背景:原发性前皮下转位后复发尺神经压迫相对罕见,和修正手术是具有挑战性的。这项研究回顾性评估了改良的前皮下转位治疗复发性尺神经压迫的临床结果。
方法:本研究纳入了8例因复发性尺神经压迫而接受改良前皮下移位术的患者。结果基于术前和术后症状,体检结果,和肌电图评估。
结果:术前所有患者均发现尺神经扩大,平均横截面积为0.15cm2(范围,0.14-0.18cm2)。术中发现,反复压迫发生在三个区域,包括内侧肌间隔(n=5),内侧上髁(n=6)和前臂筋膜的神经入口(n=1)。手术后,在无名指/小指麻木(从严重到轻度,p=0.031),握力(从48.00%到80.38%的完整侧,p<0.001)和McGowan等级(从III级到I级,p=0.049)。术后肌电图检查也显示肘部运动神经传导显着改善(速度,23.30±9.598vs.35.30±9.367,p=0.012;振幅,3.40±3.703vs.5.65±2.056,p=0.007)和手腕处的感觉神经传导(速度,27.04±22.450vs.36.45±18.099,p=0.139;振幅,1.44±1.600vs.4.00±2.642,p=0.011)。8例患者中有7例报告对术后结果满意。
结论:对于先前手术失败后复发性尺神经压迫是一种有效的治疗方法。
BACKGROUND: Recurrent ulnar nerve compression after primary anterior subcutaneous transposition is relatively rare, and revision surgery is challenging. This study retrospectively evaluated the clinical outcomes of revision anterior subcutaneous transposition for recurrent ulnar nerve compression.
METHODS: Eight patients who underwent revision anterior subcutaneous transposition for recurrent ulnar nerve compression were enrolled in this study. The outcomes were based on preoperative and postoperative symptoms, physical examination findings, and electromyographic evaluation.
RESULTS: Ulnar nerve enlargement was preoperatively found in all patients with a mean cross sectional area of 0.15 cm2 (range, 0.14-0.18 cm2). Intraoperative findings showed that recurrent compression occurred in three areas, including the medial intermuscular septum (n = 5), the medial epicondyle (n = 6) and nerve entrance to forearm fascia (n = 1). Post-operation, significant improvements were observed in ring/little finger numbness (from severe to mild, p = 0.031), grip strength (from 48.00% to 80.38% of the intact side, p < 0.001) and McGowan grade (from Grade III to Grade I, p = 0.049). Postoperative electromyography test also showed significant improvement in motor nerve conduction at elbow (velocity, 23.30 ± 9.598 vs. 35.30 ± 9.367, p = 0.012; amplitude, 3.40 ± 3.703 vs. 5.65 ± 2.056, p = 0.007) and sensory nerve conduction at wrist (velocity, 27.04 ± 22.450 vs. 36.45 ± 18.099, p = 0.139; amplitude, 1.44 ± 1.600 vs. 4.00 ± 2.642, p = 0.011). Seven of the eight patients reported satisfaction with the postoperative results.
CONCLUSIONS: Revision anterior subcutaneous transposition was an effective treatment for recurrent ulnar nerve compression from prior failed procedures.