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[1]靳國強,趙蕾,韓宗昌,等.前內側入路與后內側入路尺神經松解前置術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.
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前內側入路與后內側入路尺神經松解前置術治療肘管綜合征的對比研究()
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《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; 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
關鍵詞:
肘管綜合征;  尺神經;  手術入路;  臨床試驗
Keywords:
cubital tunnel syndrome;  ulnar nerve;  operative approach;  clinical trial
摘要:
目的:比較前內側入路與后內側入路尺神經松解前置術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,其中采用前內側入路尺神經松解前置術治療24例(前內側入路組),采用后內側入路尺神經松解前置術治療22例(后內側入路組)。男39例,女7例。年齡45～68歲,中位數(shù)55歲。左側21例,右側25例。按照肘管綜合征的Dellon分級標準,中度31例、重度15例。病程6～25個月,中位數(shù)13個月。比較2組患者的手術時間、切口長度、小指指腹兩點辨別覺、患手握力及術后并發(fā)癥發(fā)生情況。結果:前內側入路組的手術時間與后內側入路組比較,差異無統(tǒng)計學意義[(33.5±5.8)min,(33.8±4.7)min,t=0.609,P=0.546]; 切口長度短于后內側入路組[(10.0±1.8)cm,(13.0±1.9)cm,t=3.872,P=0.007]。所有患者均獲隨訪,隨訪時間25～37個月,中位數(shù)29個月。所有患者切口均愈合。術前2組患者的小指指腹兩點辨別覺比較,差異無統(tǒng)計學意義(t=-0.205,P=0.838); 末次隨訪時,2組患者的小指指腹兩點辨別覺均較術前改善[(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組末次隨訪時的小指指腹兩點辨別覺比較,差異無統(tǒng)計學意義(t=-0.206,P=0.837)。術前2組患者的患手握力比較,差異無統(tǒng)計學意義(t=-1.941,P=0.060); 末次隨訪時,2組患者的患手握力均較術前增強[(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組末次隨訪時的患手握力比較,差異無統(tǒng)計學意義(t=1.647,P=0.107)。前內側入路組,1例出現(xiàn)切口周圍皮膚麻木,未進行特殊治療,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。后內側入路組,1例出現(xiàn)肘部和前臂背側疼痛,采用營養(yǎng)神經藥物治療后改善; 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)計學意義(χ2=0.402,P=0.238)。結論:前內側入路與后內側入路尺神經松解前置術治療肘管綜合征,兩者的臨床療效和安全性相當,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).

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相似文獻/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用與研究進展[J].中醫(yī)正骨,2022,34(04):33.
[3]李建華,宿曉雷,余航,等.小切口尺神經原位有限松解術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項目(國中醫(yī)藥人教發(fā)〔2014〕20號)通訊作者:靳國強 E-mail:[email protected]
更新日期/Last Update: 2019-08-15