Blonna Davide, O'Driscoll Shawn W
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.; Department of Orthopaedics and Traumatology, University of Turin Medical School, Torino, Italy.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
Arthroscopy. 2014 Aug;30(8):947-56. doi: 10.1016/j.arthro.2014.03.022. Epub 2014 Jun 25.
The purposes of this study were to determine whether delayed-onset ulnar neuritis (DOUN) after elbow contracture release can be prevented and to compare the efficacy of ulnar nerve decompression versus subcutaneous transposition.
A retrospective study of 563 consecutive arthroscopic elbow contracture releases was conducted. The prophylactic efficacy of (1) subcutaneous transposition, (2) ulnar nerve decompression, (3) limited ulnar nerve decompression (7 to 8 cm), and (4) mini-decompression (4 to 6 cm) was assessed prospectively. The efficacy of prophylactic strategies (transposition, decompression, limited decompression, or mini-decompression) in preventing DOUN was compared by univariate survival analysis. Patients who underwent a subcutaneous transposition were matched with patients who underwent a standard open decompression or a limited decompression, according to gender, age (±10 years), diagnosis, and preoperative motion. This analysis was repeated after we excluded the patients who underwent associated open procedures (e.g., hardware removal).
DOUN occurred in 26 of 235 patients (11%) who did not undergo any prophylactic procedure versus 8 of 295 patients (3%) who underwent a prophylactic ulnar nerve decompression or transposition at the time of contracture release (P < .001). The neurologic impairment was significantly less severe after prophylactic decompression compared with patients without any prophylactic intervention (grade on Neuropathy Grading Scale, 2 vs. 4; P = .03). Ulnar nerve transposition and decompression were equally protective. The decompression length was the only factor significantly related to the failure of the prophylactic intervention (odds ratio, 0.19; P = .02). A mini-decompression was not as effective as a prophylactic procedure, whereas a limited decompression was equal to a standard decompression. The case-control analysis showed that the decompression and transposition had equal preventive effects but the transposition was associated with a higher rate of wound complications (19% vs. 4%, P = .03).
DOUN is a complication of arthroscopic elbow contracture release. Its incidence and severity can be reduced by limited open ulnar nerve decompression or transposition.
Level II, prospective comparative study with retrospective analysis.
本研究旨在确定肘关节挛缩松解术后迟发性尺神经炎（DOUN）是否能够预防，并比较尺神经减压与皮下移位术的疗效。
对连续563例关节镜下肘关节挛缩松解术进行回顾性研究。前瞻性评估（1）皮下移位术、（2）尺神经减压术、（3）有限尺神经减压术（7至8厘米）和（4）微型减压术（4至6厘米）的预防效果。通过单变量生存分析比较预防策略（移位术、减压术、有限减压术或微型减压术）在预防DOUN方面的疗效。根据性别、年龄（±10岁）、诊断和术前活动度，将接受皮下移位术的患者与接受标准开放减压术或有限减压术的患者进行匹配。在排除接受相关开放手术（如取出内固定物）的患者后，重复该分析。
235例未接受任何预防措施的患者中有26例（11%）发生DOUN，而295例在挛缩松解时接受预防性尺神经减压或移位术的患者中有8例（3%）发生DOUN（P <.001）。与未进行任何预防性干预的患者相比，预防性减压术后神经功能损害明显较轻（神经病变分级量表评分，2级对4级；P =.03）。尺神经移位术和减压术具有同等的保护作用。减压长度是与预防性干预失败显著相关的唯一因素（比值比，0.19；P =.02）。微型减压术不如预防性手术有效，而有限减压术与标准减压术效果相当。病例对照分析表明，减压术和移位术具有同等的预防效果，但移位术的伤口并发症发生率较高（19%对4%，P =.03）。
DOUN是关节镜下肘关节挛缩松解术的一种并发症。通过有限的开放尺神经减压术或移位术可降低其发生率和严重程度。
二级，前瞻性比较研究与回顾性分析。
