迟发性尺神经炎

迟发性尺神经炎Ｐａｎａｓ１８７８年首先报导。尺神经的应用解剖包括神经走行、肘管结构、神经内结构及内压、肘部动态解剖学，均与发病有关。手术发现亦相符。临床表现发病缓慢、病程长，出现尺神经受损症状与体征。治疗以早期手术为妥。手术包括髁上截骨短正肘部畸形，加深尺神经沟、神经松解、前移、内上髁切除等。尺神经前移优于松解术，而肱骨内上髁切除，神经无再受压之虞，效果更优越。     

手术治疗迟发性尺神经炎

1985年6月至1998年5月,我科共收治肘部压迫性尺神经炎26例,其中有完整随访资料的21例23条神经,根据尺神经受压的原因及部位,采用不同的手术方法进行治疗,取得了较满意的疗效.现总结报道如下:     

儿童肱骨内上髁骨折术后迟发性尺神经炎的预防

目的探讨骨折切开复位内固定并一期行尺神经前移术对肱骨内上髁骨折术后发生迟发性尺神经炎的预防作用。方法将57例眩骨内上髁骨折患者分为骨折切开复位内固定并一期行尺神经前移（32例）和单纯骨折切开复位内固定（25例）两组,对两组迟发性尺神经炎的发生率进行比较．结果骨折切开复位内固定并一期行尺神经前移组的迟发性尺神经炎发生率为6．25％,而单纯骨折切开复位内固定组为36％．两组差异有显著性（P〈0．05）。结论 肱骨内上髁骨折切开复位内同定并一期行尺神经前移能较好地预防术后迟发性尺神经炎的发生。     

右肘内侧骨脂肪瘤并迟发性尺神经炎一例

1　病例介绍患者　男 ,4 9岁。 10年前右肘部被粗绳勒伤 ,当时肿痛 ,活动受限未在意。 5年前发现右肘内侧有一包块渐长大 ,伴右手麻痛、活动受限 5个月余 ,以骨化性肌炎收入我科。检查 :右肘部外翻畸形 ,肘内侧可触及 3.5 cm× 4 cm骨性包块 ,轻度压痛 ,活动度小 ;肘关节伸 15 0°,屈 5 0°,Tinle征 (+) ;右手骨间肌萎缩 ,虎口肌肉萎缩 ,小指及环指尺侧痛触觉减退 ,轻度爪形指畸形。 X线片示肘关节两骨端增生肥大 ,关节间隙变窄 ,右桡骨小头向前脱位 ,肱骨内上髁上方有片状不规则骨化影。初诊 :1创伤性骨化性肌炎 ;2右肘迟发性尺神经炎。在…     

肘内翻畸形并迟发性尺神经炎一例报告

患者男，15岁，右肘外伤后畸形7年，环指及小指麻木、无力半年余入院。患者于7年前摔伤右肘部，当时未拍片检查，在当地诊所行局部敷药及小夹板外同定治疗，1个月后开始进行功能练习，右肘关节屈伸功能逐渐恢复，但数月后出现右肘关节内翻畸形并逐渐加重。半年前，忠者发现右手环指及小指麻木、活动无力，有部分肌肉逐渐萎缩。     

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。     

肘管综合征临床治疗进展

尺神经在肘部通过尺神经沟时受到腱膜、异常的肌肉或骨性改变的压迫而产生的症候群称肘管综合征。它是第二位常见的上肢神经卡压症，仅次于腕管综合征，发病率相当于腕管综合征的1/2。1958年Feindel和Stratford首先使用了肘管综合征这个术语。Bozentka[1]认为肘管前界是肱骨内上髁，外侧界为肘关节内侧的尺肱韧带，后侧界为尺侧腕屈肌两个头之间形成的纤维弓，管顶由尺骨鹰嘴延伸到肱骨内上髁的纤维束组成。１致病因素由于尺神经在肘部独特的解剖特点，即位置表浅、相对固定、位于肘关节屈伸轴的后方，因此极易受到损伤。它周围的组织如St…     

Cubitus valgus and tardy ulnar nerve palsy due to an intracapsular ulnar nerve

Background

We describe a patient with tardy ulnar neuropathy and cubitus valgus deformity found to have an intracapsular ulnar nerve.

Methods

An 89-year-old woman presented with severe neuropathic pain in the ulnar digits of the hand, advanced degenerative arthritis of the elbow, and tardy ulnar nerve palsy. Her pain was exacerbated with elbow movement, particularly flexion. She had paralysis of ulnar nerve innervated muscles, hypersensitivity with absence of two-point discrimination in her ulnar 1–1/2 digits, and a fixed ulnar claw deformity. She also had a grossly unstable elbow.

Results

Plain films revealed a cubitus valgus deformity (38°), an absent radial head, a dislocated proximal radioulnar joint and advanced arthritic changes. Ultrasonography revealed an indistinct ulnar nerve within the cubital tunnel which penetrated the joint. Electrophysiological studies revealed evidence of a severe ulnar neuropathy at the level of the elbow. Intraoperatively, an attenuated 2 cm length of the retrocondylar ulnar nerve was observed to be incorporated into the joint capsule tethered by a fibrous/synovial band which was released. A large effusion was drained. The ulnar nerve was transposed subcutaneously. The capsular rent was repaired in layers. She noted immediate and sustained (2 year follow-up) pain relief and regained moderate function in her interossei.

Conclusions

We believe that the chronic cubitus valgus deformity and secondary degenerative elbow joint changes led to an altered course of the nerve and attenuation of the medial joint capsule such that the ulnar nerve spontaneously buttonholed itself intra-articularly.     

超声检查对迟发性尺神经炎的应用研究

目的 探讨超声影像学对迟发性尺神经炎的研究价值.方法 对15例迟发性尺神经炎患者(损伤组)和40例健康成年人(对照组)行肘部尺神经多普勒超声检查,观察其声像图的改变,对其前后径、横径进行对照分析,并对损伤组患者行尺神经松解手术.结果 健康成年人与迟发性尺神经炎患者,二者肘部尺神经超声声像图结构特征有明显的差异,后者的强回声环增厚,与神经束相应的蜂窝状的强回声呈偏心分布,而低回声背景内有增粗的血管出现.两组肘部尺神经前后径、横径的比较差异有统计学意义(P<0.05).手术发现15例中14例肘部尺神经局部增粗,神经外膜增厚,神经束变细,束间水肿.结论 高频多普勒超声可作为迟发性尺神经炎的一种很好的临床检查手段.     

The results of operation for ulnar neuritis.

The records of 110 cases of ulnar neuritis in 100 patients have been reviewed an average of 4.4 years after anterior transposition, or release of the aponeurosis. Seventy of the patients were reviewed personally. In over half the cases no precipitating cause was apparent. At operation the nerve was constricted by the flexor carpi ulnaris aponeurosis in fifty cases but in twenty-five no abnormal pathology was found. Recovery was greatest when operation was performed within three months of the onset of symptoms. In those cases where no abnormality was found, and those in which adhesions in the postcondylar groove involved the nerve, simple release was less effective than anterior transposition. It is therefore recommended that release be restricted to patients with a short history and with an obvious aponeurotic constriction unaccompanied by adhesions. Anterior transposition is the operation of choice where no abnormality is seen or where the nerve is dislocated, compressed or tethered proximal to the aponeurosis of flexor carpi ulnaris.     

Compression neuritis of the ulnar nerve treated with simple decompression

The purpose of this investigation was to test the hypothesis submitted by Osborne (1957), which proposed that the symptoms of compression ulnar neuritis, in most cases, result from compression on the ulnar nerve at the proximal border of the aponeurosis of the flexor carpi ulnaris muscle. Thirty-two simple decompression operations were performed on 31 patients, diagnosed as suffering from compression neuritis of the ulnar nerve. They were subsequently examined over a period of 5 years. Relief from symptoms was achieved in 28 cases, whilst four patients derived no improvement from the operation. Three of the four unsuccessful cases were judged to have been incorrectly diagnosed and were not suffering from compression of the ulnar nerve in the elbow. A second operation was required in two patients, in one a second decompression and in the other anteposition. No surgical or post-surgical complications occurred.     

Abnormal ulnar nerve anatomy in the distal forearm pre-disposes to post-traumatic ulnar neuritis at the wrist.

Anatomical variations of the ulnar nerve have been described at the level of the elbow and in Guyon's canal, while the path in the forearm has always been assumed to be constant. We present a case of compressive ulnar neuropathy at the wrist pre-disposed by a presumed congenital variation of the path of the ulnar nerve at the level of the wrist which improved following surgical release of the constriction caused as a result of it.