A Study Of The Relationship Which Is Between The Clinical Situation And Ulnar Nerve Partly Changed In The Cubital Tunnel Syndrome

objectives:This study aims at observationing the local pathological change of the ulnar nerve at the elbow,binding the patient clinical symptoms and signs, analysis the local changes of the ulnar nerve associated with clinical manifestations,thus which can provide the scientific basis whether open decompression of ulnar nerve membrane in the surgical treatment and dientify the main factors for disease pathology in order to put forward a new understanding of science for the disease of cubital tunnel syndrome.Methods:The study selected the patients diagnosed with cubital tunnel syndrome were enrolled in Hand Surgery,of Tianjin Hospital from May,2010 to November,2010, reference Dellon and Mackinnon recommended staging and GuYudong recommended staging randomly selected cases of 45 cases which were met the requirements.There were 37men 8women;27 right side,18 left side; age 38-72 years old, mean 56 years old.The cases were divided into 3 groups:mild moderate and severe,which was according to GuYudong staging,and there were 15 cases in each group. We observe the appearance of cases of gross area in each cubital tunnel release ulnar nerve compression was observed after of all the patients. When open the ulnar nerve outer membrane in the cubital tunnel in surgery, observed thickness of the nerve outer membrane, sliding touch ulnar nerve traveling along the nerve andsensory texture. Cutting the ulnar nerve membrane as the size of 1.Ocm long and 0.5cm wide in the most obvious parts of the nerve lesions,10% formalin fixed the samples. Cut ulnar nerve membrane at the same size in the part chich more than 5cm in proximal parts of the lesion, and the ulnar nerve membrane were also fixed in 10% formalin as the controll.The specimens were embedded in paraffin after 2 weeks of fixed, section, HE staining,then we observed the histological changes of the ulnar nerve outer membrane through the microtome sections by optical microscope,which were 100 times and 400 times respectively, and compared with the normal specimen. All the patients before the operation were regular passing through electromyography, measure and record the nerve conduction velocity (NCV), latency and evoked potential amplitude of the ulnar nerve at elbow segment.Results:As the ulnar nerve outer membrane biopsy each one of the 45cases was compared with the normal, histological situation: ulnar nerve lesions at the outer membrane was no significant difference in the mild group,lesions outer membrane at the ulnar nerve showed focal vascular proliferation,and mature collagen fibers in the moderate group, ulnar nerve membrane showed myxoid degeneration of collagen fibers, showing a little mature collagen fibers in the severe group. Detecting and recording of the object of the nerve electrophysiology before release cubital tunnel and after intraoperative, the data showed that elbow ulnar nerve conduction velocity after release was faster than before, the incubation period shorter than the previous release is not significantly (P= 0.0032). Detecting and recording the object of the nerve electrophysiology before release epineurial and after, the data showed that the ulnar nerve conduction velocity of ulnar nerve after release release was not obvious faster than before, the incubation period shorter than the previous release is not significantly, (P=0.58) difference was not statistically significant.Conclusions:The three groups of samples elbows general appearance of the ulnar nerve have obvious correlation with the clinical manifestations and with the clinical manifestations severity. CuTS nerve conduction velocity in patients with elbow segment NCV slowed down latency, latency prolonged and no significant changes in amplitude. The severity of clinical manifestations in patients of Cubital tunnel syndrome has correlation with elbow segment nerve conduction velocity and latency,and also is directly related to the ulnar nerve compression and pathological changes, the changes of lesions elbow segment of ulnar nerve can be inferred by the ulnar nerve electrophysiological.After releasing the cubital tunnel the elbow ulnar nerve conduction velocity increased significantly and after the release epineurium has no significant changes in nerve conduction velocity, so,accordingly the this that was not found in the electrophysiological basis for membrane release. The changes of the ulnar nerve adventitia degree of no obvious correlation with clinical manifestations, the exact basis of pathological changes in the ulnar nerve can not be exact obtained by detecting the ulnar epineurial. Epineurium of the ulnar nerve compression in the course of the disease not play a major role in changing, epineurial external pressure which is the pressure inside the cubital tunnel is the main factors disease.