Comparison of In Situ Versus Subcutaneous Versus Submuscular Transpositions in the Management of McGowan Stage III Cubital Tunnel Syndrome
Comparison of In Situ Versus Subcutaneous Versus Submuscular Transpositions in the Management of McGowan Stage III Cubital Tunnel Syndrome
复制标题
原位转位、皮下转位和肌肉下转位在治疗 McGowan III 期肘管综合征中的比较
作者：
A. Izadpanah;Christopher M. Gibbs;R. Spinner;S. Kakar
背景资料：本研究的目的是评价和比较原位减压术与皮下和肌下移位术治疗晚期（McGowan III期）肘管综合征（CuTS）的临床结局。方法：对1989年2月至2009年5月在我院接受初次手术治疗CuTS的患者进行回顾性分析。纳入了至少随访12个月且手肘周围无任何骨或软组织手术的晚期切割术患者。74例患者接受了80例原发性尺神经手术。记录患者的人口统计学资料、临床症状、体格检查、电诊断结果和围手术期并发症。比较了初次手术技术，并评估了翻修手术的风险因素。结果如下：在80例外科手术中，有17例去骨瓣（21%），47例皮下移位（59%）和16例肌下移位（20%）。52%的患者在初次手术后症状得到缓解。初次手术后的总体并发症发生率为12.5%。19例患者（24%）在初次手术后中位30个月接受翻修手术。8例患者（42%）在翻修手术后症状改善。优势肢体受累、静态2点辨别力（S2PD）大于10 mm、就诊时年龄小于50岁的患者翻修手术率较高。3名患者因持续症状接受了第二次翻修手术和神经松解术。结论：晚期CuTS的总体翻修率为24%。42%的患者报告翻修手术后主观症状改善。就诊时年龄较小和S2PD较大与翻修手术率较高相关。
Background: The objective of the study was to evaluate and compare the clinical outcomes of in situ decompression with subcutaneous and submuscular transpositions for surgical management of advanced (McGowan stage III) cubital tunnel syndrome (CuTS). Methods: A retrospective review of patients in our institution undergoing primary surgery for CuTS from February 1989 to May 2009 was performed. Patients with advanced CuTS with a minimum of 12 months of follow-up without any previous bony or soft tissue procedures around the elbow were included. Seventy-four patients underwent 80 primary ulnar nerve surgeries. Patients’ demographics, presenting symptoms, physical examination, electrodiagnostic findings, and perioperative complications were recorded. Primary surgical techniques were compared and the risk factors for revision surgery were assessed. Results: Of the 80 surgical procedures, there were 17 decompressions (21%), 47 subcutaneous transpositions (59%), and 16 submuscular transpositions (20%). Fifty-two percent of patients had resolution of their symptoms after primary surgery. The overall complication rate after primary surgery was 12.5%. Nineteen patients (24%) had revision surgery at a median of 30 months after their primary procedure. Eight patients (42%) had symptomatic improvement after revision surgery. Patients with their dominant extremity affected, static 2-point discrimination (S2PD) greater than 10 mm, and age less than 50 years at presentation had a higher rate of revision surgery. Three patients had a second revision surgery and neurolysis for persistent symptoms. Conclusions: The overall revision rate in advanced CuTS was 24%. Forty-two percent of patients had reported subjective symptomatic improvement after revision surgery. Younger age at presentation and a greater S2PD were associated with a higher rate of revision surgery.