肘管综合征尺神经原位松解联合内上髁大部切除的预后因素

Prognostic factors of ulnar nerve in situ decompression combined with maximal medial epicondylectomy for cubital tunnel syndrome

摘要:

[目的] 探讨改良的尺神经原位松解联合内上髁大部切除术 （in situ decompression combined with maximal medial epi- condylectomy, UNDME） 治疗肘管综合征的预后因素。[方法] 回顾性分析 2021 年—2023 年接受 UNDME 手术的 132 例肘管综合征患者的资料。末次随访时依据顾玉东尺神经功能评定标准，“可”和“差”的患者划为不佳组，而“优”和“良”的划为优良组。采用单因素比较和二分多因素逻辑回归分析影响预后的因素。[结果]术后随访 12 个月以上，20 例患者划为不佳组， 占 15.2%；112 例划为优良组，占 84.8%。单因素分析显示，不佳组在年龄 [(59.5±6.8) 岁 vs (52.1±9.1) 岁, P＜0.001]、糖尿病比率 [是/否, (10/10) vs (18/94), P=0.002]、吸烟比率 [是/否, (10/10) vs (20/92), P=0.003]、病程 [(17.1±2.6) 个月 vs (11.9±3.6) 个月, P＜0.001] 和术前 McGowan 评级重度等级比率 [I/II/III, (0/6/14) vs (18/64/30), P=0.002] 均显著大于优良组，而不佳组术前尺神经 MCV [(33.6± 10.0) m/s vs (40.7±8.2) m/s, P＜0.001] 和 SCV [(41.8±8.4) m/s vs (47.7±8.5) m/s, P=0.005] 显著慢于优良组。两组间其他变量的差异均无统计学意义（P＞0.05）。多因素逻辑回归分析显示，病程长（OR=1.941, 95%CI: 1.371~2.748, P＜0.001）、McGowan 分级严重程度高 （OR=2.897, 95%CI: 1.003~8.362, P=0.049）和吸烟（OR=5.396, 95%CI: 1.340~21.712, P=0.018）是 UNDME 术后尺神经功能恢复不佳的独立危险因素。[结论] 改良的尺神经原位松解联合内上髁大部切除术可以缓解尺神经压迫及拉伸应变，改善神经功能。 年龄大、糖尿病、吸烟、病程长和术前 McGowan 评级重是术后恢复不佳的相关因素。

Abstract:

[Objective] To explore the prognostic factors of ulnar nerve in situ decompression combined with maximal medial epicondylectomy (UNDME) in the treatment of cubital tunnel syndrome. [Methods] A retrospective analysis was conducted on 132 patients who underwent UNDME for cubital tunnel syndrome from 2021 to 2023. At the last follow-up, according to Gu Yu-dong's ulnar nerve function assessment criteria, the patients in "fair" and "poor" were classified as the poor group, while those in "excellent" and "good" were classified as the good group. The univariate comparison and binary multivariate logistic regression were used to research the factors related to prognosis. [Results] The patients were followed up for more than 12 months after the operation. Of them, 20 patients were fall into the poor group, accounting for 15.2%, while 112 patients were in the excellent group, accounting for 84.8%. As results of univariate comparison, the poor groups proved significantly greater than the good group in terms of age [(59.5±6.8) years vs (52.1±9.1) years, P＜0.001], diabetes rates [yes/ no, (10/10) vs (18/94), P=0.002], smoking rate [yes/no, (10/10) vs (20/92), P=0.003], disease duration [(17.1 ± 2.6) months vs (11.9 ± 3.6) months, P＜0.001] and ratio of severe grades in preoperative McGowan classification [I/II/III, (0/6/14) vs (18/64/30), P=0.002], whereas the former was significantly slower than the latter in preoperative motor nerve conduction velocity (MCV) [(33.6±10.0) m/s vs (40.7±8.2) m/s, P＜ 0.001] and sensory nerve conduction velocity (SCV) [(41.8±8.4) m/s vs (47.7±8.5) m/s, P=0.005]. However, there were no statistically significant differences in other variables between the two groups (P＞0.05). Regarding to binary multivariate logistic regression, the longer disease duration (OR=1.941, 95%CI: 1.371~2.748, P＜0.001), more severity of McGowan grade (OR=2.897, 95%CI: 1.003~8.362, P=0.049), and smoking (OR=5.396, 95%CI: 1.340~21.712, P=0.018) were the independent risk factor for poor recovery of ulnar nerve function after UNDME. [Conclusion] This modified ulnar nerve in-situ decompression combined with maximal medial epicondylectomy can relieve the compression and tensile strain on the ulnar nerve and improve nerve function. The advanced age, diabetes, smoking, longer disease duration and severe preoperative McGowan grade are the factors related to poor postoperative recovery.