Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Neurosurgery. 2009 Oct;65(4 Suppl):A145-9. doi: 10.1227/01.NEU.0000338595.99259.D6.
The surgical treatment of cubital tunnel syndrome by various techniques is often met with disappointing results. An optimal treatment is not agreed upon. The authors propose a collection of techniques which they believe optimizes outcome and minimizes iatrogenic injuries.
A combination of a novel skin incision which minimizes scar and iatrogenic cutaneous nerve injury, a technique of in situ decompression, and an atraumatic technique of ensuring complete nerve exploration proximal and distal to the incision is presented; these methods have been in use by the senior author for a number of years.
Numerous reports have demonstrated that the success of in situ ulnar nerve release by division of Osborne's fascia is equivalent to the success rates of more invasive operations for the condition of ulnar neuropathy. The authors share this view in the majority of cases of ulnar neuropathy, and they present a technique that can be expanded, if necessary, on the basis of surgical findings, with only a few indications for the greater epicondylectomy or transposition procedures.
The authors present a means of treating cubital tunnel syndrome. Failure of in situ cubital tunnel release, as with failure of any ulnar procedure, can be attributed to intraoperative ulnar nerve injury, injury to the medial antebrachial cutaneous nerve, inadequate longitudinal exploration and release, scar formation with recurrent compression and/or traction, and the possibility that decompression could lead to iatrogenic symptomatic nerve subluxation. The authors discuss the rationale for a minimalist open surgical approach for the treatment of cubital tunnel syndrome, and each of these concerns is addressed.
各种技术治疗肘管综合征的效果往往不尽如人意，目前尚未达成最佳治疗方案。作者提出了一系列技术，他们认为这些技术可以优化治疗效果，同时最大限度地减少医源性损伤。
采用一种新的切口组合，最大限度地减少疤痕和医源性皮神经损伤，采用原位减压技术，并采用无创伤技术确保在切口近端和远端进行完整的神经探查；这些方法已被资深作者使用多年。
大量报道表明，通过切开 Osborne 筋膜原位松解尺神经的成功率与更具侵袭性手术治疗尺神经病变的成功率相当。作者在大多数尺神经病变的情况下都持这种观点，他们提出了一种技术，如果根据手术发现需要，可以扩展，如果有几个指征需要做大的肱骨内上髁切除术或转位手术。
作者提出了一种治疗肘管综合征的方法。如果原位肘管松解失败，就像任何尺神经手术一样，可以归因于术中尺神经损伤、前臂内侧皮神经损伤、纵向探查和松解不足、疤痕形成导致反复压迫和/或牵引、以及减压可能导致医源性症状性神经半脱位。作者讨论了微创开放式手术治疗肘管综合征的基本原理，并解决了这些问题。
