Department of Ultrasound, Tianjin Hospital, Tianjin, China.
Department of Hand microsurgery, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2021 May;13(3):840-846. doi: 10.1111/os.12922. Epub 2021 Mar 21.
To explore the effect of locating the ulnar nerve compression sites and guiding the small incision so as to decompress the ulnar nerve in situ on the elbow by high-frequency ultrasound before operation.
A retrospective analysis was conducted on 56 patients who underwent ultrasound-assisted in situ decompression for cubital tunnel syndrome from May 2018 to August 2019. The patients' average age was 51.13 ± 7.35 years, mean duration of symptoms was 6.51 ± 1.96 months, and mean postoperative follow-up was 6.07 ± 0.82 months. Nine patients had Dellon's stage mild, 39 had stage moderate, and eight had stage severe. Ultrasound and electromyography were completed in all patients before operation. The presence of ulnar nerve compressive lesion, the specific location, and the reason and extent of compression were determined by ultrasound. A small incision in situ surgery was given to decompress the ulnar nerve according to the pre-defined compressive sites.
All patients underwent in situ decompression. The compression sites around the elbow were as follows: two in the arcade of Struthers, one in the medial intermuscular septum, four in the anconeus epitrochlearis muscle, five beside the cyst of the proximal flexor carpi ulnaris (FCU), and the remaining 44 cases were all from the compression between Osborne's ligament to the two heads of the FCU. The compression localizations diagnosed by ultrasound were confirmed by operations. Preoperative ultrasound confirmed no ulnar nerve subluxation in all cases. The postoperative outcomes were satisfactory. There was no recurrence or aggravation of symptoms in this group of patients according to the modified Bishop scoring system; results showed that 43 cases were excellent, 10 were good, and three were fair.
High-frequency ultrasound can accurately and comprehensively evaluate the ulnar nerve compression and the surrounding tissues, thus providing significant guidance for the precise minimally invasive treatment of ulnar nerve compression.
探讨术前高频超声定位尺神经压迫部位并引导小切口原位减压的效果。
回顾性分析 2018 年 5 月至 2019 年 8 月期间 56 例接受超声辅助肘管综合征原位减压的患者资料。患者平均年龄 51.13±7.35 岁，症状平均持续时间 6.51±1.96 个月，平均术后随访 6.07±0.82 个月。9 例为 Dellon Ⅰ期轻度，39 例为Ⅱ期中度，8 例为Ⅲ期重度。所有患者术前均行超声和肌电图检查。超声确定尺神经受压病变的存在、具体位置以及受压的原因和程度。根据预定义的压迫部位，行小切口原位手术减压尺神经。
所有患者均行原位减压。肘管周围的压迫部位如下：Struthers 弓 2 处，内侧肌间隔 1 处，肘后肌 4 处，尺侧腕屈肌近端腱鞘 5 处，其余 44 例均位于 Osborne 韧带至尺侧腕屈肌两头之间。超声诊断的压迫定位与手术结果相吻合。所有病例术前超声均未发现尺神经半脱位。术后效果满意。根据改良 Bishop 评分系统，本组患者无复发或症状加重，43 例为优，10 例为良，3 例为可。
高频超声能准确、全面地评估尺神经压迫及周围组织情况，为尺神经压迫的精准微创治疗提供重要指导。
