神经电生理检测在肘管综合征中的应用

目的:探讨神经电生理检测在肘管综合征(CuTS)中的临床应用价值.方法:总结86例(88侧)CuTS患者(患者组)的临床神经电生理资料,并与30例(60侧)正常人(对照组)相关的电生理数据进行分析比较.结果:患者组共有19侧肢体在尺神经运动传导检测时未引出波形,有36侧肢体在尺神经感觉传导检测时未引出波形.尺神经运动传导速度肘上至肘下段为(34.56±6.27) m/s,复合肌肉动作电位潜伏期较对照组延长、波幅降低,感觉神经传导速度为(40.72±6.54)m/s,与对照组比较,差异均有极显著意义(P＜0.01).结论:神经电生理检测为诊断CuTS的可靠手段,可早期确诊及精确定位尺神经受损的部位及损伤程度.为提高其敏感性及定位的准确性,在电生理检查方法上还需进一步探讨.     

肘管综合征患者的神经电生理研究及临床表现

肘管由尺侧弯曲肌肱骨头,尺骨鹰嘴头之间的纤维性筋膜组织（弓状韧带）和肱骨内上髁髁后沟围成的骨性纤维鞘管,尺神经在肘管受压引起的一组症侯群为肘管综合征。任何破坏肘管结构或肘管内神经受摩擦损伤后均可导致肘管综合征,是仅次于腕管综合征的常见嵌压性单神经病,因此产生的以感觉异常肌肉萎缩运动受限为主要临床特征的疾病。临床易误诊为颈椎病,多发性周围神经病及胸出口综合征。     

肘管综合征的临床病因学探讨及神经电生理检查

目的 探讨肘管综合征的发病原因，评价尺神经传导速度(NCV)检查在术前诊断肘管综合征的临床价值。方法 对临床上伴有尺神经分布区受损症状及体征的患者，进行尺神经感觉神经传导速度(SCV)及运动神经传导速度(MCV)分段测定，并对这些患者进行尺神经前移术治疗。结果 共有21例(22肢)行尺神经传导速度分段测定并手术治疗。尺神经SCV测定，14例(14肢)异常，其中12例未引出电位；MCV肘上至肘下段测定，20例(21肢)减慢。手术证实尺神经受压原因为：韧带、肌腱及骨质增生压迫尺神经15肢，粘连2肢，扩张静脉及静脉丛压迫3肢，囊性肿物压迫2肢。结论 本组肘管综合征发病原因，除文献报道的常见病因外，还有其他少见原因，包括充盈的静脉丛，粗大静脉，囊肿压迫尺神经等。尺神经肘段运动神经传导速度减慢对肘管综合征有一定诊断价值。     

尺神经微创松解及前置术治疗肘管综合征39例临床分析

目的探讨尺神经微创松解及前置治疗肘管综合征的手术治疗效果。方法回顾分析我院2006-05~2010-05收治的39例肘管综合征患者,利用显微外科技术,松解尺神经,保留尺神经伴行血管-尺侧上副动脉,尺神经前置深筋膜瓣内重建宽松神经床。观察术后疗效。结果按照Amadio肘部尺神经损害的疗效标准评价:优20例,良15例,可2例,差2例,优良率89.7%。结论肘管综合征患者应尽早手术,尺神经的微创松解提高了临床治疗效果。     

34例肘管综合征尺神经松解筋膜下前置术的治疗体会

目的探讨尺神经松解筋膜下前置术治疗肘管综合征的临床疗效。方法采用尺神经外膜松解加尺神经筋膜下前置术的手术方式治疗38例肘管综合征患者,34例术后6个月～3a获随访。结果随访34例,其中30例明显改善,运动感觉功能均获恢复,2例感觉功能恢复,运动功能未恢复,2例严重损伤感觉及运动均未恢复。手术疗效优良率88.2%。结论采用尺神经外膜松解加尺神经筋膜下前置术的手术方式治疗肘管综合征临床效果良好。     

肘尺管综合征显微手术治疗17例分析

目的 探讨肘尺管综合征尺神经显微松解及保留尺神经肘管段血供分支的松解前置术治疗肘管综合征的临床效果.方法 对17例肘管综合征患者施行显微松解及保留尺神经肘部血供分支的松解前置术,术后观察其疗效.结果 15例临床症状全部消失,功能恢复正常;2例感觉功能完全恢复,运动功能大部恢复.无并发症.结论 显微松解及保留尺神经肘管段血供分支的松解前置术是治疗肘管综合征的一种有效方法.     

肘管综合征的神经电生理分析

目的 探讨肘管综合征的神经电生理特点.方法 对70例76侧经临床及手术证实为肘管综合征的患者进行神经肌电图检测及分析.结果 70例76侧肢体,尺神经感觉神经小指到腕传导速度、感觉神经动作电位波幅、尺神经运动神经肘下5cm到肘上5cm传导速度和波幅、肘下到腕传导速度和波幅等6项指标异常率分别为:42%、47%、78%、79%(包括肘上5cm到肘下5cmMCV)、28%、14%.结论 神经肌电图检查为诊断肘管综合征的可靠手段,可早期确诊及准确定位受损部位及损伤程度、判断愈后、指导治疗.     

肘管综合征的外科手术治疗

目的探讨肘管综合征的发病原因、手术方法和治疗效果。方法对21例肘管综合征患者给以手术治疗,并对发病原因、治疗方法和随访效果进行分析。结果全部病例均随访,随访时间6个月至2年。其中尺神经功能恢复效果优14例,良5例,差2例。结论肘管综合征应早期诊断,早期给以尺神经松解减压和前移手术,术后疗效满意。     

两种尺神经前置方法治疗肘管综合征的疗效比较

<正>在尺骨鹰嘴和肱骨内上髁之间有一骨性纤维鞘管,即尺神经沟,尺神经尺侧上副动脉以及尺侧上副静脉走行其中。当肘管受压或管内占位性病变时,可对尺神经造成压迫,导致神经功能障碍,从而引起相应的临床症状,称为肘管综合征。目前,对于肘管综合征的治疗尚存在一定争议[1],常用的治疗方式主要有尺神经松解术、尺神经前置术以及肱骨内上髁切除术等[2],且治疗效果不尽相同。为探讨肘管综合征的有效治疗方案,笔者对我院部分患者进行对照研究,以期     

神经肌电图检查对肘管综合征与腕尺管综合征鉴别诊断的价值

目的探讨神经肌电图检查在肘管综合征(CuTS)与腕尺管综合征(UTS)鉴别诊断中的应用价值。方法对35例单侧上肢临床症状、体征符合CuTS或UTS的患者进行尺神经、正中神经远端运动潜伏期(DML)、运动传导速度(MCV)、感觉传导速度(SCV)、波幅(AMP)及尺神经肘部寸移电位检测;尺神经、正中神经所支配的肌肉肌电图(EMG)检测。结果 35例患者中,CuTS 29例(83%),UTS 4例(11%),正常2例(6%),总异常率94%。结论神经肌电图检测可明确鉴别肘管综合征与腕尺管综合征,为临床诊断及治疗提供依据,有重要的临床应用价值。     

不同类型前置术治疗尺神经肘管卡压综合征

目的 对比不同类型前置术治疗尺神经肘管卡压综合征的临床疗效.方法 回顾性分析278例尺神经肘管卡压综合征病人的临床资料,按McGowan法分级后,随机行尺神经皮下前置术(皮下前置术)139例,"Z"字形改良肌下前置术(肌下前置术)139例.检测尺神经横截面积(CSA)、神经运动传导速度(MCV),感觉传导速度(SCV )、神经干动作电位(NAP)变化,比较两种术式的疗效.结果 McGowan Ⅰ级病人,术后 CSA,MCV,SCV,NAP均较术前明显改善(P <0.05),但两种术式间各参数和术后优良率差异均无统计学意义(P > 0.05).McGowan Ⅱ,Ⅲ级病人术后CSA,MCV,SCV,NAP均较术前明显改善(P<0.05),且两种术式间各参数和术后优良率差异均有统计学意义(P <0.05).结论 皮下前置术适于尺神经肘管卡压综合征McGowan Ⅰ级病人,而肌下前置术更适用于McGowan Ⅱ,Ⅲ级病人.     

Risk factors and outcomes in 385 cases of ulnar nerve submuscular transposition

Submuscular transposition (SMT) for treatment of ulnar nerve entrapment is commonly performed, however published comparisons of surgical techniques exclude a high proportion of the at-risk population encountered in real world practice. To examine the influence of risk factors on the clinical outcome following SMT we performed a retrospective review of all patients who underwent SMT, including patient self-reported outcome and Louisiana State University Medical Centre ulnar nerve grading scale. A total of 403 ulnar nerves were operated, with follow-up data available for 385 cases (359 patients). Risk factors (including smoking, diabetes, previous elbow trauma/pathology, subluxation, workers’ compensation) were reported in 266 of 385 surgeries (69.09%). SMT was the primary procedure in 339 nerves (88.05%), revision procedure in 46 nerves (11.95%). At last follow up 91.05% reported symptomatic improvement. Nerve grade improvement in 71.09% of primary and 67.39% revision surgery (p = 0.605). No significant difference in improvement was identified between demographic and risk categories, except for patient reported improvement in those without peripheral neuropathy (90.59% vs 73.33%, p = 0.027), and those not improved were on average older than those improved (62.94 vs. 55.68 years, p = 0.012). Superficial infection occurred in 2.6% and there were no deep infections. Application of published exclusion criteria would have resulted in exclusion of ½–⅔ of our cohort. SMT in patients with a history of elbow trauma, diabetes, workers compensation, smoking history, nerve subluxation or revision surgery have similar outcomes compared to those without these factors, whilst improved results were observed in younger patients and those without peripheral neuropathy.     

Anterior subcutaneous transposition of ulnar nerve with fascial flap and complete excision of medial intermuscular septum in cubital tunnel syndrome: a prospective patient cohort

Objective

Regarding the frequency of cubital tunnel syndrome, varieties of treatment modalities, and ambiguity of anterior subcutaneous transposition of ulnar nerve method, we aimed to evaluate the efficacy of this procedure in patients with cubital tunnel syndrome referred to Taleghani hospital between 2006 and 2009.

Methods

This study was a case series including all referred patients with definite diagnosis of cubital tunnel syndrome, treated by anterior subcutaneous transposition. Treatment results were measured according to modified Bishop rating system, and were ranked into excellent, good, fair, and poor. Variables such as gender, age (less/more than 45 years), causation, and initial severity, determined by Dellon criteria preoperatively, were analyzed by Fisher's exact test.

Results

This study was performed on 26 eligible cases including 29 elbows, 38% males and 62.1% females, with mean age of 44.5 years (ranging 23-72 years). In a 12 months follow-up post-operatively, 62% showed excellent, 20.7% good, and 17.3% fair, with no poor result. In a 1-12 months follow-up post-operatively, results showed improvement, and initial severity and old age were demonstrated to significantly affect treatment results (P < 0.07).

Conclusion

Though considered standard of care, the present study suggests that criteria for surgical techniques of ulnar nerve decompression, e.g. simple decompression vs. more extensive repair as in the present cohort, should be revised by controlled prospective studies.     

MR在尺神经卡压综合征诊疗中的应用

目的探讨MR在尺神经卡压综合征(CuTS)术前评估、术式选择、术后疗效评估中的应用价值。方法对470例CuTS患者,按Dellon术式对卡压神经行尺神经显微松解减压术。所有患者术前4周病侧组和健侧组尺神经行MR检测对照,术前、术后病侧组尺神经MR检测指标对照。结果 MR显示受累神经肿胀、增粗,信号减低,神经内线状结构消失,肿胀部位(内上髁沟、穿尺侧腕屈肌处)明显受到旋前圆肌、指浅屈肌、肘管、屈肌总腱等组织卡压;神经横截面积(CSA)相比较于健侧差异显著;术前、术后对照:MR尺神经检测结果提示神经卡压明显缓解。结论 MR能够从形态学角度提供神经卡压程度、部位等信息,同时可以清晰显示卡压神经周围解剖,适用于辅助术前评估,指导手术操作,评价手术效果。     

The dilemma of ulnar nerve entrapment at wrist in carpal tunnel syndrome

Objective

The commonest compression neuropathy in human being is carpal tunnel syndrome (CTS). The association between CTS and ulnar nerve entrapment is debatable. The objective of this study is to determine the presence of any association between CTS and ulnar entrapment neuropathy at the wrist.

Patients and methods

To test the hypothesis we conducted a case-control study. Ninety-nine healthy volunteers and 181 patients with established diagnosis of CTS enrolled to the study. Distal latencies, peak latencies and action potentials for sensory branches and distal latencies and action potentials for motor branches of both median and ulnar nerves were measured in totally 378 hands. We conducted independent t-test comparing age and sex between control and patient groups and analysis of variance to compare dichotomous and continuous variables between control group and patient subgroups.

Results

Based on our cutoffs, we found that 7.5% of CTS patients had distal latency ≥2.8 ms for ulnar sensory branches, 4.6% had distal latency ≥3.4 ms for ulnar nerve motor branches and 15% had peak latency ≥3.3 ms for ulnar sensory branches. There was not any statistically significant correlation between subgroups of CTS patients and control group.

Conclusion

The authors suggest that there may not be any association between CTS and ulnar nerve compression at the wrist. We suggest that different racial groups and multiple techniques in performing nerve conduction studies and dissimilar cutoff values for the diagnosis of entrapment neuropathies are the major causes of ambiguity in the literature. More relevant studies will have crucial importance for detecting ulnar nerve entrapment at the wrist in CTS patients.