影响肘管综合征尺神经前置临床效果的因素

Factors impacting clinical outcome of ulnar nerve anterior transposition for cubital tunnel syndrome

摘要:

[目的] 探讨影响肘管综合征尺神经前置术疗效的影响因素。[方法] 对 2018 年 12 月—2021 年 6 月行手术治疗的 89 例肘管综合征患者资料进行回顾性分析。采用顾氏分级评价临床状态，依据末次随访时患者顾氏评级将患者分为优良组和不佳组，采用单因素比较的二元逻辑回归分析探讨影响肘管综合征尺神经前置术疗效的影响因素。[结果]所有患者均顺利完成尺神经松解前置术，未出现切口感染、不愈合等不良并发症。术后随访时间 18~36 个月，平均 26.5 个月。末次随访根据顾氏肘管综合征功能评定标准评价恢复情况，优 46 例，良 25 例，可 11 例，差 7 例，优良率为 79.8%。评定为优和良的患者共 71 例划入良好组；评定为可和差的患者共 18 例划入不佳组，单因素比较表明：不佳组的糖尿病史 [是/否, (10/61) vs (7/11), P= 0.017]，肘部外伤史 [(5/66) vs (10/8), P＜0.001]，术前疾病程度 [轻/中/重, (9/43/19) vs (0/6/12), P＜0.001]，肘骨性关节炎 [(5/66) vs (5/ 13), P=0.013] 均显著高于优良组。但是，两组在年龄、性别、患侧、原发性高血压史的差异无统计学意义（P＞0.05）。逻辑回归结果表明：糖尿病 （OR=4.652, 95%CI 1.091~19.832, P=0.038）、肘部外伤史 （OR=10.111, 95%CI 2.252~45.398, P=0.003）、术前疾病程度 （OR=4.193, 95%CI 1.138~15.456, P=0.031） 是肘管综合征尺神经前置临床效果不佳的独立危险因素。[结论] 糖尿病、肘部外伤史、术前疾病程度重是肘管综合征尺神经前置临床效果不佳的危险因素，应引起临床医生的重视。

Abstract:

[Objective] To explore the factors affecting the consequence of ulnar nerve anterior transposition (UNAT) for cubital tunnel syndrome (CTS). [Methods] A retrospective study was done on 89 patients who received UNAT for CTS in our department from December 2018 to June 2021. The clinical status was evaluated using Gu's scale, and the patients were divided into good group and poor group at the last follow-up. The factors impacting outcome of UNAT for CTS were investigated by univariate comparison and binary logistic regression analysis. [Results] All patients had the ulnar nerve release and anterior transposition performed smoothly without incision infection, nonunion and other complications, and followed up for 18 to 36 months, with an average of 26.5 months. According to Gu's functional evaluation criteria for CTS, 46 patient were excellent, 25 cases were good, 11 cases were fair, 7 cases were poor, with excellent and good rate of 79.8%. A total of 71 patients who rated as excellent and good were classified into the good group, while the remaining 18 patients rated as fair and poor were classified into the poor group. Regarding univariate comparison, the poor group was significantly greater than the good group in terms of diabetes mellitus [y/n, (10/61) vs (7/11), P=0.017], the elbow injury history [(5/66) vs (10/8), P＜0.001], preoperative disease severity [mild/moderate /severe, (9/43/19) vs (0/6/12), P＜0.001], elbow osteoarthritis [(5/66) vs (5/13), P=0.013]. However, there were no significant differences between the two groups in age, sex, affected side, and history of essential hypertension (P＞0.05). As results of logistic regression, diabetes mellitus (OR=4.652, 95% CI 1.091~19.832, P=0.038), history of elbow trauma (OR=10.111, 95% CI 2.252~ 45.398, P=0.003), preoperative disease severity (OR=4.193, 95%CI 1.138~15.456, P=0.031) were independent risk factors for poor clinical outcomes of UNAT for CTS. [Conclusion] Diabetes mellitus, history of elbow trauma and preoperative disease severity are risk factors for poor clinical effect of ulnar nerve anterior transposition for cubital tunnel syndrome, which should be paid attention to by clinicians.