Shah Chirag M, Calfee Ryan P, Gelberman Richard H, Goldfarb Charles A
Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
J Hand Surg Am. 2013 Jun;38(6):1125-1130.e1. doi: 10.1016/j.jhsa.2013.02.039. Epub 2013 May 3.
To prospectively analyze, using validated outcome measures, symptom improvement in patients with mild to moderate cubital tunnel syndrome treated with rigid night splinting and activity modifications.
Nineteen patients (25 extremities) were enrolled prospectively between August 2009 and January 2011 following a diagnosis of idiopathic cubital tunnel syndrome. Patients were treated with activity modifications as well as a 3-month course of rigid night splinting maintaining 45° of elbow flexion. Treatment failure was defined as progression to operative management. Outcome measures included patient-reported splinting compliance as well as the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Short Form-12. Follow-up included a standardized physical examination. Subgroup analysis included an examination of the association between splinting success and ulnar nerve hypermobility.
Twenty-four of 25 extremities were available at mean follow-up of 2 years (range, 15-32 mo). Twenty-one of 24 (88%) extremities were successfully treated without surgery. We observed a high compliance rate with the splinting protocol during the 3-month treatment period. Quick Disabilities of the Arm, Shoulder, and Hand scores improved significantly from 29 to 11, Short Form-12 physical component summary score improved significantly from 45 to 54, and Short Form-12 mental component summary score improved significantly from 54 to 62. Average grip strength increased significantly from 32 kg to 35 kg, and ulnar nerve provocative testing resolved in 82% of patients available for follow-up examination.
Rigid night splinting when combined with activity modification appears to be a successful, well-tolerated, and durable treatment modality in the management of cubital tunnel syndrome. We recommend that patients presenting with mild to moderate symptoms consider initial treatment with activity modification and rigid night splinting for 3 months based on a high likelihood of avoiding surgical intervention.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
采用经过验证的疗效指标，对采用硬性夜间夹板固定及调整活动方式治疗的轻至中度肘管综合征患者的症状改善情况进行前瞻性分析。
2009年8月至2011年1月期间，前瞻性纳入19例（25个肢体）诊断为特发性肘管综合征的患者。患者接受活动调整以及为期3个月的硬性夜间夹板固定治疗，保持肘关节屈曲45°。治疗失败定义为进展至手术治疗。疗效指标包括患者报告的夹板依从性以及手臂、肩部和手部快速残疾问卷和简短健康调查问卷-12。随访包括标准化体格检查。亚组分析包括检查夹板固定成功与尺神经活动度增加之间的关联。
25个肢体中的24个在平均2年的随访期（范围15 - 32个月）时可进行评估。24个肢体中的21个（88%）成功接受非手术治疗。我们观察到在3个月的治疗期内夹板固定方案的依从率很高。手臂、肩部和手部快速残疾评分从29显著改善至11，简短健康调查问卷-12身体成分汇总评分从45显著改善至54，简短健康调查问卷-12精神成分汇总评分从54显著改善至6（此处原文可能有误，推测应为62）。平均握力从32千克显著增加至35千克，82%可进行随访检查的患者尺神经激发试验结果转阴。
硬性夜间夹板固定联合活动调整似乎是治疗肘管综合征的一种成功、耐受性良好且持久的治疗方式。我们建议，出现轻至中度症状的患者，基于避免手术干预的高可能性，考虑初始采用活动调整和硬性夜间夹板固定治疗3个月。
研究类型/证据水平：治疗性II级。
