本文選題：肘管綜合征 + 帶血運(yùn)前置術(shù)　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:肘管綜合征是周圍神經(jīng)卡壓性疾病中的常見病,目前臨床對(duì)其明確診斷并不難,除依靠臨床體征表現(xiàn)以外,最有價(jià)值的輔助檢查是神經(jīng)電生理檢測(cè),但是其目前仍存在臨床分型界限不清及治療方案不統(tǒng)一等問題。本文通過回顧性研究臨床肘管綜合征患者資料,以定量指標(biāo)跨肘段運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度(MNCV)分組,探討帶血運(yùn)前置術(shù)治療肘管綜合征的療效及肘段神經(jīng)傳導(dǎo)速度在不同階段時(shí)行手術(shù)治療的效果,為選擇手術(shù)時(shí)機(jī)提供依據(jù)。方法:(1)按照臨床流行病學(xué)回顧性調(diào)查研究的方法,回顧分析2008年1月~2014年1月的肘管綜合征患者,病例主要由河北醫(yī)科大學(xué)第二醫(yī)院病案室提供,所有患者均行尺神經(jīng)帶血運(yùn)前置術(shù)。所有患者術(shù)前均行神經(jīng)電生理檢查,明確診斷為肘管綜合征,并且符合入選標(biāo)準(zhǔn),選取其中臨床資料較完整的病例,少數(shù)資料丟失病例通過電話、郵件等方式補(bǔ)充完整,最終共60例病例納入研究分析。(2)術(shù)前參考顧玉東建議臨床分型,依據(jù)尺神經(jīng)跨肘段運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度將肘管綜合征患者分為三組:甲組MNCV≥40 m/s;乙組MNCV40~30m/s;丙組MNCV≤30m/s。(3)術(shù)后療效評(píng)價(jià):所有患者手術(shù)后全部獲得隨訪,平均隨訪時(shí)間29個(gè)月(10-58個(gè)月)。收集三組患者的環(huán)、小指麻木疼痛癥狀、感覺檢查、握力、骨間肌萎縮及爪形手恢復(fù)情況等資料,進(jìn)行統(tǒng)計(jì)學(xué)分析比較,統(tǒng)計(jì)學(xué)方法采用x2檢驗(yàn)、單因素ANOVA分析及獨(dú)立樣本非參數(shù)檢驗(yàn)。結(jié)果:(1)60例患者全部行尺神經(jīng)帶血運(yùn)前置術(shù),術(shù)后恢復(fù)情況采用顧玉東建議的肘管綜合征功能評(píng)定標(biāo)準(zhǔn)評(píng)定,其療效結(jié)果為:優(yōu)26例,良22例,可11例,差1例,優(yōu)良率為80%。甲,乙,丙三組的優(yōu)良率分別為:90%(18/20),85%(17/20),55%(11/20)。甲組和乙組比較:差異無統(tǒng)計(jì)學(xué)意義(P0.05)。甲組與丙組比較及乙組與丙組比較:差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)麻木疼痛恢復(fù)情況:甲組:完全消失17例,明顯緩解3例,仍有部分0例,持續(xù)存在0例。乙組:完全消失16例,明顯緩解3例,仍有部分1例,持續(xù)存在0例。丙組:完全消失12例,明顯緩解6例,仍有部分2例,持續(xù)存在2例。(3)感覺恢復(fù)情況:甲組:S4:12例,S3:8例,S2:2例,S1~S0:0例。乙組:S4:8例,S3:8例,S2:4例,S1~S0:0例。丙組:S4:,7例,S3:8例,S2:2例,S1~S0:2例。(4)骨間肌萎縮恢復(fù)情況:甲組:無萎縮17例,輕度萎縮2例,中度萎縮1例,重度萎縮0例。乙組:無萎縮14例,輕度萎縮4例,中度萎縮2例,重度萎縮0例。丙組:無萎縮3例,輕度萎縮6例,中度萎縮6例,重度萎縮5例。(5)握力恢復(fù)情況:甲組:正常10例,明顯增加8例,增加2例,無變化及減退0例。乙組:正常8例,明顯增加8例,增加4例,無變化及減退0例。丙組:正常1例,明顯增加2例,增加9例,無變化及減退8例。(6)爪形手恢復(fù)情況:甲組:無爪形手13例,輕度3例,中度1例,重度0例。乙組:無爪形手13例,輕度4例,中度3例,重度0例。丙組:無爪形手7例,輕度7例,中度4例,重度2例。三組比較麻木疼痛癥狀及感覺恢復(fù)情況,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(見Table3,4)。三組比較骨間肌萎縮、握力及爪形手恢復(fù)情況結(jié)果均為,甲組和乙組比較:差異無統(tǒng)計(jì)學(xué)意義(P0.05)。甲組與丙組比較及乙組與丙組比較:差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(見Table5~7)。結(jié)論:1帶伴行血管尺神經(jīng)松解前置術(shù)治療肘管綜合征臨床療效滿意。2肘段尺神經(jīng)運(yùn)動(dòng)傳導(dǎo)速度不同階段時(shí)手術(shù)效果有明顯差異,建議當(dāng)患者M(jìn)NCV≥40 m/s時(shí)可以保守治療;當(dāng)MNCV40~30m/s時(shí),可以保守治療或手術(shù)治療,但保守治療時(shí)需定期復(fù)查MNCV,如果MNCV無恢復(fù)甚至繼續(xù)減慢,則應(yīng)立即采取手術(shù)治療;當(dāng)MNCV≤30m/s時(shí),應(yīng)及早采取手術(shù)治療。
[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 媯，

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