中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (10): 1690-1695.doi: 10.4103/1673-5374.167770

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

尺神经皮下前置改善中重度肘管综合征的神经功能

  

  • 收稿日期:2015-06-12 出版日期:2015-10-28 发布日期:2015-10-28
  • 基金资助:

    国家自然科学基金(31271284、31171150、81171146, 30971526, 31100860,31040043, 31371210);973项目(2014CB542200)

Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

Wei Huang, Pei-xun Zhang, Zhang Peng, Feng Xue, Tian-bing Wang*, Bao-guo Jiang*   

  1. Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing, China
  • Received:2015-06-12 Online:2015-10-28 Published:2015-10-28
  • Contact: Bao-guo Jiang, M.D., Ph.D. or Tian-bing Wang, M.D.,jiangbaoguo@vip.sina.com or wangtianbing@medmail.com.cn.
  • Supported by:

    This study was supported by grants from the National Program on Key Basic Research Project of China (973 Program), No. 2014CB542200; a grant from Innovation Program of Ministry of Education, No. IRT1201; the National Natural Science Foundation of China, No. 31271284, 31171150, 81171146, 30971526, 31100860, 31040043, 31371210; and Program for New Century Excellent Talents in University of Ministry of Education of China, No. BMU20110270.

摘要:

肘管综合征的治疗方式很多,但是最佳的手术治疗方式并不明确。为了评价尺神经皮下前置治疗中重度肘管综合征的疗效并分析与预后有关的因素,我们回顾性分析了手术治疗的中重度肘管综合征62例(65侧),均行尺神经皮下前置修复。修复前按照Goldberg改良的McGowan分型评估肘管综合征的严重程度:18侧(28%)为ⅡA型,20侧(31%)为ⅡB型,27侧(42%)为Ⅲ型。修复前、后患者臂肩手功能障碍评分和目测类比评分均显著降低。修复后按照Wilson-Krout标准评估疗效:38侧(58%)为优,16 侧(25%)为良,7侧(11%)为一般,4侧(6%)为差,优良率为83%。患者修复前肘管综合征的严重程度与修复后疗效成反比。与Wilson-Krout标准分型优、良组比较,一般、差组患者年龄更大,神经电生理检测显示其神经传导速度和动作电位波幅更低。结果证实尺神经皮下前置,治疗中重度肘管综合征修复神经损伤的效果安全有效,按疾病严重程度、年龄、神经电生理指标可以预测修复后效果。

关键词: 神经再生, 周围神经损伤, 尺神经压迫综合征, 电生理学, 神经传导速度, 感觉神经传导速度, 年龄, 治疗, 尺神经前置, 国家自然科学基金

Abstract:

Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients (65 elbows) diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial
severity of the disease was evaluated using the McGowan scale as modified by Goldberg: 18 patients (28%) had grade IIA neuropathy, 20 (31%) had grade IIB, and 27 (42%) had grade III. Postoperatively, according to the Wilson & Krout criteria, treatment outcomes were excellent in 38 patients (58%), good in 16 (25%), fair in 7 (11%), and poor in 4 (6%), with an excellent and good rate of 83%. A negative correlation was found between the preoperative McGowan grade and the postoperative Wilson & Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

Key words: nerve regeneration, peripheral nerve injury, ulnar nerve compression syndrome, age, motor nerve conduction velocity, electrophysiology, sensory nerve conduction velocity, modified McGowan scale, Wilson &, Krout criteria, anterior transposition, ulnar nerve, NSFC grant, neural regeneration