To Analysis The Curative Effect Of Anterior Transposition With Blood Supply Of Ulnar Nerve For The Cubital Tunnel Syndrome And The Value Of Motor Nerve Conduction Velocity In The Elbow To Choose Operation Time

Objective: Cubital tunnel syndrome is of common diseases in peripheral nerve entrapment disease.It is not difficult for clinical diagnosis.Except rely on clinical signs,the most valuable auxiliary examination is electrodiagnosis. but the clinical parting line of Cubital tunnel syndrome is not clear and its’ treatment is not yet unified.In this paper,all material is analyzed through retrospective study to explore the curative effect of anterior transposition with blood supply of ulnar nerve for the cubital tunnel syndrome and the postoperative recovery effect in different stage of nerve conduction velocity.To provide a basis on choosing the timing of surgery.Method:1 Based respective cohort study of clinical epidemiology of design patterns,recalling the collection in January 2008-2014 in patients with cubital tunnel syndrome. Cases are mainly provided by the record room of the second hospital of hebei medical university.All patients were performed anterior transposition with blood supply of ulnar nerve.All patients with electromyography in the preoperative conforms to the cubital tunnel syndrome inclusion criteria.we selected those cases with complete main data,primary data selection criteria at the same time a full case,individual data missing persons by telephone or other means of communication to be completed,the final total of 60 cases were included in the analysis of cases.2 Refer to the clinical classification suggested by yudong Gu, cubital tunnel syndrome can be divided into three degrees accord to motor nerve conduction velocity in the preoperative.A group: the ulnar nerve motor conduction speed at the elbow(MNCV)≥40 m/s.B group: the ulnar nerve motor conduction speed at the elbow(MNCV) is 40 ~ 30 m/s.C group:the ulnar nerve motor conduction speed at the elbow(MNCV) is 30 m/s or less.3 Postoperative Curative Effect Evaluation:All patients were follow-up after surgery.Postoperative follow-up time ranged from 10 to 58 months, the average is 29 months.Analysis the curative effect of anterior transposition with blood supply of ulnar nerve,and compare each group including ring and pinkie pain, feelling, grip strength, interosseous muscle atrophy and hand claw.Statistical methods use t-test,Chi-square test and independent samples nonparametric tests.Results:1 All 60 patients were treated by anterior transposition with blood supply of ulnar nerve.According to the cubital tunnel syndrome function evaluation standard suggested by Yudong Gu,the results were graded as excellent in 26 cases,good in 22 cases,fair in 11 cases,and bad in 1 cases.The overall excellent and good rate Was 80.0%.The excellent and good rate of three groups was 55%(11/20), 85%(17/20), 90%(18/20), respectively.2 Numb and pain recovery: In group A: completely disappeared in 7 cases, obviously alleviate in 9 cases, there are still reserve some in 2 cases, persist in 2 cases.In group B: completely disappeared in 16 cases, obviously alleviate in 3 cases,there are still reserve some in 1 cases,, persist in 0 cases.In group C:completely disappear in 17 cases,obviously alleviate in 3 cases, there are still reserve some in 0 cases, persist in 0 case.Sensory Recovery: In group A: S4 in 7 cases, 9 cases of S3 and S2 in 2 cases, S1 to S0 in 2 cases.In group B: S4 in 8 cases, 8 cases of S3 and S2 in 4 cases, S1 to S0 in 0 case.In group C: S4 in 12 patients, 8 cases in S3, S2 in 2 cases, S1 to S0 in 0 case.Interosseous muscle atrophy recovery:In group A: no atrophy in 2 cases, mild atrophy 8 cases, obvious atrophy in 0 cases.In group B: no atrophy 8 cases, mild atrophy in 7 cases, obvious atrophy in 5 cases.In group C: no atrophy in 18 cases, mild atrophy in 2 cases, obvious atrophy in 0 case.Grip strength recovery: In group A:normal in 1 case, significant increase in 2 cases, increased in 9 cases, no change and loss in 8 cases. In group B: normal in 8 cases,significantly increased in 8 cases, increased in 4 cases, no change and the loss in 0 case. In group C: normal in 10 cases, significantly increased in 8 cases, increased in 2 cases, no change and loss in 0 case.Claw hand recovery: In group A: no claw hand in 7 cases, mild claw hand in 7 cases,obvious claw hand in 6 cases.In group B: no claw hand in 15 cases, mild claw hand in 5 cases, obvious claw hand in 0 case.In group C: no claw hand in 17 cases,mild claw hand in 3 cases,obvious claw hand in 0 case.There were no significant differences between the three groups about the curative effect of numb pain sensation and sensory recovery(P> 0.05).The comparative results between the three groups about interosseous muscle atrophy recovery,grip strength recovery and claw hand recovery were same. There were no significant differences between group A and group B, There were significant differences between group A and group C.There were significant differences between group B and group C.Conclusion:1 The anterior transposition with blood supply of ulnar nerve lead to Satisfactory results in the treatment of cubital tunnel syndrome.2 When patients’ motor nerve conduction velocity were in different stage,the curative effect of operation was obvious different.This paper suggested that patients can choose conservative treatment when patients’ MNCV is 40m/s or higher;When MNCV is 40 ~ 30 m/s, patients can choose both conservative treatment and surgery.But patients who chose conservative treatment should check MNCV regularly, if MNCV isn’t recovery and even slow down, you should take surgery immediately;When MNCV is 30 m/s or less, patients should take surgery at once.