肘管扩大成形术治疗肘关节炎性肘管综合征

[目的]对于肘关节炎性病变引起继发性尺神经卡压,减少尺神经前移引起的尺神经分支损伤、血运破坏等并发症,恢复和保持肘管内尺神经的解剖位置。[方法]肘关节骨性关节炎引起肘管综合征中重度患者26例,采用肘管扩大成形术治疗肘管综合征。[结果]根据患者临床症状中度患者12例,重度患者14例。术后随访26例患者临床症状均明显改善,其中效果显著20例,有效5例,无效1例,满意率为76.92%。[结论]肘管扩大成形术能有效治疗肘关节炎性肘管综合征,且对中重度患者均有良好效果。     

肘管综合征原位松解手术中关于尺神经卡压部位的探讨

目的探讨肘管综合征原位松解手术中尺神经的卡压部位并评估治疗效果。方法 2017年1月-2019年1月,采用尺神经原位松解术治疗肘管综合征22例,术前全部经神经肌电图证实,所有病例行尺神经原位松解术,根据术中探查情况,分析尺神经卡压部位。结果术中发现造成肘部尺神经卡压部位中Osborne韧带卡压10例,肘关节腱鞘囊肿卡压7例,被尺侧腕屈肌两头之间腱性组织卡压5例。尺神经功能(主要是感觉)在术后均有显著改善。结论肘管综合征行尺神经原位松解手术中,造成尺神经卡压的部位主要有Osborne韧带、腱鞘囊肿和尺侧腕屈肌两头之间腱性组织。找到尺神经卡压点并予以处理对尺神经原位松解手术的效果至关重要。     

尺神经沟扩大成形尺神经松解术治疗肘管综合征

目的探讨肘管综合征的病因、尺神经沟扩大成形松解术的疗效及对肘关节功能的影响。方法对60例肘管综合征的病因、尺神经沟扩大成形手术所见和随访结果进行分析。结果创伤性肘关节炎、尺神经沟变浅、肘外翻畸形、尺神经滑脱、肘管内占位等是肘管综合征的主要致病因素,尺神经沟扩大成形治疗肘管综合征疗效好,肘关节功能正常。结论创伤性肘关节炎、尺神经沟变浅、肘外翻畸形、尺神经滑脱是尺神经沟扩大成形松解术治疗肘管综合综合征的适应征。尺神经沟扩大成形治疗肘管综合征方法可靠,对肘关节功能无影响。     

关节清理成形尺神经松解前置术治疗中重度肘关节骨关节炎伴肘管综合征

目的探讨中重度肘关节骨关节炎伴肘管综合征的手术治疗方法与临床效果。方法 2007年2月-2016年2月,对48例中重度肘关节骨关节炎伴肘管综合征患者采用关节松解清理成形、尺神经松解皮下前置术治疗。手术取肘关节后内侧入路或联合外侧入路,清除增生骨赘,切除增生滑膜,取出关节腔内的游离体,用磨钻打磨做鹰嘴窝、冠状突窝及桡骨头窝成形,并行尺神经松解皮下前置术治疗,术后10～14 d在支具保护下行肘关节主被动伸屈及前臂旋转功能康复训练。结果术后48例随访1～8年,平均3.5年,肘关节屈伸活动度由术前平均37°至术后115°;参照Mayo肘关节功能评分标准,优良率为93.7%;采用疼痛视觉模拟评分(VAS),疼痛由术前平均5.0分改善至0.5分;电生理检查尺神经传导速度及体感诱发电位均明显恢复;采用顾玉东肘管综合征功能评定标准评价,优20例,良27例,可1例。所有病例术后疼痛获得了长期缓解,肘关节活动度得到了明显改善。结论肘关节清理成形尺神经松解皮下前置术可以改善肘关节活动度,缓解神经卡压症状,但远期随访肘关节活动范围随着活动强度的增加仍会有继发性的部分丧失。     

尺神经沟扩大神经束间松解治疗重度肘管综合征临床研究

目的 总结尺神经沟扩大显微镜下神经束间松解术及尺神经前移显微镜下神经束间松解术治疗重度肘管综合征的疗效. 方法 2002年12月-2007年1月,采用尺神经沟扩大显微镜下神经束间松解治疗22例重度肘管综合征患者(治疗组),与2001年7月-2004年11月,采用尺神经前移显微镜下神经束间松解治疗的22例患者(对照组)进行比较.治疗组:男17例,女5例;年龄21～66岁,平均43.8岁.肘关节骨性关节炎17例,尺神经滑脱3例,肘外翻畸形2例.左侧8例,右侧14例.病程6～69个月.对照组:男18例,女4例;年龄20～64岁,平均42.1岁.肘关节骨性关节炎16例,尺神经滑脱4例,肘外翻畸形及肱骨内髁骨折移位畸形愈合致尺神经沟变窄变浅各1例.左侧7例,右侧15例.病程5～67个月. 结果 两组患者术后切口均I期愈合.治疗组术后1 d,患者小指麻木均明显减轻、消失;对照组术后3～5 d,患者小指麻木明显减轻、消失.两组患者均获随访,随访时间12～45个月,平均20.1个月.肌电图检查示尺神经传导速度均正常.按照中华医学会外科学会上肢部分功能评定试用标准和Lascar分级法评价疗效,治疗组优21例,良1例,优良率100%:对照组优19例,良2例,可1例,优良率95.45%.治疗组和对照组术前评分分别为(2.89±0.15)分和(2.91±0.13)分,差异无统计学意义(P＞0.05);术后分别为(11.32±1.04)分和(9.91±1.48)分,差异有统计学意义(P＜0.01). 结论 尺神经沟扩大神经束间松解和尺神经前移、神经束间松解均是治疗重度肘管综合征的有效方法,前者优于后者.     

带血管蒂尺神经松解前置治疗肘管综合征

目的 初步探讨带血管蒂尺神经松解前置治疗肘管综合征的疗效.方法 总结分析79例带血管蒂尺神经松解前置术治疗肘管综合征患者,采用肘管切开带血管蒂尺神经松解皮下前置35例、深部前置(带血管蒂肌下前置术:带血管蒂肌内前置术)治疗肘管综合征44例.结果 随访6个月～8年,平均随访3.5年.疗效按Macnicol肘管综合征术后客观判断标准评定,带血管蒂尺神经松解皮下前置术者35例,优8例,良12例,可11例,差4例;带血管蒂尺神经松解深部前置44例,优14例,良11例,可15例,差3例.结论 应用显微外科技术行带血管蒂尺神经松解前置治疗肘管综合征的效果确切,在手术显微镜下操作可有效的保护神经外膜伴行的营养血管,长期疗效满意.     

肘管综合征的手术治疗

目的　探讨尺神经松解前移手术治疗肘管综合征的临床效果。方法　应用此术式治疗 2 7例肘管综合征。结果　经随访 ,本组病例尺神经功能均有较大改善。结论　尺神经松解前移术为治疗肘管综合征较佳术式。     

带尺侧下副动脉尺神经松解前置术治疗肘管综合征

目的 总结带尺侧下副动脉尺神经松解前置术治疗肘管综合征的手术方法及临床效果.方法 2005年9月-2006年5月,采用保留尺侧下副动脉在尺神经上的吻合支,行带血供尺神经松解前置术治疗25例肘管综合征.男19例,女6例:年龄20～72岁,平均60岁.发病至手术时间2个月～3年,平均6.7个月.发病原因:骨性关节炎23例,肘管内囊肿及尺神经滑脱各1例.术前按Pasque肘管综合征评分系统评定:可19例,差6例.电生理检查:肘关节周围尺神经运动神经传导速度<42 m/s.结果 术后切口均1期愈合,无手术并发症及复发患者.25例术后均获随访,随访时间1年～2年半,平均13.9个月.按Pasque肘管综合征评分系统评定:优15例,良9例,可1例,优良率96%;与术前评定结果比较,差异有统计学意义(P＜0.05).电生理检查;肘关节周围尺神经运动神经传导速度>42m/s.结论 带尺侧下副动脉尺神经松解前置术是治疗肘管综合征的安全有效方法之一.     

尺神经沟填埋神经外膜松解治疗肘管综合征

目的 探讨采用尺神经沟填埋、神经外膜松解及尺神经皮下前移、神经外膜松解术治疗肘管综合征的疗效.方法 对肘管综合征采用尺神经沟填埋术治疗20例(治疗组),采用尺神经皮下前移术治疗20例(对照组).结果 两组均获随访,时间10～41个月,平均18.6个月.疗效评定按照上肢功能评定标准:治疗组优良率95％,对照组优良率90％,差异无统计学意义(P＞0.05).结论 尺神经沟填埋术与皮下前移术是治疗肘管综合征的有效方法.     

肘管综合征手术方法的改进

目的介绍尺神经沟加深开大的方法—肘管成形术治疗肘管综合征的经验,并对本方法治疗结果进行评估。方法对28例肘管综合征行自尺神经沟的外侧缘完整剥离骨膜掀向内侧,加深开大尺神经沟后骨蜡止血,骨膜复原,尺神经移回原处。结果术后随访6个月～4年(平均26﹒8个月),术后感觉就有所恢复,2个月感觉恢复正常,手指运动得到改善,术后半年爪形手消失,无一例复发或无恢复。结论肘管综合征通过加深开大尺神经沟有效的解除了尺神经卡压,避免了以往尺神经前移造成的粘连及第2次卡压的出现。     

超声检查在肘管综合征诊治中的应用

目的探讨超声检查在诊断和治疗肘管综合征中的临床意义。方法对34例临床及肌电图检测确诊为肘管综合征的患者，分轻、中、重度三期，应用B超进行检测，与30例（60侧）健康人肘管B超检查结果进行对比研究；同时将B超发现的形态学异常表现与术中所见进行对比研究。结果B超检查显示肘管综合征患者尺神经横截面积，尺神经厚度，尺神经横截面积肿胀率，尺神经厚度肿胀率平均值均大于对照组；随着临床症状逐渐加重，尺神经横截面积肿胀率增大，而尺神经肘段运动传导速度减慢。同时B超发现的形态学异常表现，与术中所见一致。结论B超检查对肘管综合征的诊断、尺神经病变程度的分期，以及治疗方式的选择均有参考价值，为临床提供了一种简单、可靠、无创的检测方法。     

Intraoperative measurement of pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome

PURPOSE: Little is known about whether the pressure adjacent to the ulnar nerve actually is increased in patients with cubital tunnel syndrome or if it is a causative factor. We measured the pressure adjacent to the ulnar nerve in patients with cubital tunnel syndrome during surgery and verified whether or not there was an association with patient age, duration of the disease, motor nerve conduction velocity, and severity of the ulnar nerve neuropathy. METHODS: Eight elbows in 8 patients with an average age of 62 years were treated surgically and the extraneural pressures within the cubital tunnel were measured during surgery by using a fiberoptic microtransducer. Pressure was measured 3 times with the elbow fully extended and then 3 times with the elbow flexed 130 degrees. The transducers were placed at 1, 2, and 3 cm distal to the proximal edge of the Osborne ligament. The severity of the neuropathy was evaluated according to Akahori's classification. The ulnar nerve palsy was graded as stage III in 5 patients and as stage IV in 3 patients. RESULTS: The average pressures within the cubital tunnel at 1, 2, and 3 cm distal to the proximal edge of the cubital tunnel retinaculum with the elbow flexed were 105, 29, and 18 mm Hg, respectively. The pressures at 1 and 2 cm distal to the proximal edge of the cubital tunnel retinaculum were significantly higher in elbow flexion than in elbow extension. There was also a positive correlation between the pressure and patient age but this was not significant The pressures correlated significantly with the stage of ulnar nerve neuropathy, motor nerve conduction velocity, and disease duration. CONCLUSIONS: The extraneural pressure within the cubital tunnel actually was increased in the patients and compression of the ulnar nerve might be a causative factor of cubital tunnel syndrome.     

Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression.

In it's native position, deep to Osborne's ligament, within the retrocondylar groove of the elbow, the ulnar nerve courses with a significant lever distance posterior to the elbow axis of rotation. In this position, flexion of the elbow places longitudinal traction and local compression forces on the nerve. This biomechanical consideration, as well as variations in anatomy, may potentially contribute to a decrease in the nerve's microcirculation and partial pressure of oxygen, leading to cubital tunnel syndrome. Anterior transposition of the ulnar nerve at the elbow for cubital tunnel syndrome will eliminate natural as well as pathological traction and compression forces; the procedure relieves the nerve of potential microcirculation compromise. Risks of mobilizing the nerve for transposition, however, include iatrogenic ischemia from segmental separation of the nerve from its mesentery-like extrinsic blood supply. Intrinsic interstitial "step-ladder" vessels within the substance of the ulnar nerve allow it to be separated from its extrinsic circulation safely, making anterior transposition a logical and reasonable choice for cubital tunnel syndrome requiring operative intervention.     

内窥镜治疗肘管综合征

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(deep flexor—pronator aponeurosis)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—27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。     

Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow

BACKGROUND: Medial elbow ganglia have been reported in association with cubital tunnel syndrome. This lesion is thought to occur rarely and has not been emphasized in the literature. The purposes of the present study are to report our experience with this lesion in order to elucidate its prevalence as well as its clinical and radiographic features, to describe our operative findings, and to present the results of surgical treatment. METHODS: Four hundred and eighty-seven elbows in 472 patients were treated for cubital tunnel syndrome between 1980 and 1999. We performed a retrospective study of the thirty-eight patients who had a medial ganglion. All of the ganglia were excised, and the ulnar nerve was translocated subcutaneously. Thirty-two patients were followed for a mean of thirty-seven months. RESULTS: Medial elbow ganglion was the third most common causative factor associated with cubital tunnel syndrome, with an overall prevalence of 8%. Resting pain in the medial aspect of the elbow was reported by twenty-five of the thirty-eight patients, and a sudden onset of numbness in the ring and little fingers or of medial elbow pain without prior symptoms was reported by twenty-nine patients. The symptoms lasted two months or less in thirty-one patients. All ganglia originated from the medial aspect of the ulnohumeral joint, and radiographs of that joint showed degenerative changes in thirty-seven patients. At the time of follow-up, all measurements of sensory and motor function of the ulnar nerve had improved and no recurrence of nerve palsy was found. CONCLUSIONS: Although uncommon, medial elbow ganglia have a strong association with osteoarthritis of the elbow and can cause a relatively acute onset of cubital tunnel syndrome. A patient with cubital tunnel syndrome associated with elbow osteoarthritis who complains of medial elbow pain or severe numbness within two months after the onset of the syndrome should be strongly suspected of having a ganglion. Most ganglia are occult, and ultrasonography and magnetic resonance imaging can assist in the preoperative diagnosis. Careful excision of the ganglion performed concurrently with subcutaneous anterior transposition of the ulnar nerve can produce satisfactory results.     

带筋膜尺神经前移治疗肘管综合征

目的 研究带筋膜尺神经前移在肘管综合征治疗中的应用。方法 采用带筋膜的尺神经多术治疗４０例肘管综合征。结果 感觉运动评分提高了３９．２％,有效率达９１．８％。结论带筋膜尺神经前移治疗肘管综合征有助于保护尺神经的血供及神经分支。慢性肘部牵拉伤是导致肘管综合征的主要因素。     

尺神经肌下前置术后解剖学变化及动态分析

目的从解剖学的角度为治疗肘管综合征选择肌下前置术式提供理论依据. 方法分析32例肘管综合征临床资料,男22例,女10例.年龄17～73岁.观察尺侧上副血管的分支分布及其与尺神经的关系,尺神经病变的部位、范围、粗细等;用扩张器测量新肘管容积.将20侧福尔马林固定的成人尸体上肢标本,分别制成尺神经皮下前置及肌下前置模型,动态观测设定范围内尺神经移位前后肘关节不同伸屈状态下的长度变化,进行对比分析. 结果尺侧上副动脉可与尺神经一同前置,新肘管重建后可充分容纳尺神经.皮下前置伸肘位时,尺神经较移位前被拉长7.55%±0.52%,差异有统计学意义(P＜0.05);肌下前置伸肘位时,尺神经长度与术前比较差异无统计学意义(P＞0.05). 结论肘部尺神经肌下前置术较好地解决了尺神经肘部受压迫及屈肘受牵拉的问题,尺神经前置后其血供及组织床良好,新肘管宽松,对尺神经无卡压,术式符合生物力学及神经生理学要求,是治疗肘管综合征可选择的术式.     

肘管综合征135例尺神经皮下前移术疗效分析

目的 随访肘管综合征135例尺神经皮下前移术治疗效果.方法 分析2002年2月一2005年12月,135例肘管综合征尺神经皮下前移患者的病情特点及效果.其中男109例,女26例,男女比例为4.2:1.41岁以上占68.1%.以手指活动笨拙就诊15例(占11%);电生理检测均有尺神经肘部段卡压征象.42例合并肘部骨折史.占病因的31%.135例均采用尺神经外膜松解,皮下前移术.结果 术后92例获得2-5年随访.平均2.5年;43例失访.按中华医学会手外科学会上肢功能评定标准,本组优72例,良12例,差8例,优良率为91.3%.结论 尺神经皮下前移术简单、有效,术中应保护前臂内侧皮神经、尺神经血供及分支,并确保尺神经无张力.应重视因肘部骨折和以手部活动笨拙为主要症状的早期诊治.     

Recurrent cubital tunnel syndrome. Etiology and treatment.

Controversy surrounds the treatment of recurrent cubital tunnel syndrome after previous surgery. Irrespective of the surgical technique, namely pure decompression in the ulnar groove and the cubital tunnel distal of the medial epicondyle, and the different methods of volar transposition (subcutaneous, intramuscular, and submuscular), the results of surgical therapy of cubital tunnel syndrome are often not favorable, especially in cases of long-standing symptoms and severe deficits. Twenty-two patients who had previously undergone surgical treatment for ulnar nerve entrapment at the elbow were evaluated because of persistent or recurrent pain, paresthesia, numbness, and motor weakness. Ten patients had undergone a nerve transposition, 5 patients underwent a simple decompression of the ulnar nerve, and 7 patients experienced two previous operations with different surgical techniques. Two patients underwent surgery at our hospital, whereas 20 patients underwent their primary surgery at other institutions. Various surgical techniques were used during the subsequent surgery, such as external neurolysis, subcutaneous anterior transposition, and subsequent transfer of the nerve back into the sulcus. The causes of continued or recurrent symptoms after initial surgery included dense perineural fibrosis of the nerve after subcutaneous transposition, adhesions of the nerve to the medial epicondyle and retention of the medial intermuscular septum. The average follow-up after the last procedure was 7 months (2 - 20 months). All 7 patients with subsequent transfer of the ulnar nerve back into the sulcus became pain-free, whereas only 11 of 15 patients who had external neurolysis or subcutaneous transposition became free of pain or experienced reduced pain. The recovery of motor function and return of sensibility were variable and unpredictable. In summary, reoperation after primary surgery of cubital tunnel syndrome gave satisfactory results in 18 of 22 cases. Subsequent transfer of the ulnar nerve back into the sulcus promises to be useful in cases in which subcutaneous transposition had not been successful.