Seyfettinoğlu Firat, Karaer Ali, Sertöz Zeki, Dülgeroğlu Ali, Koruyucu Melike Bedel, Bora Osman Arslan
Department of Orthopedics and Traumatology, İzmir Atatürk Training and Research Hospital, Turkey.
Eklem Hastalik Cerrahisi. 2012;23(2):88-93.
The morphology and functional results of the ulnar nerve were evaluated in patients treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome.
Thirteen elbows of 13 patients (8 males, 5 females; mean age 41 years; range 25 to 56 years) treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome were investigated. The involvement was on the dominant side in six patients. There was a 25° cubitus valgus deformity in one patient. No significant etiologic cause was found in the other patients. Seven patients were treated with anterior subcutaneous transposition and six with simple decompression. During the follow-ups, the atrophy magnitude, the new pressure areas and the intrinsic structure of the nerve tissue along the ulnar nerve path were evaluated by using soft tissue ultrasonography (USG). The flow rate of the artery supplying the ulnar nerve by Doppler mode USG and ulnar nerve conduction rate by electromyography (EMG) were assessed. Functional results were evaluated according to the Akahori's criteria and the modified Bishop scoring system. The average follow-up time was two years (range 12-44 months).
In the Doppler USG examination, no arterial blood flow supplying the ulnar nerve was found in five of seven patients who underwent anterior transposition. A blood flow decrease of approximately 20 cm/s was found in two patients. A blood flow decrease of 10 cm/s on average was found in six patients who underwent simple decompression. There was a significant difference between the two groups (p<0.05). The control EMG revealed an increase of 9 m/s in the ulnar nerve conduction rate in the transposition group (p>0.05) and an increase of 17 m/s in the simple decompression group compared to the preoperative values (p<0.05). In seven patients who underwent anterior subcutaneous transposition, five excellent and two good results and an average of 8.2 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. In six patients who underwent simple decompression, five excellent results, and one good result and an average of 8.1 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. There was no statistically significant difference between functional results of both surgical techniques (p>0.05).
Although the functional results of the cubital tunnel syndrome surgery are good, it must be noted that the blood supply to the nerve may be distorted, especially during anterior transposition. If there is no additional requirement, simple decompression may be considered as the first option.
对因诊断为肘管综合征而接受单纯减压和皮下前置术治疗的患者的尺神经形态和功能结果进行评估。
对13例因诊断为肘管综合征而接受单纯减压和皮下前置术治疗的患者（8例男性，5例女性；平均年龄41岁；范围25至56岁）的13个肘部进行了研究。6例患者患侧为优势侧。1例患者存在25°肘外翻畸形。其他患者未发现明显病因。7例患者接受了皮下前置术，6例接受了单纯减压术。在随访期间，通过软组织超声检查（USG）评估尺神经走行沿线神经组织的萎缩程度、新的受压区域和内在结构。通过多普勒模式超声检查评估供应尺神经的动脉血流速度，并通过肌电图（EMG）评估尺神经传导速度。根据赤堀标准和改良的毕晓普评分系统评估功能结果。平均随访时间为两年（范围12至44个月）。
在多普勒超声检查中，7例接受前置术的患者中有5例未发现供应尺神经的动脉血流。2例患者血流速度下降约20 cm/s。6例接受单纯减压术的患者平均血流速度下降10 cm/s。两组之间存在显著差异（p<0.05）。对照肌电图显示，与术前值相比，前置术组尺神经传导速度增加9 m/s（p>0.05），单纯减压组增加17 m/s（p<0.05）。根据赤堀标准和改良的毕晓普评分系统，7例接受皮下前置术的患者分别获得5例优和2例良的结果，平均得分为8.2分。6例接受单纯减压术的患者分别获得5例优和1例良的结果，平均得分为8.1分。两种手术技术的功能结果之间无统计学显著差异（p>0.05）。
尽管肘管综合征手术的功能结果良好，但必须注意，尤其是在皮下前置术过程中，神经的血液供应可能会受到影响。如果没有其他特殊要求，单纯减压可被视为首选方案。
