Beekman R, Wokke J H J, Schoemaker M C, Lee M L, Visser L H
Department of Neurology, Atrium Medical Center, PO Box 4446, 6401 CX Heerlen, The Netherlands.
Neurology. 2004 Nov 9;63(9):1675-80. doi: 10.1212/01.wnl.0000142535.24626.90.
To determine the outcome in patients with ulnar neuropathy at the elbow (UNE) treated surgically or conservatively, and the prognostic value of clinical, sonographic, and electrophysiologic features.
After a median follow-up of 14 months, 69 of 84 patients initially included in a prospective blinded study on the diagnostic value of sonography in UNE were re-evaluated. The patients underwent renewed systematic clinical and sonographic examination. Patients were scored as having a poor (stable or progressive symptoms) or favorable (complete remission of symptoms or improvement) outcome.
Of the 74 initially affected arms, 12 (16%) had a complete remission, 21 (28%) improved, 25 (34%) remained stable, and 16 (22%) had progression. Surgically treated patients (28 arms) had a more favorable outcome than those treated conservatively (p = 0.03). After surgery, the mean ulnar nerve diameter decreased from 3.2 to 2.9 mm (p = 0.03), while this was not seen after conservative treatment. Multiple logistic regression analysis showed that more outspoken nerve enlargement found during sonography at the time of the diagnosis was associated with a poor outcome (OR: 2.9, p = 0.009). Furthermore, the presence of a motor conduction block (OR: 0.2, p = 0.03) and motor velocity slowing across the elbow (OR: 0.1, p = 0.01) were associated with a favorable outcome.
More pronounced ulnar nerve thickening at the time of the diagnosis is associated with poor outcome at follow-up, especially in conservatively treated cases, while electrodiagnostic signs of demyelination on testing indicate favorable outcome.
确定接受手术或保守治疗的肘管综合征（UNE）患者的预后，以及临床、超声和电生理特征的预后价值。
在一项关于超声对UNE诊断价值的前瞻性盲法研究中，最初纳入的84例患者在中位随访14个月后，对其中69例进行了重新评估。患者接受了再次的系统临床和超声检查。根据患者的症状改善情况分为预后差（症状稳定或进展）或预后良好（症状完全缓解或改善）。
在最初受影响的74条手臂中，12条（16%）完全缓解，21条（28%）有所改善，25条（34%）保持稳定，16条（22%）病情进展。接受手术治疗的患者（28条手臂）比接受保守治疗的患者预后更好（p = 0.03）。手术后，尺神经平均直径从3.2毫米降至2.9毫米（p = 0.03），而保守治疗后未观察到这种情况。多因素logistic回归分析显示，诊断时超声检查发现更明显的神经增粗与预后不良相关（比值比：2.9，p = 0.009）。此外，存在运动传导阻滞（比值比：0.2，p = 0.03）和肘部运动速度减慢（比值比：0.1，p = 0.01）与预后良好相关。
诊断时尺神经增厚更明显与随访时预后不良相关，尤其是在保守治疗的病例中，而电诊断测试中的脱髓鞘迹象表明预后良好。
