Black B T, Barron O A, Townsend P F, Glickel S Z, Eaton R G
C.V. Starr Hand Surgery Center and St. Luke's-Roosevelt Hospital, New York, NY 10025, USA.
J Bone Joint Surg Am. 2000 Nov;82(11):1544-51. doi: 10.2106/00004623-200011000-00005.
Anterior transposition of the ulnar nerve at the elbow produces generally good results regardless of whether the nerve is transposed subcutaneously, intramuscularly, or submuscularly. The eventual recovery of nerve function is related less to the specific surgical technique than to the severity of the intrinsic nerve pathology. A primary variable in surgical management is the duration of postoperative elbow immobilization. The purpose of this study was to review the longterm results of a specific technique of subcutaneous anterior transposition of the ulnar nerve that utilizes a stabilizing fasciodermal sling. The study compared the results of immediate and late institution of a range of motion postoperatively.
Forty-seven patients with fifty-one elbows were reexamined, by an investigator who had not been involved in their treatment, at a minimum of two years (range, twenty-four months to fourteen years) after an anterior transposition. Of the fifty-one elbows, twenty-one were immobilized for two to three weeks whereas thirty were managed with an immediate range of motion.
At the latest follow-up evaluation, there were occasional, mild paresthesias in 16 percent of the limbs and there was still subjective weakness of 19 percent. Both pinch and grip strength had increased substantially. No patient had lost elbow motion. A positive Tinel sign persisted in 31 percent of the limbs, but it was mildly positive in most of them. The elbow flexion test was uniformly negative. The results for 92 percent of the limbs were satisfactory to the patients, who stated that they would undergo the same procedure again if necessary. Overall, 73 percent of the limbs had an excellent result; 18 percent, a good result; 4 percent, a fair result; and 6 percent, a poor result. With the numbers available, no significant difference could be detected, with regard to these outcomes, between the group managed with elbow immobilization and that managed with immediate elbow mobilization. However, patients treated with a postoperative cast returned to work at an average of thirty days after surgery whereas the group treated with immediate motion of the elbow returned to work at an average of ten days.
This technique of stabilized subcutaneous anterior transposition of the ulnar nerve yielded predictably good results for a wide spectrum of patients. Patients returned to their occupation sooner when the elbow had been mobilized immediately.
无论尺神经是在皮下、肌内还是肌下移位，肘部尺神经前移位术通常都能取得较好的效果。神经功能的最终恢复与其说是与特定的手术技术有关，不如说是与内在神经病变的严重程度有关。手术治疗中的一个主要变量是术后肘部固定的持续时间。本研究的目的是回顾一种利用稳定的筋膜皮吊带进行尺神经皮下前移位的特定技术的长期结果。该研究比较了术后立即和延迟进行活动范围训练的结果。
47例患者的51个肘部在进行前移位术后至少两年（范围为24个月至14年）由未参与其治疗的研究者进行复查。在这51个肘部中，21个固定两到三周，而30个则立即进行活动范围训练。
在最近的随访评估中，16%的肢体偶尔有轻度感觉异常，19%仍有主观无力感。捏力和握力均有显著增加。没有患者肘部活动丧失。31%的肢体Tinel征阳性，但大多数为轻度阳性。屈肘试验均为阴性。92%的肢体结果让患者满意，患者表示如有必要会再次接受相同的手术。总体而言，73%的肢体结果优秀；18%良好；4%尚可；6%较差。就现有数据而言，在这些结果方面，肘部固定组和立即进行肘部活动组之间未发现显著差异。然而，术后使用石膏固定的患者平均在术后30天恢复工作，而立即进行肘部活动的组平均在术后10天恢复工作。
这种稳定的尺神经皮下前移位技术对广泛的患者产生了可预测的良好效果。肘部立即活动时患者恢复工作更快。
