摘要
目的评价肌电图辅助定位小切口尺神经松解术治疗肘管综合征的疗效及手术适应证。方法选取无明显手内在肌萎缩及肘关节畸形，具有典型临床症状和体征的肘管综合征患者12例，术前通过神经短节段传导（short-segment nerve conduction test，SSCT）检测的方法，以相邻两次动作电位波幅下降〉50％或潜伏期差〉0．5船为定位标准，对上述患者进行卡压点定位，采用小切口局部尺神经松解术式，并观察卡压点术中与术前定位比较。结果术中观测结果证明尺神经损害部位位于肱骨内上髁上方3cm到肱骨内上髁下方1cm之间，与术前SSCT法检测卡压部位相符。12例术后均主诉手部有明显轻松感；术后3个月感觉异常全部恢复，刺痛觉及爪形指恢复，捏力和抓握力恢复；术后6个月时小指展肌肌力已完全恢复至正常，两点分辨觉平均为5．0min，神经传导速度（NCV）均〉45．0m／s，波幅开始增加，SSCT无阳性发现；术后1年肌肉萎缩基本恢复，屈肘试验、肘部Tinel征、夹纸试验阴性，7例肌电图无阳性发现，1例NCV仍低于正常标准，但无临床症状及体征。术中观察神经卡压位置与术前肌电图定位相符。结论肌电图辅助定位小切口尺神经松解术治疗肘管综合征是一种有效的方法。
Objective To evaluate the therapeutic effect of in sire ulnar nerve decompression at the euhital tunnel via a small incision assisted with eleetromyogaphy localization and discuss the surgical indications. Methods Twelve patients who were diagnosed with idiopathic eubital tunnel syndrome （CUTS） without intrinsic muscle atrophy and elbow deformity were involved in the study. Before the operation, short-segment nerve conduction test （SSCT） was carried out. The exact compression site was determined by the 〉 50% reduction in amplitude or 〉 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1cm intervals. An in situ ulnar nerve release at the compression site was performed. Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-opemtive SSCT localization. Results Intraopemtive findings confirmed that lesions were located from 3cm above to 1cm below the medial epicondyle, which coincided with the compression sites determined by SSCT. All the patients reported alleviation of hand discomfort postoperatively. Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared. Pinprick sensation recovered. There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination. Claw deformity disappeared. Six months after the surgery, the strength of abductor digiti minimi returned to normal. Two-point discrimination of the little finger was 5.0 mm on average. Nerve conduction velocity returned to 〉 45.0 m/s. Action potential amplitude increased and SSCT yielded no positive findings. Mild atrophy was reversed one year postoperatively. Elbow flexion test, Tinel＇ s sign and Froment＇ s test were all negative. Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.
出处
《中华手外科杂志》
CSCD
北大核心
2011年第2期99-101,共3页
Chinese Journal of Hand Surgery
关键词
肘管综合征
肌电描记术
尺神经
Cubital tunnel syndrome
Electromyography
Ulnar nerve
