Yahya Ayesha, Malarkey Andrew R, Eschbaugh Ryan L, Bamberger H Brent
1 Ohio University, Athens, USA.
Hand (N Y). 2018 Sep;13(5):516-521. doi: 10.1177/1558944717725377. Epub 2017 Aug 23.
Cubital tunnel syndrome is the second most common compression neuropathy affecting the upper extremity. The aim of this study was to determine the preferred surgical treatment for cubital tunnel syndrome by members of the American Society for Surgery of the Hand (ASSH).
We invited members of the ASSH research mailing list to complete our online survey. They were presented with 6 hypothetical cases and asked to choose their preferred treatment from the following options: open in situ decompression, endoscopic decompression, submuscular transposition, subcutaneous transposition, medial epicondylectomy, and conservative management. This was assessed independently and anonymously through an online survey (SurveyMonkey).
1069 responses were received. Seventy-three percent of the respondents preferred to continue conservative management when a patient presented with occasional paresthesias for greater than 6 months with a normal electromyogram (EMG) or nerve conduction velocity (NCV). Sixty-five percent picked open in situ decompression if paresthesias, weakness of intrinsics, and EMG/NCV reports of mild to moderate ulnar nerve entrapment was present. More than 50% of respondents picked open in situ decompression, as their preferred treatment when sensory loss of two-point discrimination of less than 5 or more than 10 was present in addition to the findings mentioned above. Seventy-nine percent of the respondents said their treatment algorithm would change if ulnar nerve subluxation was present.
Our survey results indicate that open in situ decompression is the preferred operative procedure, if there is no ulnar nerve subluxation, among hand surgeons for cubital tunnel syndrome.
肘管综合征是影响上肢的第二常见的压迫性神经病变。本研究的目的是确定美国手外科协会（ASSH）成员对于肘管综合征首选的手术治疗方法。
我们邀请ASSH研究邮件列表的成员完成我们的在线调查。向他们展示6个假设病例，并要求他们从以下选项中选择首选的治疗方法：原位开放减压、内镜减压、肌下转位、皮下转位、内上髁切除术和保守治疗。通过在线调查（SurveyMonkey）独立且匿名地对此进行评估。
共收到1069份回复。当患者出现偶尔的感觉异常超过6个月且肌电图（EMG）或神经传导速度（NCV）正常时，73%的受访者倾向于继续保守治疗。如果存在感觉异常、内在肌无力以及EMG/NCV报告显示尺神经轻度至中度卡压，50%以上的受访者选择原位开放减压。当除上述表现外还存在两点辨别觉感觉丧失小于5或大于10时，超过50%的受访者选择原位开放减压作为他们的首选治疗方法。79%的受访者表示，如果存在尺神经半脱位，他们的治疗方案会改变。
我们的调查结果表明，对于肘管综合征，如果不存在尺神经半脱位，原位开放减压是手外科医生首选的手术方法。
