小切口单纯肘管松解术治疗肘管综合征

目的 通过临床研究分析小切口单纯肘管松解术治疗肘管综合征的适应证。选择病程平均为2．5人月,无肘部骨折或畸形的9例男性患者进行手术。于尺神经沟作2－3cm长的小切口,仅切开肘管及其远端的弓状韧带,在尺神经鞘膜内注射1ml确炎舒松－A。结果 9例的手尺侧麻木感于术后1个月内消失,刺痛觉减退在术后半年恢复正常。2例骨间肌蚓关肌有轻度肌萎缩者在术后1年半完全恢复。结论 对肘部无骨折畸形,病程短,无明显肌萎缩,爪形手畸形的肘管综合征可以采用小切口单纯肘管松解要治疗。     

肘管综合征36例分析

报告１９８５年至１９９３年手术治疗肘管综合征３６例，均行尺神经松解前移术，优良率９１．７％，认为尺神经松解前移术是治疗肘管综合征的有效方法，在手术显微镜下进行了无损操作是提高疗效的重要手段。     

内窥镜及显微镜辅助下三切口治疗肘管综合征

目的总结在内窥镜及显微镜辅助下采用三切口行尺神经松解并皮下前置术治疗肘管综合征的手术方法和疗效。方法 2008年5月-2009年8月,在内窥镜及显微镜辅助下采用三切口行尺神经松解并皮下前置术治疗13例肘管综合征患者。其中男4例,女9例;年龄32～60岁,平均47.5岁。致病原因:外伤性肱骨内侧髁陈旧性骨折畸形1例,无明显外伤、长时间屈肘作业10例,尺神经滑脱2例。左侧6例,右侧7例。病程4～30个月。发病至手术时间3～20个月,平均8.5个月。10例伴手内肌萎缩。结果手术均顺利完成,手术时间45～60 min。术后切口Ⅰ期愈合,无感染等并发症发生。术后患者均获随访,随访时间12～18个月,平均14个月。术后第1天,患者环、小指及掌、尺侧皮肤麻木感明显减轻。术后2周肌电图检查示前臂尺神经运动传导速度增快,波幅改善,手内肌募集反应增强。术后3个月,10例伴手内肌萎缩患者中7例肌力恢复正常,余3例肌力大部分恢复。术后12个月,患者肘管综合征临床症状消失,肘关节功能恢复正常。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等分级法评价疗效,获优10例,良3例,优良率100%。患者术后12～16 d(平均14 d)恢复日常工作。随访期内均无复发。结论内窥镜及显微镜辅助下采用三切口治疗肘管综合征具有手术切口小,组织创伤轻,尺神经松解及减压彻底等优点,患者术后能早期恢复日常工作,是一种治疗肘管综合征安全有效的微创手术方法。     

小切口尺神经松解术在青年人轻型肘管综合征中的应用

目的评价小切口尺神经松解术在轻型肘管综合征中的疗效。方法采用小切口尺神经松解术,对青年轻型肘管综合征早期手术干预。结果有效地阻断病情发展,手术创伤及瘢痕相对较小。结论易于年轻人接受,取得了较好效果。     

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…     

内窥镜下肘管减压术治疗肘管综合征体会

目的探讨内窥镜下肘管减压术治疗肘管综合征的经验和方法。方法在肱骨内上髁与鹰嘴间做一＂Z＂字切口,直视下在尺神经沟内显露尺神经,在内窥镜引导下,用推刀沿外套管沟槽切断屈肌-旋前肌深腱膜和Struthers弓,松解肘管近侧和远侧各约10cm。结果根据Wilson和Krout推荐疗效评价标准：19例患者23侧术后随访3～23个月,14侧疗效为优,7例疗效为良,1例疗效为可,1例疗效为差。结论本术式切口小、组织损伤轻、操作简单、安全、疗效确切。     

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。     

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：工治疗肝管综合征26例，观察尺侧上副供血情况。结果：经随访，本组病例尺神经功能有较大改善。结论：尺神经松解前移术为治疗肘管综合征的较佳术式。     

内镜辅助尺神经前置术治疗肘管综合征的疗效随访

目的 探讨内镜辅助下尺神经松解皮下前置治疗肘管综合征的临床疗效. 方法 2008年2月至2010年6月,共收治肘管综合征患者44例,均行尺神经松解皮下前置术治疗,其中行开放性肘管切开手术28例,内镜下手术16例.对比两组手术时间、术后用药情况、创口瘢痕长度、术后住院时间.术后随访1 ～ 12个月,观察术后工作恢复时间并评价尺神经功能. 结果 内镜组平均手术时间(67.20±19.69)min,术后瘢痕长(1.50±0.58)cm,术后止痛药使用率6.3％,术后平均住院时间(2.40±1.42)d,平均恢复工作时间(14.60±4.69)d;开放组平均手术时间(62.80±11.06)min,术后瘢痕长(8.70±1.42)cm,术后止痛药使用率42.8％,平均住院时间(5.70±2.53)d,平均恢复工作时间(29.40±8.75)d,两组差异均有统计学意义(均为P＜ 0.05).按中华手外科学会周围神经功能评定标准,术后12个月,尺神经功能评分:开放组优良率82.14％,内镜组优良率81.25％,差异无统计学意义(P＞0.05). 结论 内镜组具有皮肤切口小、组织创伤轻、并发症少、术后疼痛轻,早期恢复日常工作等优点,且能获得与开放肘管切开尺神经松解皮下前置术相同的疗效.     

小切口治疗肘管综合征的临床疗效分析

目的 探讨小切口治疗肘管综合征的临床应用.方法 2010年12月至2011年11月,对12例肘管综合征患者术前肌电图评估尺神经损伤的程度,采用小切口加肱骨内上髁部分切除的方法进行治疗.术后石膏托固定2d,保护性地活动肘关节.结果 12例患者均获得随访,时间为4个月至1年,感觉较术前有明显改善,神经支配的手外在肌肌力较术前增强,手内在肌均没有进一步的萎缩,6例爪形手程度有所改善.按中华医学会手外科学会上肢部分功能评定试用标准评定:优6例,良4例,可2例；优良率83.3％.结论 在把握好适应证的情况下,采用小切口加肱骨内上髁部分切除治疗肘管综合征是一种可行的方法.     

肘管综合征的解剖和病因学探讨

[目的]探讨肘管综合征的解剖特点和发病原因。[方法]对65例肘管综合征患者的临床资料和术中所见,以及其中25例患者术前肌电图检查的结果进行综合研究分析。[结果]术中见60例患者存在肘管弓状韧带的肥厚增生,卡压磨损尺神经导致炎性病变;术前肌电图检查发现25例患者的尺神经传导速度均减慢,平均传导速度为27.97m/s;运动反应波幅降低,平均电压为1.95mv;潜伏期延长,平均时间为5.41ms;65例肘管综合征患者,继发于肘部创伤25例,慢性劳损15例,慢性骨关节炎14例,占位病变5例,先天异常有6例。[结论]肘部的创伤及慢性劳损可以导致肘管弓状韧带出现肥厚增生,引起尺神经卡压磨损,这是肘管综合征最常见的病因;其他病因还包括慢性骨关节炎,占位病变和先天异常;尺神经可被机械性卡压和磨损,出现慢性缺血缺氧,导致肘管综合征的发生;详细的体格检查和术前的肌电图检查是诊断肘管综合征的主要手段,在诊断时应注意该病与其他部位迟发性尺神经麻痹的鉴别。     

Endoscopic cubital tunnel release

A minimally invasive endoscopic approach has been successfully applied to surgical treatment of cubital tunnel syndrome. This procedure allows for smaller incisions with faster recovery time. This article details relevant surgical anatomy, indications, contraindications, surgical technique, complications, and postoperative management.     

Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome

PURPOSE: This study was designed to test the hypothesis that patients with an initial diagnosis of cubital tunnel syndrome are more likely to present with muscle atrophy than patients with an initial diagnosis of carpal tunnel syndrome. METHODS: A list of patients presenting to the office of a single hand surgeon from January 2000 to June 2005 with an initial diagnosis of isolated, idiopathic carpal tunnel syndrome or cubital tunnel syndrome was generated from billing records. The medical records of 58 patients with cubital tunnel syndrome and 370 patients with carpal tunnel syndrome were reviewed for age, gender, diabetes, and presence of atrophy. RESULTS: Twenty-three of 58 patients with an initial diagnosis of cubital tunnel syndrome had atrophy compared with only 62 out 370 patients with an initial diagnosis of carpal tunnel syndrome. Multiple logistic regression revealed that age (odds ratio, 1.06; 95% CI, 1.04-1.08) and diagnosis (cubital tunnel patients were more likely than carpal tunnel patients to present with atrophy; odds ratio, 4.5; 95% CI, 2.7-8.6) were factors significantly associated with atrophy at presentation. CONCLUSIONS: Patients with carpal tunnel syndrome present earlier in the course of their disease than patients with cubital tunnel syndrome. Patients with cubital tunnel syndrome are more likely to present with muscle atrophy, reflecting advanced nerve damage that may not respond to surgery.     

Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel

PURPOSE: Ulnar neuropathy at the cubital tunnel (UCT) is diagnosed on the basis of history, physical examination, and nerve conduction studies (NCSs); however, the wide spectrum of findings often makes the diagnosis difficult. The purpose of this study was to document the ultrasonographic differences in ulnar nerve size between patients with UCT and control subjects, and to correlate those differences with clinical examination findings and NCS abnormalities, thereby testing the validity of ultrasound (US) as an additional adjunct diagnostic modality for UCT. METHODS: Fifteen elbows in 14 patients with symptoms, clinical examination, and NCS findings consistent with UCT had US of the ulnar nerve. Patients were excluded if they had a history of polyneuropathy, acute trauma involving the upper extremity, previous trauma in the region of the elbow (including previous surgery), or brachial plexus injury. The control group consisted of 60 elbows from 30 normal volunteers that also had US. Maximal cross-sectional areas (CSAs) were measured and compared for the 2 groups and a correlation analysis was performed between nerve size and NCS findings. RESULTS: The average CSA of the ulnar nerve was 0.065 cm(2) in the control group, whereas in the UCT group it was 0.19 cm(2), indicating a significant statistical difference in ulnar nerve size between the 2 groups. The Pearson correlation coefficient between motor nerve conduction velocity of the ulnar nerve and the CSA was 0.80. CONCLUSIONS: High-resolution US is a noninvasive, safe, and reliable modality for imaging the ulnar nerve at the elbow and it may provide a valuable adjunct to NCS in the diagnosis of UCT.     

肘管综合征的病因及治疗体会

目的 探讨肘管综合征的发病因素、治疗方法及临床效果。方法 32例(33侧)均行手术治疗，对其病因、治疗和随访结果进行分析。结果 随诊19例，随访6个月～4年：尺神经功能改善：优9例，良7例，差3例。结论 肘管综合征应早期诊断，早期行尺神经减压松解、前移术，术后效果满意。     

Posttraumatic ulnar neuropathy versus non-traumatic cubital tunnel syndrome: Clinical features and response to surgery

Summary The outcome of 53 patients operated on either for posttraumatic ulnar neuropathy (PUN) or non-traumatic cubital tunnel syndrome (CTS) was reviewed after 3 years follow-up. Results were analyzed and compared considering the surgical technique used (neurolysis versus anterior transposition or combined) and a variety of clinical features that could influence outcome after nerve release. In the whole series, excellent outcome was obtained in 39 patients (73%). No major differences were found with the different surgical procedures. Slightly better results, but no statistically significant, were found in cases with CTS. As to clinical parameters, patients with CTS had a higher mean age, a shorter duration of symptoms and most were men. The presence of symptoms for more than one year before operation significantly diminished the chance of satisfactory recovery in cases with CTS, but not in those with PUN. For both CTS- and PUN-cases with symptoms for more than one year, neurolysis plus anterior transposition was the more useful technique. Our study shows that CTS and PUN differ to a certain extent in their clinical profile, electrophysiological findings and response to different surgical approaches and hence can be considered as two different clinical entities.