中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (3): 519-524.doi: 10.4103/1673-5374.245479

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

严重肘管综合征无感觉神经传导时手术疗效

  

  • 出版日期:2019-03-15 发布日期:2019-03-15
  • 基金资助:

    国家自然科学基金(81371374)

Surgical treatment for severe cubital tunnel syndrome with absent sensory nerve conduction

Jin-Song Tong 1, 2, 3 , Zhen Dong 1, 2, 3 , Bin Xu 1, 2, 3 , Cheng-Gang Zhang 1, 2, 3 , Yu-Dong Gu 1, 2, 3   

  1. 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
    2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
    3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
  • Online:2019-03-15 Published:2019-03-15
  • Contact: Zhen Dong, MD, PhD, dongzhenhsh@163.com.
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. 81371374 (to ZD).

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摘要：

重度肘管综合征患者中，当尺神经感觉传导缺失时可能伴有更严重的神经损伤，据此推测此类患者一般预后较差。但既往此类报道极少，且研究结论不一，所以关于尺神经感觉传导缺失对于肘管综合征手术治疗效果的影响仍不明确。作者纳入了114例重度肘管综合征患者，其中88例患者尺神经感觉传导缺失，26例患者感觉传导可引出。所有患者均接受尺神经原位松解或皮下前置术修复，术后随访时间≥2年。患者整体手功能预后评估指标包括术后McGowan分级，Bishop评分和DASH评分。随访结果发现，对尺神经感觉传导缺失的重度肘管综合征患者，71例(80.7%)术后McGowan评级至少改善1级，76例(86.4%)术后Bishop评分为优良等级，DASH评分由术前平均49.5分改善为术后平均13.1分。与尺神经感觉传导可引出患者对比，此类患者表现出更差的术后McGowan评级和更高的DASH评分，但在Bishop评级上无显著差异。这些临床数据显示，对于尺神经感觉传导无法引出的重度肘管综合征患者，原位松解或皮下前置术均可以取得一定的临床疗效，但尺神经感觉传导无法引出时亦为重度肘管综合征患者手术治疗预后不良的危险因素。

orcid: 0000-0003-4433-5171(Zhen Dong)

关键词: 尺神经感觉传导缺失, 肘管综合征, 严重程度, 电生理检测, 原位松解, 皮下前置, 手术疗效, 预后分析, 周围神经卡压, 神经再生

Abstract:

For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects sur¬gical outcomes remains uncertain owing to a scarcity of reports and conflicting results. One hundred and fourteen cases (88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) were subjected to either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) score. For patients with absent sensory nerve action potential, 71 cases (80.7%) achieved at least one McGowan grade improvement, 76 hands (86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative Mc¬Gowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syn¬drome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Hua shan Hospital, Fudan University, China (approval No. 2017142).

Key words: nerve regeneration, absent sensory nerve action potential, cubital tunnel syndrome, disease severity, electrodiagnostic testing, in situ decompression, subcutaneous transposition, surgical outcomes, prognostic factors, peripheral nerve compression, neural regeneration