带血运前置术治疗肘管综合征的疗效及应用MNCV选择手术时机的价值

发布时间：2018-04-19 08:10

  本文选题：肘管综合征 + 带血运前置术　； 参考：《河北医科大学》2015年硕士论文

【摘要】：目的:肘管综合征是周围神经卡压性疾病中的常见病,目前临床对其明确诊断并不难,除依靠临床体征表现以外,最有价值的辅助检查是神经电生理检测,但是其目前仍存在临床分型界限不清及治疗方案不统一等问题。本文通过回顾性研究临床肘管综合征患者资料,以定量指标跨肘段运动神经传导速度(MNCV)分组,探讨带血运前置术治疗肘管综合征的疗效及肘段神经传导速度在不同阶段时行手术治疗的效果,为选择手术时机提供依据。方法:(1)按照临床流行病学回顾性调查研究的方法,回顾分析2008年1月~2014年1月的肘管综合征患者,病例主要由河北医科大学第二医院病案室提供,所有患者均行尺神经带血运前置术。所有患者术前均行神经电生理检查,明确诊断为肘管综合征,并且符合入选标准,选取其中临床资料较完整的病例,少数资料丢失病例通过电话、邮件等方式补充完整,最终共60例病例纳入研究分析。(2)术前参考顾玉东建议临床分型,依据尺神经跨肘段运动神经传导速度将肘管综合征患者分为三组:甲组MNCV≥40 m/s;乙组MNCV40~30m/s;丙组MNCV≤30m/s。(3)术后疗效评价:所有患者手术后全部获得随访,平均随访时间29个月(10-58个月)。收集三组患者的环、小指麻木疼痛症状、感觉检查、握力、骨间肌萎缩及爪形手恢复情况等资料,进行统计学分析比较,统计学方法采用x2检验、单因素ANOVA分析及独立样本非参数检验。结果:(1)60例患者全部行尺神经带血运前置术,术后恢复情况采用顾玉东建议的肘管综合征功能评定标准评定,其疗效结果为:优26例,良22例,可11例,差1例,优良率为80%。甲,乙,丙三组的优良率分别为:90%(18/20),85%(17/20),55%(11/20)。甲组和乙组比较:差异无统计学意义(P0.05)。甲组与丙组比较及乙组与丙组比较:差异均有统计学意义(P0.05)。(2)麻木疼痛恢复情况:甲组:完全消失17例,明显缓解3例,仍有部分0例,持续存在0例。乙组:完全消失16例,明显缓解3例,仍有部分1例,持续存在0例。丙组:完全消失12例,明显缓解6例,仍有部分2例,持续存在2例。(3)感觉恢复情况:甲组:S4:12例,S3:8例,S2:2例,S1~S0:0例。乙组:S4:8例,S3:8例,S2:4例,S1~S0:0例。丙组:S4:,7例,S3:8例,S2:2例,S1~S0:2例。(4)骨间肌萎缩恢复情况:甲组:无萎缩17例,轻度萎缩2例,中度萎缩1例,重度萎缩0例。乙组:无萎缩14例,轻度萎缩4例,中度萎缩2例,重度萎缩0例。丙组:无萎缩3例,轻度萎缩6例,中度萎缩6例,重度萎缩5例。(5)握力恢复情况:甲组:正常10例,明显增加8例,增加2例,无变化及减退0例。乙组:正常8例,明显增加8例,增加4例,无变化及减退0例。丙组:正常1例,明显增加2例,增加9例,无变化及减退8例。(6)爪形手恢复情况:甲组:无爪形手13例,轻度3例,中度1例,重度0例。乙组:无爪形手13例,轻度4例,中度3例,重度0例。丙组:无爪形手7例,轻度7例,中度4例,重度2例。三组比较麻木疼痛症状及感觉恢复情况,差异无统计学意义(P0.05)。(见Table3,4)。三组比较骨间肌萎缩、握力及爪形手恢复情况结果均为,甲组和乙组比较:差异无统计学意义(P0.05)。甲组与丙组比较及乙组与丙组比较:差异均有统计学意义(P0.05)。(见Table5~7)。结论:1带伴行血管尺神经松解前置术治疗肘管综合征临床疗效满意。2肘段尺神经运动传导速度不同阶段时手术效果有明显差异,建议当患者MNCV≥40 m/s时可以保守治疗;当MNCV40~30m/s时,可以保守治疗或手术治疗,但保守治疗时需定期复查MNCV,如果MNCV无恢复甚至继续减慢,则应立即采取手术治疗;当MNCV≤30m/s时,应及早采取手术治疗。
[Abstract]:Objective: cubital tunnel syndrome is a common disease of peripheral nerve compression diseases, the current clinical diagnosis is not difficult, in addition to relying on clinical symptoms, auxiliary examination is the most valuable electrophysiological examination, but the problems still exist in the clinical classification and treatment of blurred boundaries are not uniform. In this paper, through a retrospective study of clinical data of patients with cubital tunnel syndrome, the quantitative index of cross elbow segment motor nerve conduction velocity (MNCV) group, study of vascularized transposition in the treatment of cubital tunnel syndrome and curative effect of elbow segment nerve conduction velocity in different stages during the surgical treatment effect, provide the basis for the choice of operation methods:. (1) according to the clinical epidemiological retrospective investigation of patients, retrospective analysis of January 2008 ~2014 in January of the cubital tunnel syndrome, were mainly provided by the medical record department of the second hospital of Hebei Medical University, all The patients underwent vascularized ulnar nerve transposition. Electrophysiological examination were performed in all patients before surgery, diagnosis of cubital tunnel syndrome, and met the inclusion criteria, the more complete clinical data of cases, a few data loss cases by telephone, mail and other ways to complete the final, a total of 60 patients were included in the analysis. (2) preoperative reference Gu Yudong recommended clinical basis, ulnar nerve cross elbow segment motor nerve conduction velocity of the cubital tunnel syndrome were divided into three groups: group MNCV = 40 m/s; group B, group C MNCV40~30m/s; MNCV = 30m/s. (3) to evaluate the curative effect after operation: all patients were followed up after surgery. The average follow-up time of 29 months (10-58 months). The three groups were collected, the little finger numbness and pain symptoms, sensory testing, grip strength, interosseous muscle atrophy and claw hand recovery data, comparative statistical analysis, statistical methods using x2 妫，

本文编号：1772277