Bultmann C
Klinik für Handchirurgie, Rhönklinikum, Bad Neustadt/Saale.
Handchir Mikrochir Plast Chir. 2009 Feb;41(1):28-34. doi: 10.1055/s-0029-1185289. Epub 2009 Feb 17.
Aim of this study was to evaluate our own results after endoscopic decompression of the ulnar nerve in cubital tunnel syndrome (CuTS) and to compare them with those in the literature.
Between April 2005 and April 2006 52 patients with clinically and neurologically verified CuTS received an endoscopic decompression of the ulnar nerve. Patients with concomitant pathology or recurrent disease were excluded. Pre- and postoperatively, the history was taken and an extensive clinical examination was carried out. Grip strength and pinch strength were measured, as was the static two-point discrimination. All ulnar nerve-innervated muscles were tested for their neurological muscle power. Tinel's sign, Froment's sign and the elbow flexion test were examined. Nerve subluxation was documented. All patients underwent nerve conduction studies with documentation of the velocity distal and proximal of the cubital tunnel. 47 patients (90%) were available for re-evaluation after eight months. The results were evaluated using the Dellon classification and the modified Bishop rating system. According to the Dellon classification 10 patients had mild, 21 moderate and 16 severe CuTS. Statistical significance was verified using the Wilcoxon test. All operations, as described by Hoffmann and Siemionow, were performed only by the author.
In 94% of the followed patients sensibility was normalised. Grip strength improved from 75% of the contralateral side to 94%. The proximal nerve conduction velocity improved significantly postoperatively. According to the modified Bishop rating system 31 patients (66%) had an excellent, 15 patients (32%) a good and 1 patient (2%) a fair result. There were no poor results. On average, patients reached 7.7 points on the Bishop scale; those patients with stage Dellon III alone reached 7.5 points. Complications included subcutaneous harmless haematomas in 4% of all cases and a laceration of a single motor branch of the ulnar nerve innervating the flexor carpi ulnaris in two patients with restitutio ad integrum.
In this study endoscopic decompression of the ulnar nerve in CuTS proved to be a patient-oriented and excellent method with very good, reproducible results, even in Dellon III patients.
本研究旨在评估我们自己对肘管综合征（CuTS）患者行尺神经内镜减压术后的结果，并与文献中的结果进行比较。
2005年4月至2006年4月期间，52例经临床和神经学检查确诊为CuTS的患者接受了尺神经内镜减压术。排除伴有其他病变或复发性疾病的患者。术前和术后均采集病史并进行全面的临床检查。测量握力和捏力，以及静态两点辨别觉。对所有由尺神经支配的肌肉进行神经肌肉力量测试。检查Tinel征、Froment征和屈肘试验。记录神经半脱位情况。所有患者均接受神经传导研究，记录肘管远侧和近侧的速度。47例患者（90%）在8个月后可进行重新评估。结果采用Dellon分类法和改良的Bishop评分系统进行评估。根据Dellon分类法，10例患者为轻度CuTS，21例为中度，16例为重度。采用Wilcoxon检验验证统计学意义。所有手术均按照Hoffmann和Siemionow所描述的方法，仅由作者本人进行。
在94%的随访患者中，感觉恢复正常。握力从对侧的75%提高到94%。术后近端神经传导速度显著提高。根据改良的Bishop评分系统，31例患者（66%）结果优秀，15例患者（32%）结果良好，1例患者（2%）结果尚可。无结果差的情况。患者在Bishop量表上平均得分为7.7分；仅为Dellon III期的患者得分为7.5分。并发症包括所有病例中有4%出现皮下无害血肿，2例患者尺神经支配尺侧腕屈肌的单一运动支发生撕裂，均已完全恢复。
在本研究中，CuTS患者行尺神经内镜减压术被证明是一种以患者为导向的优秀方法，即使对于Dellon III期患者也能取得非常好且可重复的结果。
