| ObjectivesThis study aims at evaluating the application of electroneurophysiology monitoring in the diagnosis/treatment of cubital tunnel syndrome(CTs) and discussing the effect of compressing agent excision and epineurium dissection on the recovery of never function by monitoring change of preoperative,intra operative and postoperative ulnar never conduction velocity as well as analyzing the correlation of severity and prognosis with electroneurophysiology indices to provide scientific proofs for the early diagnosis for the CTs improving the operation method,reducing operation wound and finally,improving the surgical outcome.MethodsThe study was conducted among the sample of 61 in-patients with CTs in orthopedics department of Tianjin Medical University General Hospital to evaluating the application of electroneurophysiology monitoring in the diagnosis/treatment of CTs by using(1)one-sample t test and Spearman correlations analysis to compare the difference of ulnar nerve conduction velocity,latent period and amplitude between patients and normal as well as analyzing the correlation of severity with electroneurophysiology indices;(2)assessing the accuracy of electroneurophysiology position oriented diagnosis by comparing the estimated compressing position(tested by using electroneurophysiology short section movement technique) and actual compressing position.(3) analyzing the change of nerve conduction velocity,latent period and amplitude before-after the compressing agent excision and before-after epineurium dissection by paired-samples t test to discuss the short-term effect of these two processes on the recovery of unlar never function;(4) evaluating the surgical outcome at the 6th month after operation and its correlation with nerve conduction velocity,latent period and amplitude.Results55(90.16%) patients were followed up at the 6th month after operation.(1) the nerve conduction velocity,latent period and amplitude of subjects are 26.16±11.68(m/s),13.71±3.47(ms) and 0.34±0.20(mv) respectively;comparing to normal value,they have slower nerve conduction velocity and longer latent period.(2) the severity of illness is negative correlation with nerve conduction velocity(r= -0.863,p=0.000) and positive correlation with latent period(r=0.354,p=0.037).(3)the accuracy rate of entrapment position positioning by electroneurophysiology position oriented diagnosis is reached to 85%.(4) nerve conduction velocity is increased,the latent period is shorten with highly statistical significance after compressing agent excision;however,there are no significant change in the electroneurophysiology indices after epineurium dissection.(5)the pathology exam shows that the most of compressing agents(87.26%) are hyaline degeneration of ligaments with hyperplastic adipose tissue and small vessels, 1 of them with calcified cartilage tubercle,3 of them contain skeletal muscle;the microscopic anatomy of other 7 compressing agents are 2 cases of angiolipoma,1 case of osteochondroma,1 case of neurilemmoma and 3 cases of ganglionic cyst.(6)most of subjects(65.46%) have satisfactory therapeutic effect after operation, however,minority of them(12.73%) have poor outcome;the surgical outcome is negative correlation with preoperative nerve conduction velocity(r= -0.862,p=0.000)Conclusion(1) Preoperative electroneurophysiology exam is conducive to the diagnosis, prognosis forecasting and severity judgment of CTs as well as locating the diseased region exactly.(2) Intra operative monitoring can estimate the effects of certain operation procedures on the short-term recovery of never function to provide proofs for the improvement of operation.(3)Nerve function has recovery after compressing agent excised,but no improvement after epineurium dissection according to electroneurophysiology exam,the necessity of epineurium dissection need further study.(4)the surgical therapeutic effect is related to the degree of nerve damage,the more severity damage is,the poorer outcome it would appeared.As a simple, non-invasive and objective exam method,electroneurophysiology exam should be widespread used for the diagnosis and treatment of CTs in the future. |
