Department of Othorpaedics, The Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Department of Cardiology, The Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China.
Neurosurgery. 2019 Dec 1;85(6):E1068-E1075. doi: 10.1093/neuros/nyz239.
Intraneural ganglion (IG) cysts have been considered curiosities and their pathogenesis remains controversial.
To clarify ulnar nerve at the elbow (UNE) pathogenesis and long-term surgical outcomes by presenting 9 rare cases of IG of the UNE.
Surgical treatment of IG was performed. Clinical symptoms, physical examinations, and electromyogram were evaluated pre- and postoperatively. At least 4 yr of follow-up was performed.
The Tinel's sign became negative and local elbow pain disappeared in all 9 patients after surgery, and the average visual analog scale/score dropped from 4.9 (3-8) to 0 (0-0) after 6.2 d (2-10) on average. Two patients retained positive Froment test, "claw hand" and paresthesias with the 2-point discrimination much different from the contralateral little finger. Postoperative the UK Medical Research Council muscle strength score (MRC) grades of the flexor carpi ulnaris and the flexor digitorum profundus muscle of the fourth and fifth digits recovered to M4-M5 from M0-M2 in all 9 patients. The postoperative MRC grades of the third to fourth lumbrical muscles, the interossei, and the hypothenar recovered to M3-M5 from M0-M2 in 7 patients. Cystic articular branch (CAB) was found in all 9 patients intraoperatively. No symptomatic recurrence of IG was seen. The mean motor nerve conduction velocity of ulnar nerve across the elbow recovered from 5.3 to 41.2 m/s.
A unifying articular theory is responsible for the pathogenesis of IG of UNE and disconnection of the CAB would prevent recurrence. The long-term outcome is good after surgical treatment of IG of UNE.
神经内腱鞘囊肿（IG）被认为是一种罕见病变，其发病机制仍存在争议。
通过报告 9 例罕见的肘尺神经（UNE）IG 病例，阐明其发病机制和长期手术结果。
对 IG 进行手术治疗。评估术前和术后的临床症状、体格检查和肌电图。至少随访 4 年。
9 例患者术后 Tinel 征均转为阴性，肘部局部疼痛消失，平均视觉模拟评分/评分从术前的 4.9（3-8）降至术后 6.2 天（2-10）的 0（0-0）。2 例患者保留阳性 Froment 试验、“爪形手”和两点辨别觉，与对侧小指差异很大。术后 UK 医学研究委员会（MRC）尺侧腕屈肌和第四、五指深屈肌肌力评分从 M0-M2 恢复到 M4-M5。9 例患者中，有 7 例第三至第四蚓状肌、骨间肌和小鱼际肌的术后 MRC 评分从 M0-M2 恢复到 M3-M5。所有 9 例患者术中均发现囊性关节支（CAB）。未发现 IG 有症状复发。尺神经肘部跨距运动神经传导速度从 5.3 恢复至 41.2 m/s。
关节统一理论是导致 UNE IG 发病机制的原因，而 CAB 的分离可防止复发。UNE IG 手术后长期效果良好。
