Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity

ObjectiveTo assess the diagnostic performance of electrophysiology and nerve ultrasound in ulnar neuropathies of varying clinical severity in 135 consecutive patients.MethodsClinical severity of ulnar neuropathy was graded on a 4 point scale from very mild (symptoms only) to severe (marked atrophy of intrinsic hand muscles). Sensitivity and localization ability of electrophysiology and nerve ultrasound were assessed for each point of the scale.ResultsUltrasound had higher sensitivity than electrophysiology in clinically very mild (20% and 3% for ultrasound and electrophysiology, respectively) and mild (62% and 47% for ultrasound and electrophysiology, respectively) neuropathies, had greater localizing ability in axonal ulnar neuropathies, and identified nerve hypermobility.Ultrasound nerve cross-sectional area had strong positive correlation with both clinical and electrophysiological severity scores, but with significant overlap across the severity groups.ConclusionThe diagnostic work-up of ulnar neuropathies was improved by using both electrophysiology and ultrasound at all levels of clinical severity. Ultrasound increased the diagnostic yield in very mild and mild neuropathies, localized all the ulnar neuropathies with abnormal non-localizing electrophysiology and identified nerve hypermobility.SignificanceThis is the first detailed analysis of the diagnostic performance of electrophysiology and ultrasound in ulnar neuropathies of varying severity.     

肱骨内上髁骨折致尺神经卡压1例

患者,男,17岁,因右肘肿痛,活动受限30min于2005年6月15日来我院就诊。患者于30min前与同学扳手腕时突感右肘内侧疼痛难忍,逐渐肿胀,活动受限,右手各指无麻木。查体:右肘内侧肿胀明显,压痛,可触及骨擦感,右肘伸屈活动及前臂旋转活动受限,右手各指活动良好,感觉正常。X线片示右肱     

肘关节后脱位并尺骨冠状突骨折9例临床疗效分析

目的 探讨肘关节后脱位并尺骨冠状突骨折的治疗方法。方法 总结2000年3月～2003年5月9例肘关节后脱位合并尺骨冠状突骨折患者的治疗经验，根据骨折类型分别采用内外侧入路对8例患者进行手术治疗，术后配合早期功能锻炼。结果 所有患者随访8～24个月，根据HSS评分标准，优5例（55.6%)，良2例（22.2%)，一般2例（22.2%)，优良率77.8%，无严重肘关节并发症发生。结论 选择恰当的手术入路和早期功能锻炼是提高该类骨折效果的关键。     

The Mitek mini anchor in the treatment of the gamekeeper's thumb

The fixation of a distally ruptured ulnar collateral ligament of the MP 1 (Metacarpophalangeal) joint without a portion of ligament which can be sutured or a small bony fragment can be accomplished with a variety of methods, most of which require drillholes through borth cortices and a counter incision as well as the removal of the material at a second stage [1, 11, 13, 15]. The Mitek bone mini anchor (Ethicon-Mitek®) proved to be a reliable and quick alternative [10, 12, 16, 18, 19]. It was successfully used in eleven patients with excellent stability of the reconstructed joint.     

肘部尺神经半脱位的解剖学和流行病学研究

目的：研究肘部尺神经半脱位的发生原因及其临床意义。方法：对１００侧成人尸体肘部的尺神经位置进行解剖观察；在人群中随机调查了８５４位正常人肘部尺神经的位置。结果：肘管深度为７．１±０．１４ｍｍ（χ±ｓχ）。解剖观察发现，６侧肢体的尺神经在屈肘时发生半脱位，肘管深度平均为４．８ｍｍ。８５４位正常人肘部尺神经半脱位发生率为８．９％（７６／８５４）。结论：绝大多数的肘部尺神经半脱位是先天性的。肘部尺神经半脱位不一定是肘部尺神经卡压的发病原因。     

Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation

Post-traumatic ulnar carpal translocation is a rare, severe ligamentous injury to the wrist. Radiologic findings include widening of the radiocarpal joint space at the radial styloid process and ulnar displacement of the carpus. Less than 50% of the lunate articulates with the radius in the neutral position; the lunate is tilted dorsally with palmar subluxation due to a ruptured radioscapholunate (RSL) ligament. This malposition should be called rotatory palmar subluxation of the lunate (RPSL), by analogy to rotatory subluxation of the scaphoid (RSS). In contrast to dorsiflexed intercalated segment instability (DISI), in RPSL the RSL ligament is ruptured and, in the majority of cases, the scapholunate ligament remains intact. A prompt diagnosis should lead to successful treatment.     

肘关节后脱位伴桡骨头和尺骨冠突骨折 (恐怖三联征)5例初步报告

[目的]介绍"肘关节恐怖三联征"的概念(肘关节后脱位同时伴有桡骨头和尺骨冠突骨折),并报告5例患者的临床治疗体会。[方法]自2004年4月～2007年3月,作者共收治肘关节三联征损伤5例。桡骨头骨折按Mason法分类:Ⅱ型4例,Ⅲ型1例;按Schatzker法分类:Ⅰ型1例,Ⅱ型3例,Ⅲ型1例。尺骨冠突骨折按Regan-Morrey法分类:Ⅰ型1例,Ⅱ型4例;按O′Driscoll法分类:5例均为Ⅰ型。4例采取了手术内固定治疗,以3 mm钛空心拉力螺钉或1 mm K针分别固定冠突和桡骨头,并缝合修复肘内外侧副韧带。术后屈肘90°前臂旋转中立位石膏外固定3周,开始屈伸和旋转康复训练。[结果]4例手术治疗的患者经3个月～3年随访,骨折愈合,肘关节稳定,无疼痛。肘关节屈伸幅度平均120°,前臂旋转幅度平均110°。3例随访1年以上,Mayo肘关节功能评分:优2例,良1例。未手术治疗的1例功能评定为差,有肘关节不稳定和疼痛。[结论]肘关节恐怖三联征的骨折片虽然很小,但伴有肘内外侧副韧带撕裂,肘关节严重不稳定。只有在重建了骨关节和软组织结构稳定的基础上,及早(3周内)进行康复锻炼,才能获得较好的功能恢复。     

电刺激在修复远端尺神经损伤中的应用

目的 :阐明神经束支定位法在远端尺神经损伤修复中的作用。方法 :选择 4 2例远端尺神经损伤病例 ,进行神经内束支分离 ,双极电刺激定位后束膜吻合 ,与 17例外膜吻合组对照。结果 :束支分离定位法在远端尺神经损伤修复中的成功率为 90 .5%,治疗组较对照组感觉恢复率有提高 ,但无明显差异 ( P>0 .0 5) ,运动功能恢复率显著提高 ( P<0 .0 1)。结论 :神经内束支分离定位应用于远端尺神经损伤修复是可行的 ,并能提高其功能恢复率。