Jiang Su, Xu Wendong, Shen Yundong, Xu Jian-Guang, Gu Yu-Dong
Department of Hand Surgery, HuaShan Hospital, Fudan University, Shanghai, People's Republic of China.
Ann Plast Surg. 2012 Jan;68(1):62-6. doi: 10.1097/SAP.0b013e318211913c.
The optimal treatment for cubital tunnel syndrome is widely debated. The purpose of this study is to describe the technique of an endoscopic-assisted ulnar nerve decompression using carbon dioxide insufflation in association with subcutaneous anterior transposition and to assess the success or failure of the method of treatment.
In all, 8 male and 4 female patients with an average age of 42 years (range, 25-56) who presented signs, symptoms, and abnormal neurophysiological studies of cubital tunnel syndrome were recruited in the retrospective study. Between August 2008 and June 2009, they were operated on using a 0-degree lens endoscope. Preoperatively, they were classified according to the Dellon scale, and the Bishop rating system was used to evaluate the postoperative outcomes.
Preoperatively, 5 patients were rated as mild, another 5 as moderate, and the remaining 2 as severe. The average length of the incision was 15 ± 3 mm, the mean length of the ulnar nerve decompression was 18 ± 2 cm, and the whole duration of surgery (skin to skin) lasted 30 ± 5 minutes. The endoscopic-assisted cubital tunnel release under carbon dioxide insufflation and subcutaneous anterior transposition surgeries in all patients were performed with no difficulty. All the patients had improvement in symptoms of cubital tunnel syndrome and 10 of 12 patients scored excellent according to the modified Bishop Rating System at a minimum of 1 year after surgery.
Endoscopy-assisted cubital tunnel release under carbon dioxide insufflation demonstrated similar results compared with conventional open surgeries, besides, it may avoid problems such as long incision, painful scarring, and have additional advantages of providing an extended endoscopic view, which is safe and mini-invasive with favorable results in a 12-month follow-up.
尺神经沟综合征的最佳治疗方法存在广泛争议。本研究的目的是描述一种使用二氧化碳充气联合皮下前路转位的内镜辅助尺神经减压技术，并评估该治疗方法的成败。
在这项回顾性研究中，共纳入了8例男性和4例女性患者，平均年龄42岁（范围25 - 56岁），这些患者均表现出尺神经沟综合征的体征、症状及异常神经生理学研究结果。在2008年8月至2009年6月期间，使用0度镜头内镜对他们进行手术。术前，根据德龙量表对患者进行分类，并使用毕晓普评分系统评估术后结果。
术前，5例患者被评为轻度，另外5例为中度，其余2例为重度。切口平均长度为15±3毫米，尺神经减压平均长度为18±2厘米，整个手术时长（皮肤切开至缝合）为30±5分钟。所有患者的二氧化碳充气联合皮下前路转位的内镜辅助尺神经沟松解手术均顺利完成。所有患者的尺神经沟综合征症状均有改善，12例患者中有10例在术后至少1年时根据改良毕晓普评分系统获得了优异评分。
与传统开放手术相比，二氧化碳充气下的内镜辅助尺神经沟松解术显示出相似的结果，此外，它可能避免长切口、疼痛性瘢痕等问题，还具有提供扩展内镜视野的额外优势，在12个月的随访中安全且微创，效果良好。
