하행굉골내상과기군경골도원위중건,관찰신적척신경수도대소、척신경활동도.술후수방관찰환자회복정황.결과 45례경과6～18개월적수방,술중현미경시하관찰도척측상부동맥대전치척신경보지량호적관주,술중굉골내상과기군경골도원위중건,고정뢰고학절,신주관수도주관절신직위가무장력통과직경8mm적확장기,굴신활동시척신경이동도량호.술후회복정황채용고옥동건의적주관종합정공능평정표준평정:우20례,량17례,가8례;우량솔위82.22％.소유환자술후3개월굴완、선전기력균회복지술전수평.결론 척측상부동맥적반행전치사척신경재전치후획득량호적혈공,저유리우신경공능적회복.동시척신경기하전치술병차굉골내상과기군경골도원위중건,장척신경전치우척측완굴기、선전원기하,신주관수도족구대,대신경무잡압,주위조직소송,능교호지해결척신경주부수압급굴주수견랍등문제.경골도원위고정뢰고、학절,술후무수석고고정,가조기진행보호성활동,진조회복정상생활여공작.
Objective To investigate the clinical effectiveness of treating moderate to severe cubital tunnel syndrome with ulnar nerve decompression,anterior submuscular transposition and medial epicondyle muscle group in situ reconstruction via a bone tunnel.Methods The clinical data of 45 cases of moderate to severe cubital tunnel syndrome diagnosed between January 2005 and October 2012 were analyzed.The ulnar nerve was decompressed and its perfnsion by the superior ulnar collateral artery was observed under the surgical microscope intraoperatively.After ulnar nerve was transposed anteriorly,the detached medial epicondyle muscle group was reconstructed in situ through a bone tuunel under direct view.The size of the new ulnar nerve tunnel and mobility of the ulnar nerve were observed.Postoperative recovery was follow-up including pain,sensation,muscular atrophy recovery,claw hand,grip strength,wrist flexion and forearm pronation.Results All 45 cases were follow-up for 6 to 18 months.Intraoperative microscopic observation showed good ulnar nerve perfusion by the superior ulnar collateral artery.Reattachment of the medial epicondyle muscle group was secure.The newly formed cubital tunnel could allow an 8 mm dilator without tension in elbow full extension position.Ulnar nerve could glide freely upon elbow flexion and extension.According to the cubital tunnel syndrome function evaluation standard suggested by Gu Yudong,the results were graded as excellent in 20 cases,good in 17 cases,and fair in 8 cases.The overall excellent and good rate was 82.22％.Wrist flexion and forearm pronation force recovered to preoperative level in all the patients 3 months after the operation.Conclusion Including superior ulnar collateral artery in the anterior transposition of the ulnar nerve provides good blood supply to the nerve and benefits nerve recovery.In situ reconstruction of the medial epicondyle muscle group through a bone tunnel puts the ulnar nerve anderneath flexor carpi ulnaris and pronator teres.The new tunnel is big enough to avoid compression of the nerve.The surrounding tissues are loose so there will be neither ulnar nerve compression around the elbow nor nerve stretch upon elbow flexion.Muscle reattachment via a bone tunnel is secure.No postoperative elbow immobilization with a cast is needed.This allows early protected movement and early return to normal life and work.