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内镜辅助下尺神经松解术治疗肘管综合征。

Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome.

机构信息

Unit of Neurosurgery, Hospital de Base do Distrito Federal, Asa Norte, Brasília 70853-060 Distrito Federal, Brazil.

出版信息

Acta Neurochir (Wien). 2010 Apr;152(4):619-25. doi: 10.1007/s00701-009-0578-9. Epub 2009 Dec 22.

Abstract

PURPOSE

Recently, the simple decompression of the ulnar nerve has been advocated as the best surgical approach for the treatment of the cubital tunnel syndrome. Encouraged by the positive results observed with the use of the endoscopic approach for the treatment of the carpal tunnel syndrome, there have been reports about the use of endoscopes for decompression of the ulnar nerve at the level of the elbow since 1999. The objective of this study was to demonstrate the surgical results obtained with a simple and replicable technique employed for endoscopic release of the ulnar nerve in cases of cubital tunnel syndrome.

METHODS

It was retrospectively studied thirteen patients who presented signs and symptoms of cubital tunnel syndrome and who were operated on by an endoscopically assisted technique, from 2007 to 2009. The approach included the use of a 0 degrees lens neuroendoscope usually employed for ventricular endoscopy. Preoperative clinical and electrophysiological data were collected and compared to those observed 6 months after the surgery. The Dellon's scale was used for rating the severity of the lesions, and the postoperative outcome was assessed based on the Bishop rating system.

RESULTS

All procedures were completed successfully via the endoscopically assisted approach, and no surgery had to be converted to an open operation. Postoperatively, 76.9% of the cases were completely free of signs and symptoms (8 and 9 points on the Bishop scale), 15.3% presented with light complaints (7 points), and only one subject (7.6%) reached 5 points on the outcome scale. Complete normalization of the electrophysiological studies was also observed in seven patients, most of whom were classified preoperatively as Dellon's grades I and II, but three of whom were classified as grade III. Normalization of the sensory conduction studies was observed in ten cases, normalization of the motor conduction studies in six subjects, and in four patients, there was improvement in electromyographic parameters.

CONCLUSIONS

The endoscopically assisted approach for decompression of the ulnar nerve at the level of the elbow is a minimally invasive technique that demonstrated surgical results similar to those reported via the open approach. It may have additional advantages such as the reduction of soft tissue manipulation, faster mobilization of the arm, and quicker return of the patients to their daily activities.

摘要

目的

最近,单纯的尺神经减压被提倡为治疗肘管综合征的最佳手术方法。内镜治疗腕管综合征的积极效果鼓舞人们尝试内镜下治疗肘管综合征,自此之后,1999 年以来已有关于内镜下肘管尺神经减压的报道。本研究的目的是展示一种简单且可复制的技术的手术结果,该技术用于内镜下治疗肘管综合征的尺神经松解。

方法

回顾性研究了 2007 年至 2009 年间采用内镜辅助技术治疗的 13 例有肘管综合征症状和体征的患者。该方法包括使用通常用于脑室内镜的 0 度镜头神经内镜。收集术前临床和电生理数据,并与术后 6 个月的观察结果进行比较。采用 Dellon 量表评估病变严重程度,采用 Bishop 评分系统评估术后结果。

结果

所有手术均通过内镜辅助方法成功完成,无需转为开放手术。术后,76.9%的病例完全无任何症状和体征(Bishop 评分 8 或 9 分),15.3%的病例有轻微症状(7 分),只有 1 例(7.6%)的病例达到结局评分 5 分。7 例患者的电生理研究也完全正常,其中大多数患者术前为 Dellon 分级 I 和 II,但有 3 例为 III 级。10 例患者的感觉传导研究正常,6 例患者的运动传导研究正常,4 例患者的肌电图参数有所改善。

结论

内镜辅助下肘管尺神经减压是一种微创技术,其手术结果与开放手术相似。它可能具有额外的优势,如减少软组织操作、更快地活动手臂和更快地恢复患者的日常活动。

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