Alnot J Y, Frajman J M
Département de Chirurgie du Membre Supérieur, Hôpital Bichat, Paris.
Ann Chir Main Memb Super. 1992;11(1):5-13. doi: 10.1016/s0753-9053(05)80046-8.
Seventy-four patients were operated at Bichat hospital for chronic ulnar nerve entrapment at the elbow between 1982 and 1988. For 62 of them, the etiology of the compression was idiopathic and these cases were treated by neurolysis only or, if the nerve was unstable, by neurolysis associated with medial epicondylectomy. For 12 of them, the etiology of the compression was post-traumatic and these cases were treated by anterior subcutaneous transposition of the nerve using a fat sling. The average follow-up is 28 months and the results take into account the clinical preoperative grading according Mac Gowan's classification: grade I subjective symptoms combined with hypoesthesia in ulnar fingers grade II: weakness and wasting of the interossei combined with subjective symptoms, grade III: marked weakness and wasting of the interossei, adductor pollicis, and hypothenar muscles combined with anesthesia in ulnar fingers. The 62 idiopathic compressions treated by neurolysis only or, if the nerve was unstable, by neurolysis associated with medial epicondylectomy showed 51 very good and good results. The 12 post-traumatic compressions treated by anterior subcutaneous transposition of the nerve using a fat sling showed 9 very good and good results. The authors stress the importance of their approach which takes account of the clinical preoperative grading and the etiology of the compression in order to apply correct surgical treatment.
1982年至1988年间，74例患者在比沙医院接受了肘部慢性尺神经卡压手术。其中62例患者卡压病因不明，这些病例仅通过神经松解术治疗，或者如果神经不稳定，则通过神经松解术联合内侧上髁切除术治疗。另外12例患者卡压病因是创伤后，这些病例采用脂肪吊带行神经前皮下移位术治疗。平均随访时间为28个月，结果考虑了术前根据麦高恩分类法进行的临床分级：I级为主观症状合并尺侧手指感觉减退；II级为骨间肌无力和萎缩合并主观症状；III级为骨间肌、拇收肌和小鱼际肌明显无力和萎缩合并尺侧手指感觉缺失。仅通过神经松解术治疗的62例特发性卡压病例，或者如果神经不稳定，则通过神经松解术联合内侧上髁切除术治疗的病例中，有51例效果非常好或良好。采用脂肪吊带行神经前皮下移位术治疗的12例创伤后卡压病例中，有9例效果非常好或良好。作者强调了他们的治疗方法的重要性，该方法考虑了术前临床分级和卡压病因，以便实施正确的手术治疗。
