Rogers M R, Bergfield T G, Aulicino P L
Department of Orthopaedic Surgery, Eastern Virginia Graduate School of Medicine, Norfolk.
Clin Orthop Relat Res. 1991 Aug(269):193-200.
Various procedures have been recommended for the treatment of cubital tunnel syndrome. Simple decompression in situ, medial epicondylectomy, subcutaneous transposition, intramuscular transposition, and submuscular transposition all have their advocates. The results of the surgical treatment for cubital tunnel syndrome are related to the severity of the compressive neuropathy at the time of diagnosis and to the adequate decompression of the nerve at all sites of potential compression at the time of surgical treatment. Fourteen patients who had previously undergone surgical treatment for cubital tunnel syndrome were evaluated because of persistent pain, paresthesia, numbness, and motor weakness. All patients had documented persistent compression of the ulnar nerve on clinical and electromyographic evaluation. The indication for repeat surgical exploration in all patients was unremitting pain despite nonoperative treatment. All patients had been treated by neurolysis and submuscular transposition of the ulnar nerve as described by Learmonth. The causes of continued pain after initial surgery included retention of the medial intermuscular septum, dense perineural fibrosis of the nerve after intramuscular and subcutaneous transposition, adhesions of the nerve to the medial epicondylectomy site, and recurrent subluxation of the nerve over the medial epicondyle after subcutaneous transposition. Revision surgery was found to be highly successful for relief of pain and paresthesias; however, the recovery of motor function and return of sensibility were variable and unpredictable.
对于肘管综合征的治疗，已经推荐了多种手术方法。原位简单减压、内上髁切除术、皮下移位、肌内移位和肌下移位都有各自的支持者。肘管综合征手术治疗的结果与诊断时压迫性神经病变的严重程度以及手术治疗时在所有潜在压迫部位对神经的充分减压有关。对14例先前因肘管综合征接受过手术治疗的患者进行了评估，这些患者存在持续疼痛、感觉异常、麻木和运动无力的症状。所有患者经临床和肌电图评估均记录有尺神经持续受压。所有患者再次手术探查的指征均为尽管进行了非手术治疗但仍有持续疼痛。所有患者均按照利尔蒙特所描述的方法接受了尺神经松解和肌下移位治疗。初次手术后持续疼痛的原因包括肌间隔保留、肌内和皮下移位后神经的致密神经周纤维化、神经与内上髁切除部位的粘连以及皮下移位后神经在内上髁上方的复发性半脱位。发现翻修手术在缓解疼痛和感觉异常方面非常成功；然而，运动功能的恢复和感觉的恢复是可变的且不可预测的。
