Lee Sang Ki, Lee Gyu Sang, Choy Won Sik
From the Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
Ann Plast Surg. 2018 May;80(5):533-538. doi: 10.1097/SAP.0000000000001437.
This study aimed to retrospectively analyze the clinical results of anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique in patients with severe cubital tunnel syndrome (CTS).
From January 2007 to May 2015, 36 patients with grade III CTS based on McGowan's classification were enrolled. All patients were treated with anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique. To evaluate clinical outcomes, all patients underwent preoperative and final follow-up assessments of disabilities of the arm, shoulder, and hand scores, nerve conduction velocity, 2-point discrimination, and pinch and grip strength. Overall functional outcomes were evaluated after a mean follow-up of 53 months using the Modified Bishop rating system. We analyzed the statistical correlation of patients' duration of symptom and age with clinical results.
At the final follow-up, the average disabilities of the arm, shoulder, and hand, nerve conduction velocity, 2-point discrimination, and grip and pinch strengths significantly improved in all patients. At least a 1-McGowan grade improvement was achieved in 34 extremities (94.4%). According to the modified Bishop scores, 30 patients (83.3%) achieved good or excellent outcomes and 2 extremities (5.5%) had poor outcomes. There was a significant negative correlation between prolonged symptom duration and the Modified Bishop score at the final follow-up, but age did not affect the functional outcome.
In McGowan grade III severe CTS, anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique leads to satisfactory outcomes. Longer symptom duration is associated with poorer results, and the outcome is not correlated with age. Therefore, active surgical treatment should be considered regardless of age before severe disease occurs.
本研究旨在回顾性分析采用屈肌 - 旋前肌V - Y延长技术行尺神经前肌下转位术治疗重度肘管综合征（CTS）患者的临床效果。
纳入2007年1月至2015年5月间36例基于McGowan分级为III级CTS的患者。所有患者均采用屈肌 - 旋前肌V - Y延长技术行尺神经前肌下转位术。为评估临床疗效，所有患者均接受术前及末次随访时的上肢、肩部和手部功能障碍评分、神经传导速度、两点辨别觉以及捏力和握力评估。采用改良Bishop评分系统在平均随访53个月后评估总体功能结局。我们分析了患者症状持续时间和年龄与临床疗效的统计学相关性。
在末次随访时，所有患者的上肢、肩部和手部平均功能障碍、神经传导速度、两点辨别觉以及握力和捏力均有显著改善。34个肢体（94.4%）至少提高了1个McGowan分级。根据改良Bishop评分，30例患者（83.3%）获得良好或优秀结局，2个肢体（5.5%）结局较差。在末次随访时，症状持续时间延长与改良Bishop评分之间存在显著负相关，但年龄不影响功能结局。
在McGowan III级重度CTS中，采用屈肌 - 旋前肌V - Y延长技术行尺神经前肌下转位术可获得满意疗效。症状持续时间越长，结果越差，且结局与年龄无关。因此，在严重疾病发生前，无论年龄大小，均应考虑积极手术治疗。
