Grandizio Louis C, Maschke Steven, Evans Peter J
Department of Orthopedics, Geisinger Medical Center, Danville, PA.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.
J Hand Surg Am. 2018 Oct;43(10):933-940. doi: 10.1016/j.jhsa.2018.03.057. Epub 2018 Jun 8.
Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy in the upper extremity. There are considerable diagnostic and therapeutic challenges associated with treating patients after a failed primary procedure for CuTS. Distinguishing cases of recurrence versus persistence and identifying concomitant pathology can guide treatment. Conditions that mimic CuTS must be carefully ruled out and coexisting dysfunction of the medial antebrachial cutaneous nerve needs to be addressed. Results of revision procedures are not as reliable as primary procedures for CuTS; however, improvements in pain and paresthesias are noted in approximately 75% of patients. Nerve wraps represent a promising adjuvant treatment option, but long-term outcome data are lacking. External neurolysis and anterior transposition after failed CuTS procedures are supported by case series; multicenter, prospective randomized trials are needed to guide treatment further and improve outcomes.
肘管综合征（CuTS）是上肢第二常见的压迫性神经病变。对于初次治疗失败的CuTS患者，在后续治疗中存在相当大的诊断和治疗挑战。区分复发与持续存在的病例并识别合并的病理情况可指导治疗。必须仔细排除疑似CuTS的病症，并且需要处理内侧前臂皮神经的并存功能障碍。CuTS翻修手术的结果不如初次手术可靠；然而，约75%的患者疼痛和感觉异常有所改善。神经包裹术是一种有前景的辅助治疗选择，但缺乏长期疗效数据。病例系列支持在CuTS手术失败后进行外膜松解术和前路转位术；需要多中心、前瞻性随机试验来进一步指导治疗并改善疗效。
