Luo Shixing, Zhao Jinmin, Su Wei, Li Xiaofeng
Department of Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi 530021, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 May;24(5):577-80.
To evaluate and compare the efficacy of anterior subcutaneous and submuscular transposition of the ulnar nerve in treating cubital tunnel syndrome.
From August 2006 to August 2008, 66 patients with cubital tunnel syndrome were treated with anterior subcutaneous transposition (subcutaneous group, 24 cases) and with anterior submuscular transposition (submuscular group, 42 cases). According to McGowan stages, all patients were at Stage 2 or 3 entrapment neuropathy with paresthesia in the ring and small fingers. Respectively, 3 cases and 8 cases complicated by interosseous muscle atrophy in subcutaneous group and in submuscular group. No significant difference was found in gender, age, duration of the disease, and complication between two groups (P < 0.05). The surgical features, distribution of Bishop rates, two-point discrimination test, muscular strength, and complications were recorded.
The operation time was (28.4 +/- 5.2) minutes in subcutaneous group and (43.8 +/- 5.6) minutes in submuscular group, showing significant difference (P < 0.01). The incision length was (12.2 +/- 2.5) cm in subcutaneous group and (13.6 +/- 2.8) cm in submuscular group, showing significant difference (P < 0.05). All patients were followed up 1-3 years. According to Bishop scoring system, the results were excellent in 18 cases, good in 4 cases, and poor in 2 cases in subcutaneous group; excellent in 36 cases, good in 3 cases, and poor in 3 cases in submuscular group; and showing no significant difference between two groups (P > 0.05). At 6 months postoperatively, two-point discrimination and grip strength were improved when compared with that of preoperation (P < 0.05), but there was no significant difference between two groups (P > 0.05). Pain and dysesthesia of the scar were noted in 1 patient of the subcutaneous group and 3 patients of the submuscular group. No infection or hematoma was found and no patient needed reoperation.
Both operative methods are effective alternative for treating cubital tunnel syndrome. The anterior subcutaneous anterior transposition of the ulnar nerve has fewer traumas, and it is a better choice for some old patients.
评估并比较尺神经皮下前置术和肌下前置术治疗肘管综合征的疗效。
2006年8月至2008年8月，66例肘管综合征患者分别接受皮下前置术（皮下组，24例）和肌下前置术（肌下组，42例）治疗。根据麦高恩分期，所有患者均为2期或3期卡压性神经病，伴有环指和小指感觉异常。皮下组和肌下组分别有3例和8例合并骨间肌萎缩。两组患者在性别、年龄、病程及并发症方面差异无统计学意义（P>0.05）。记录手术特点、毕晓普评分分布、两点辨别觉测试、肌力及并发症情况。
皮下组手术时间为（28.4±5.2）分钟，肌下组为（43.8±5.6）分钟，差异有统计学意义（P<0.01）。皮下组切口长度为（12.2±2.5）cm，肌下组为（13.6±2.8）cm，差异有统计学意义（P<0.05）。所有患者均随访1 - 3年。根据毕晓普评分系统，皮下组优18例，良4例，差2例；肌下组优36例，良3例，差3例；两组差异无统计学意义（P>0.05）。术后6个月，两点辨别觉和握力较术前改善（P<0.05），但两组间差异无统计学意义（P>0.05）。皮下组有1例患者出现瘢痕疼痛和感觉异常，肌下组有3例。未发现感染或血肿，无患者需要再次手术。
两种手术方法都是治疗肘管综合征的有效选择。尺神经皮下前置术创伤较小，对于一些老年患者是较好的选择。
