Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Neurosurgery. 2020 Jun 1;86(6):769-777. doi: 10.1093/neuros/nyz322.
Patients with severe cubital tunnel syndrome often have poor functional recovery with conventional surgical treatment. Postsurgical electrical stimulation (PES) has been shown to enhance axonal regeneration in animal and human studies.
To determine if PES following surgery for severe cubital tunnel syndrome would result in better outcomes compared to surgery alone.
Patients with severe cubital tunnel syndrome in this randomized, double-blind, placebo-controlled trial were randomized in a 1:2 ratio to the control or stimulation groups. Control patients received cubital tunnel surgery and sham stimulation, whereas patients in the stimulation group received 1-h of 20 Hz PES following surgery. Patients were assessed by a blinded evaluator annually for 3 yr. The primary outcome was motor unit number estimation (MUNE) and secondary outcomes were grip and key pinch strength and McGowan grade and compound muscle action potential.
A total of 31 patients were enrolled: 11 received surgery alone and 20 received surgery and PES. Three years following surgery, MUNE was significantly higher in the PES group (176 ± 23, mean + SE) compared to controls (88 ± 11, P < .05). The mean gain in key pinch strength in the PES group was almost 3 times greater than in the controls (P < .05). Similarly, other functional and physiological outcomes showed significantly greater improvements in the PES group.
PES enhanced muscle reinnervation and functional recovery following surgery for severe cubital tunnel syndrome. It may be a clinically useful adjunct to surgery for severe ulnar neuropathy, in which functional recovery with conventional treatment is often suboptimal.
患有严重肘管综合征的患者经传统手术治疗后功能恢复往往较差。术后电刺激（PES）已被证明可促进动物和人体研究中的轴突再生。
确定与单独手术相比，手术后进行 PES 是否会导致严重肘管综合征患者获得更好的结果。
这项随机、双盲、安慰剂对照试验纳入了严重肘管综合征患者，按 1:2 的比例随机分为对照组或刺激组。对照组患者接受肘管手术和假刺激，而刺激组患者在手术后接受 1 小时 20Hz 的 PES。患者在 3 年内每年由盲法评估员进行评估。主要结局是运动单位数量估计（MUNE），次要结局是握力和捏力强度以及 McGowan 分级和复合肌肉动作电位。
共纳入 31 例患者：11 例单独接受手术，20 例接受手术和 PES。术后 3 年，PES 组的 MUNE 明显高于对照组（176±23，均值±SE）（P<0.05）。PES 组的关键捏力平均增益几乎是对照组的 3 倍（P<0.05）。同样，其他功能和生理结局也显示 PES 组的改善明显更大。
PES 增强了严重肘管综合征手术后的肌肉再神经支配和功能恢复。对于常规治疗功能恢复往往不理想的严重尺神经病变，它可能是手术的一种有用的辅助治疗方法。
