Kim Daniel H, Han Kisoo, Tiel Robert L, Murovic Judith A, Kline David G
Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
J Neurosurg. 2003 May;98(5):993-1004. doi: 10.3171/jns.2003.98.5.0993.
In this article the authors present a retrospective analysis of 654 surgical outcomes in patients with ulnar nerve entrapments, injuries, and tumors during a 30-year period.
Data were gathered between 1968 and 1998 at Louisiana State University Health Sciences Center. Mechanisms of injuries or lesions included 460 entrapments at the elbow level (70%), 76 lacerations (12%), 52 stretches/contusions (8%), 34 fractures/dislocations (5%), 12 gunshot wounds (2%), two injection-induced injuries (0.3%), and 13 nerve sheath tumors (2%). In cases of entrapment, direct operative recordings uniformly demonstrated a slowing of conduction at the elbow, even in cases in which preoperative noninvasive studies had been nondiagnostic. Intraoperative electrical "inching" studies also demonstrated significant conduction abnormalities that lie just proximal to and through the olecranon notch rather than distal, beneath the flexor carpi ulnaris muscle. There were only eight exceptions to this. Lesions not in continuity due to the injury required primary or secondary end-to-end sutures or graft repair. Aided by intraoperative nerve action potential recording, lesions in continuity received either external or internal neurolysis and split repair or resection followed by end-to-end suture or graft repair. Functional recoveries of Grade 3 or better were seen in 81 (92%) of 88 patients who underwent neurolysis, 42 (72%) of 58 patients who received suture repair, and 24 (67%) of 36 patients who received graft repair. Nevertheless, fewer Grade 4 or 5 recoveries were reached than those seen in patients with radial or median nerve injuries. Nerve sheath tumors were resected with preservation of preoperative function in five of seven patients.
Although difficult to obtain, useful functional recovery can be achieved with proper surgical management of ulnar nerve entrapments and injuries.
本文作者对30年间尺神经卡压、损伤及肿瘤患者的654例手术结果进行回顾性分析。
数据收集于1968年至1998年期间的路易斯安那州立大学健康科学中心。损伤或病变机制包括460例肘部卡压（70%）、76例撕裂伤（12%）、52例牵拉伤/挫伤（8%）、34例骨折/脱位（5%）、12例枪伤（2%）、2例注射性损伤（0.3%）以及13例神经鞘瘤（2%）。在卡压病例中，直接手术记录均显示肘部传导减慢，即使术前无创检查未明确诊断的病例也是如此。术中电“逐段”研究还显示，显著的传导异常位于鹰嘴切迹近端及穿过该切迹处，而非尺侧腕屈肌下方的远端。仅有8例例外。因损伤导致不连续的病变需进行一期或二期端端缝合或移植修复。在术中神经动作电位记录的辅助下，连续的病变接受外部或内部神经松解及劈开修复，或切除后进行端端缝合或移植修复。接受神经松解的88例患者中，81例（92%）功能恢复达3级或更好；接受缝合修复的58例患者中，42例（72%）；接受移植修复的36例患者中，24例（67%）。然而，与桡神经或正中神经损伤患者相比，达到4级或5级恢复的患者较少。7例患者中的5例神经鞘瘤切除后保留了术前功能。
尽管难以实现，但对尺神经卡压和损伤进行适当的手术处理可实现有效的功能恢复。
