摘要
目的 探究Osborne韧带悬吊尺神经前置术在肘管综合征治疗中的应用,并对影响患者预后的因素进行分析.方法 前瞻性选取2020年9月至2022年8月在秦皇岛市第一医院进行治疗的102例肘管综合征患者,采用信封法将患者分组:对照组(n=51)和研究组(n=51).对照组行传统手术治疗,研究组行Osborne韧带悬吊尺神经前置术治疗.比较两组患者的治疗效果,记录手术前、手术后6个月患者的肌电指标[患侧尺神经传导速度(NCV)、患侧小指展肌复合肌肉动作电位波幅(CMAP)、运动电位潜伏期(MEPLP)]、疼痛程度[(VAS)评分]、现时痛强度(PPI)评分、上肢功能障碍测定量表(DASH)评分,并探究影响患者预后情况的因素.结果 研究组患者的有效率为96.08％,显著高于对照组(84.31％),差异有统计学意义(P＜0.05).研究组患者手术后6个月的NCV、CMAP分别为(50.77±3.98)m/s、(5.77±0.46)mV,高于对照组[(43.29±4.56)m/s、(4.12±0.39)mV];研究组 MEPLP 为(2.28±0.61)ms,低于对照组[(3.38±0.74)ms],差异均有统计学意义(P＜0.05).研究组患者手术后6个月的VAS评分、PPI评分、DASH评分均分别为(1.69±0.78)、(1.06±0.45)、(26.66±7.46)分,均低于对照组[(3.77±0.64)、(1.98±0.35)、(36.91±6.16)分],差异均有统计学意义(P＜0.05).102例患者经手术治疗,在随访期结束时,73例患者纳入预后良好组,29例纳入预后不良组.两组在肘部外伤史、病程方面比较,差异均无统计学意义(P＞0.05),在年龄、性别、长期屈肘工作、肌肉萎缩、患病手与优势手为同侧、手部握力、是否采用Osborne韧带悬吊方面比较,差异均有统计学意义(P＜0.05).Logistic回归分析结果显示,肌肉萎缩及未采用O sborne韧带悬吊为影响患者预后不良的危险因素(P＜0.05).结论 采用Os-borne 韧带悬吊尺神经前置术对肘管综合征患者进行治疗可有效提高治疗有效率,改善患者的肌电图指标,缓解患者的疼痛程度,改善上肢功能障碍;此外,肌肉萎缩是影响患者预后不良的危险因素,可能会对患者的康复产生负面影响,应予以关注.
Abstract
Objective To explore the application of Osborne ligament suspension and ulnar nerveanterior transposition surgery in the treat-ment of cubital tunnel syndrome and analyze the factors affecting the prognosis of patients.Methods A total of 102 patients with cubital tunnel syndrome treated in the First Hospital of Qinhuangdao hospital from September 2020 to August 2022 were selected and grouped by envelope meth-od:the control group(n=51)and the study group(n=51).The control group underwent traditional surgical treatment,and the study group underwent Osborne ligament suspension and ulnar nerve pretreatment.The treatment effect of the two groups was compared,and the myographic index[nerve conduction velocity(NCV),composite muscle action potential amplitude(CMAP),motor potential latency(MEPLP)],pain level[visual analogue scale(VAS)score],present pain intensity(PPI)score,and disabilities of the arm,shoulder and hand(DASH)score were re-corded before surgery and 6 months after surgery,and the factors affecting the prognosis of the patients were explored.Results The effective rate of the study group patients was 96.08％,which was significantly higher than that of the control group(84.31％),and the difference was statisti-cally significant(P＜0.05).At 6 months after surgery,the NCV and CMAP of the study group were(50.77±3.98)m/s and(5.77±0.46)mV,respectively,which were higher than those of the control group[(43.29±4.56)m/s and(4.12±0.39)mV];and the MEPLP was(2.28 ±0.61)ms in the study group,which was lower than that of the control group[(3.38±0.74)ms],the differences were statistically significant(P＜0.05).At 6 months after surgery,the VAS score,PPI score,and DASH score of the study group were(1.69±0.78),(1.06±0.45),and(26.66±7.46)points,respectively,which were lower than those of the control group[(3.77±0.64),(1.98±0.35),and(36.91±6.16)points],and the differences were statistically significant(P＜0.05).102 patients were surgically treated with surgery,and at the end of the follow-up period,73 patients were included in the good prognosis group and 29 patients were included in the poor prognosis group.There was no statistical difference in the history of elbow trauma(P＞0.05),but in age,sex,long-term elbow flexion,muscle atrophy,diseased hand and dominant hand,and hand grip strength,and whether to use Osborne ligament suspension(P＜0.05).The results of Logistic regression analysis showed that muscle atrophy and the absence of Osborne ligament suspension were risk factors for poor prognosis in patients(P＜0.05).Conclu-sion The treatment of patients with cubital tunnel syndrome with Osborne ligament suspension and ulnar nerveanterior transposition surgery can ef-fectively improve the treatment efficiency,improve the electromyography index,relieve the pain degree of patients,and improve the upper limb dysfunction;muscle atrophy is a risk factor affecting the poor prognosis of patients,which may have a negative impact on the rehabilitation of pa-tients,which should be paid attention to.
基金项目
河北省医学科学研究课题计划(20211489)
秦皇岛市科学技术研究与发展计划(202004A112)
NETL
NSTL
维普
万方数据