84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]靳國強(qiáng),趙蕾,韓宗昌,等.前內(nèi)側(cè)入路與后內(nèi)側(cè)入路尺神經(jīng)松解前置術(shù)治療肘管綜合征的對比研究[J].中醫(yī)正骨,2019,31(08):20-24.
　JIN Guoqiang,ZHAO Lei,HAN Zongchang,et al.A retrospective trial of ulnar nerve neurolysis and anterior transposition through anteromedial approach versus posteromedial approach for treatment of cubital tunnel syndrome[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(08):20-24.
點(diǎn)擊復(fù)制

前內(nèi)側(cè)入路與后內(nèi)側(cè)入路尺神經(jīng)松解前置術(shù)治療肘管綜合征的對比研究()
分享到：

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年08期
頁碼:
20-24
欄目:
臨床研究
出版日期:
2019-08-20

文章信息/Info

Title:
A retrospective trial of ulnar nerve neurolysis and anterior transposition through anteromedial approach versus posteromedial approach for treatment of cubital tunnel syndrome
作者:
靳國強(qiáng); 趙蕾; 韓宗昌; 孟憲杰
(河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002)
Author(s):
JIN Guoqiang; ZHAO Lei; HAN Zongchang; MENG Xianjie
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關(guān)鍵詞:
肘管綜合征;  尺神經(jīng);  手術(shù)入路;  臨床試驗(yàn)
Keywords:
cubital tunnel syndrome;  ulnar nerve;  operative approach;  clinical trial
摘要:
目的:比較前內(nèi)側(cè)入路與后內(nèi)側(cè)入路尺神經(jīng)松解前置術(shù)治療肘管綜合征的臨床療效及安全性。方法:回顧性分析46例肘管綜合征患者的病例資料,其中采用前內(nèi)側(cè)入路尺神經(jīng)松解前置術(shù)治療24例(前內(nèi)側(cè)入路組),采用后內(nèi)側(cè)入路尺神經(jīng)松解前置術(shù)治療22例(后內(nèi)側(cè)入路組)。男39例,女7例。年齡45～68歲,中位數(shù)55歲。左側(cè)21例,右側(cè)25例。按照肘管綜合征的Dellon分級標(biāo)準(zhǔn),中度31例、重度15例。病程6～25個月,中位數(shù)13個月。比較2組患者的手術(shù)時(shí)間、切口長度、小指指腹兩點(diǎn)辨別覺、患手握力及術(shù)后并發(fā)癥發(fā)生情況。結(jié)果:前內(nèi)側(cè)入路組的手術(shù)時(shí)間與后內(nèi)側(cè)入路組比較,差異無統(tǒng)計(jì)學(xué)意義[(33.5±5.8)min,(33.8±4.7)min,t=0.609,P=0.546]; 切口長度短于后內(nèi)側(cè)入路組[(10.0±1.8)cm,(13.0±1.9)cm,t=3.872,P=0.007]。所有患者均獲隨訪,隨訪時(shí)間25～37個月,中位數(shù)29個月。所有患者切口均愈合。術(shù)前2組患者的小指指腹兩點(diǎn)辨別覺比較,差異無統(tǒng)計(jì)學(xué)意義(t=-0.205,P=0.838); 末次隨訪時(shí),2組患者的小指指腹兩點(diǎn)辨別覺均較術(shù)前改善[(8.7±1.2)mm,(5.2±0.8)mm,t=11.190,P=0.000;(8.9±1.1)mm,(5.3±0.7)mm,t=14.674,P=0.000]; 2組末次隨訪時(shí)的小指指腹兩點(diǎn)辨別覺比較,差異無統(tǒng)計(jì)學(xué)意義(t=-0.206,P=0.837)。術(shù)前2組患者的患手握力比較,差異無統(tǒng)計(jì)學(xué)意義(t=-1.941,P=0.060); 末次隨訪時(shí),2組患者的患手握力均較術(shù)前增強(qiáng)[(21.6±3.0)N,(31.5±2.7)N,t=-16.237,P=0.000;(21.7±2.8)N,(30.9±2.9)N,t=-11.413,P=0.000]; 2組末次隨訪時(shí)的患手握力比較,差異無統(tǒng)計(jì)學(xué)意義(t=1.647,P=0.107)。前內(nèi)側(cè)入路組,1例出現(xiàn)切口周圍皮膚麻木,未進(jìn)行特殊治療,自行緩解; 1例出現(xiàn)切口周圍瘢痕組織增生,采用自粘性軟聚硅酮敷料貼敷后改善。后內(nèi)側(cè)入路組,1例出現(xiàn)肘部和前臂背側(cè)疼痛,采用營養(yǎng)神經(jīng)藥物治療后改善; 1例出現(xiàn)切口周圍瘢痕組織增生,采用自粘性軟聚硅酮敷料貼敷后改善。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.402,P=0.238)。結(jié)論:前內(nèi)側(cè)入路與后內(nèi)側(cè)入路尺神經(jīng)松解前置術(shù)治療肘管綜合征,兩者的臨床療效和安全性相當(dāng),但前者的創(chuàng)傷更小。
Abstract:
Objective:To compare the clinical curative effects and safety of ulnar nerve neurolysis and anterior transposition through anteromedial approach versus posteromedial approach for treatment of cubital tunnel syndrome(CTS).Methods:The medical records of 46 patients with CTS were analyzed retrospectively.Twenty-four patients were treated with ulnar nerve neurolysis and anterior transposition through anteromedial approach(anteromedial approach group),while the others were treated with ulnar nerve neurolysis and anterior transposition through posteromedial approach(posteromedial approach group).The patients consisted of 39 males and 7 females,and ranged in age from 45 to 68 years(Median=55 yrs)and in disease course from 6 to 25 months(Median=13 months).The CTS located at left elbow for 21 patients and right elbow for 25 patients.According to Dellon classification criteria,the CTS belonged to moderate-grade(31)and severe-grade(15).The operative time,incision length,two-point discrimination(2PD)in pulp of little finger,hand grip strength of affected side and postoperative complications were recorded and compared between the 2 groups respectively.Results:There was no statistical difference in operative time between anteromedial approach group and posteromedial approach group(33.5+/-5.8 vs 33.8+/-4.7 min,t=0.609,P=0.546).

參考文獻(xiàn)/References:

[1] PALMER B A,HUGHES T B.Cubital tunnel syndrome[J].J Hand Surg Am,2010,35(1):153-163.
[2] 張紅,霍曉明,齊華光,等.高頻超聲在肘管綜合征診斷中的應(yīng)用[J].中醫(yī)正骨,2016,28(6):28-30.
[3] 童勁松,董震.肘管綜合征術(shù)式的研究進(jìn)展[J].中國修復(fù)重建外科雜志,2016,30(9):1166-1169.
[4] LASCAR T,LAULAN J.Cubital tunnel syndrome:a retrospective review of 53 anterior subcutaneous transposi-tions[J].J Hand Surg Br,2000,25(5):453-456.
[5] 趙飛,張博聞,黃永祿,等.尺神經(jīng)皮下前置與筋膜下前置治療肘管綜合征[J].中華手外科雜志,2017,33(6):461-463.
[6] 周炎,豐峰,瞿新叢,等.兩種尺神經(jīng)前置方法治療肘管綜合的療效比較[J].中國修復(fù)重建外科雜志,2012,26(4):429-432.
[7] 常文凱,黃熠東,黃龍,等.尺神經(jīng)不對稱前置術(shù)治療肘管綜合征[J].中華手外科雜志,2018,34(5):353-355.
[8] 趙民,邵新中,吳金英,等.尺神經(jīng)原位松解術(shù)與尺神經(jīng)松解皮下前置術(shù)治療肘管綜合征的療效比較[J].實(shí)用手外科雜志,2016,30(4):413-415.
[9] 趙曉非,李春游,靳國強(qiáng),等.尺神經(jīng)肌膜瓣下前置聯(lián)合可吸收醫(yī)用膜包裹治療肘管綜合征[J].中醫(yī)正骨,2013,25(10):75-76.
[10] 李俊明,李艷華,宛磊,等.改良肌筋膜瓣固定尺神經(jīng)前置術(shù)[J].中國矯形外科雜志,2018,26(11):1048-1052.
[11] 孫良智,欒素嫻,孫建民,等.帶血管蒂尺神經(jīng)肌筋膜下前置術(shù)治療中度肘管綜合征[J].中國矯形外科雜志,2017,25(5):399-403.
[12] AZAR F M,BEATY J H,CANALE S T.坎貝爾骨科手術(shù)學(xué)[M].唐佩福,王巖,盧世壁,譯.13版.北京:北京大學(xué)醫(yī)學(xué)出版社,2018:3018.
[13] 顧玉東.腕管綜合征與肘管綜合征的臨床分型現(xiàn)狀與建議[J].中華骨科雜志,2011,31(7):818-819.
[14] 顧玉東,王澍寰,侍德.手外科手術(shù)學(xué)[M].2版.上海:復(fù)旦大學(xué)出版社,2010:707-708.
[15] 高士濂.實(shí)用解剖圖譜·上肢分冊[M].3版.上海:上海科學(xué)技術(shù)出版社,2012:178.
[16] QING C,ZHANG J,WU S,et al.Clinical classification and treatment of cubital tunnel syndrome[J].Exp Ther Med,2014,8(5):1365-1370.
[17] JARIWALA A,BANSAL N,NICOL G M,et al.Outcome analysis of cubital tunnel decompression[J].Scott Med J,2015,60(3):136-140.
[18] 高凱鳴,勞杰,趙新,等.帶血管蒂尺神經(jīng)前置術(shù)治療重度肘管綜合征的臨床療效觀察[J].中華手外科雜志,2017,33(6):458-460.
[19] 任鵬,阿不來提·阿不拉,程二林,等.尺神經(jīng)松解前置聯(lián)合手內(nèi)在肌重建治療重度肘管綜合征[J].中國修復(fù)重建外科雜志,2016,30(5):604-607.
[20] VERVELD C J,DANOFF J R,LOMBARDI J M,et al.Adipose flap versus fascial sling for anterior subcutaneous transposition of the ulnar nerve[J].Am J Orthop(Belle Mead NJ),2016,45(2):89-94.
[21] HUANG W,ZHANG P X,PENG Z,et al.Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome[J].Neural Regen Res,2015,10(10):1690-1695.
[22] SOLTANI A M,BEST M J,FRANCIS C S,et al.Trends in the surgical treatment of cubital tunnel syndrome:an analysis of the national survey of ambulatory surgery database[J].J Hand Surg Am,2013,38(8):1551-1556.
[23] LEE S K,SHARMA S,SILVER B A,et al.Submuscular versus subcutaneous anterior ulnar nerve transposition:a rat histologic study[J].J Hand Surg Am,2009,34(10):1811-1814.
[24] MACADAM S A,GANDHI R,BEZUHLY M,et al.Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome:a meta-analysis[J].J Hand Surg Am,2008,33(8):1314.e1-1314.e12.
[25] 林海濱,林澗,鄭曉暉,等.前臂內(nèi)側(cè)皮神經(jīng)營養(yǎng)血管遠(yuǎn)端蒂皮瓣的臨床應(yīng)用[J].中國臨床解剖學(xué)雜志,2008,26(3):335-337.
[26] 施娣,劉鴻,劉雷,等.前臂皮神經(jīng)與淺靜脈解剖學(xué)研究[J].中華實(shí)驗(yàn)外科雜志,2015,32(12):3132-3134.
[27] 路云翔,陳郁鮮,沈俊,等.保留前臂內(nèi)側(cè)皮神經(jīng)后支的尺神經(jīng)松解前置術(shù)治療肘管綜合征12例[J].中華顯微外科雜志,2014,37(2):208.
[28] SARRIS I,G?BEL F,GAINER M,et al.Medial brachial and antebrachial cutaneous nerve injuries:effect on outcome in revision cubital tunnel surgery[J].J Reconstr Microsurg,2002,18(8):665-670.(收稿日期:2019-06-07 本文編輯:郭毅曼)

相似文獻(xiàn)/References:

[1]張紅,霍曉明,齊華光,等.高頻超聲在肘管綜合征診斷中的應(yīng)用[J].中醫(yī)正骨,2016,28(06):28.
[2]段小圓,邢國勝,趙文君,等.超聲檢查在肘管綜合征診療中的應(yīng)用與研究進(jìn)展[J].中醫(yī)正骨,2022,34(04):33.
[3]李建華,宿曉雷,余航,等.小切口尺神經(jīng)原位有限松解術(shù)治療中重度肘管綜合征[J].中醫(yī)正骨,2025,37(02):66.

備注/Memo

備注/Memo:
基金項(xiàng)目:國家中醫(yī)藥管理局全國名老中醫(yī)藥專家傳承工作室建設(shè)項(xiàng)目(國中醫(yī)藥人教發(fā)〔2014〕20號)通訊作者:靳國強(qiáng) E-mail:[email protected]
更新日期/Last Update: 2019-08-15