Harder Kristina, Lukschu Sandra, Dunda Sebastian E, Krapohl Björn Dirk
Department of Plastic and Hand Surgery, St. Marien-Krankenhaus Berlin, Germany; Center for Musculoskeletal Surgery, Charité - Medical University of Berlin, Germany.
GMS Interdiscip Plast Reconstr Surg DGPW. 2015 Dec 21;4:Doc19. doi: 10.3205/iprs000078. eCollection 2015.
Cubital tunnel syndrome represents the second most common compression neuropathy of the upper limb. For more than four decades there has been a controversy about the best surgical treatment modality for cubital tunnel syndrome. In this study the results of 28 patients with simple ulnar nerve decompression are presented. Data analyses refers to clinical examination, personal interview, DASH-questionnaire, and electrophysiological measurements, which were assessed pre- and postoperatively. 28 patients (15 females, 13 males) were included in this study. The average age at time of surgery was 47.78 years (31.68-73.10 years). The period from onset of symptoms to surgery ranged from 2 to 24 months (mean 6 months). The mean follow-up was 2.11 years (0.91-4.16 years). Postoperatively there was a significant decrease in DASH score from 52.6 points to 13.3 points (p<0.001). Also the electrophysiological findings improved significantly: motor nerve conduction velocity increased from 36.0 m/s to 44.4 m/s (p=0.008) and the motor nerve action potential reached 5,470 mV compared to 3,665 mV preoperatively (p=0.018). A significant increase of grip strength from 59% (in comparison to the healthy hand) to 80% was observed (p=0.002). Pain was indicated by means of a visual analog scale from 0 to 100. Preoperatively the median level of pain was 29 and postoperatively it was 0 (p=0.001). The decrease of the two-point-discrimination of the three ulnar finger nerves was also highly significant (p<0.001) from 11.3 mm to 5.0 mm. Significant postoperative improvement was also observed in the clinical examination concerning muscle atrophy (p=0.002), clawing (p=0.008), paresthesia (p=0.004), the sign of Froment (p=0.004), the sign of Hoffmann-Tinel (p=0.021), and clumsiness (p=0.002). Overall nearly 90% of all patients were satisfied with the result of the operation. In 96.4% of all cases, surgery improved the symptoms and in one patient (3.6%) the success was noted as "poor" because the symptoms remained unchanged. In 35.7% the success was graded as "moderate", in 10.7% as "good" and in 50.0% as "very good".
肘管综合征是上肢第二常见的压迫性神经病变。四十多年来，关于肘管综合征的最佳手术治疗方式一直存在争议。本研究展示了28例单纯尺神经减压患者的治疗结果。数据分析涉及临床检查、个人访谈、DASH问卷以及术前和术后评估的电生理测量。本研究纳入了28例患者（15例女性，13例男性）。手术时的平均年龄为47.78岁（31.68 - 73.10岁）。从症状出现到手术的时间为2至24个月（平均6个月）。平均随访时间为2.11年（0.91 - 4.16年）。术后DASH评分从52.6分显著降至13.3分（p<0.001）。电生理检查结果也显著改善：运动神经传导速度从36.0米/秒增至44.4米/秒（p = 0.008），运动神经动作电位从术前的3665毫伏达到5470毫伏（p = 0.018）。握力从（与健侧手相比）59%显著增加到80%（p = 0.002）。疼痛通过0至100的视觉模拟量表表示。术前疼痛中位数为29，术后为0（p = 0.001）。尺侧三指神经两点辨别觉从11.3毫米降至5.0毫米也有高度显著下降（p<0.001）。在肌肉萎缩（p = 0.002）、爪形手（p = 0.008）、感觉异常（p = 0.004）、Froment征（p = 0.004）、Hoffmann - Tinel征（p = 0.021）和手部笨拙（p = 0.002）等临床检查方面，术后也有显著改善。总体而言，近90%的患者对手术结果满意。在所有病例中，96.4%的手术改善了症状，1例患者（3.6%）手术效果被评为“差”，因为症状未改变。35.7%的手术效果被评为“中等”，10.7%为“良好”，50.0%为“非常好”。
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