Van Nest Duncan, Ilyas Asif M
Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States.
Department of Orthopedics, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
J Hand Microsurg. 2020 Oct;12(Suppl 1):S28-S32. doi: 10.1055/s-0039-1694292. Epub 2019 Nov 18.
The current understanding of revision rates following surgery for the primary surgical treatment of idiopathic cubital tunnel syndrome (CuTS) remains unclear. The purpose of this study was to describe and compare the rate of revision surgery following in situ decompression (SD) versus anterior transposition (AT) after the surgical treatment of idiopathic CuTS and examine possible predicting variables for revision. A retrospective cohort study was performed at a single institution by querying records for all CuTS surgeries performed between January 2010 and December 2015. The initial query resulted in 1,967 cases. Exclusion criteria included acute trauma, concurrent unrelated primary elbow procedure, revision surgery, incomplete records, and age younger than 18 or older than 89 years. A total of 1,384 surgeries met criteria for study inclusion. A case-control study was then performed with 39 cases of revision and a group of 76 control cases that did not undergo revision surgery. Bivariate analysis followed by multivariate logistic regression was performed to evaluate predictors of revision. Of the 1,384 procedures, 979 were SDs (70.7%) and 405 were ATs (29.3%). Among the 1,384 total procedures, there were 39 primary cubital tunnel surgeries resulting in a revision surgery (2.8%). The revision rate for SD was 3.1% and the revision rate for AT was 2.2%. Predictors of revision were younger age, increased nerve conduction velocity, and decreased duration of symptoms. In the surgical treatment of idiopathic CuTS, the overall revision rate is low (2.8%). This study found no significant difference in revision rate between SD and AT, but that risk for revision surgery overall was associated with younger age, increased nerve conduction velocity, and decreased duration of symptoms. This is a therapeutic, level III study.
目前对于原发性特发性肘管综合征（CuTS）手术治疗后的翻修率的认识仍不明确。本研究的目的是描述和比较特发性CuTS手术治疗后原位减压（SD）与前移位（AT）后的翻修手术率，并检查可能的翻修预测变量。
在单一机构进行了一项回顾性队列研究，通过查询2010年1月至2015年12月期间所有CuTS手术的记录。初始查询产生了1967例病例。排除标准包括急性创伤、同期无关的原发性肘部手术、翻修手术、记录不完整以及年龄小于18岁或大于89岁。共有1384例手术符合研究纳入标准。然后进行了一项病例对照研究，其中39例为翻修病例，一组76例为未进行翻修手术的对照病例。进行了双变量分析，随后进行多变量逻辑回归以评估翻修的预测因素。
在1384例手术中，979例为SD（70.7%），405例为AT（29.3%）。在1384例总手术中，有39例原发性肘管手术导致了翻修手术（2.8%）。SD的翻修率为3.1%，AT的翻修率为2.2%。翻修的预测因素为年龄较小、神经传导速度增加和症状持续时间缩短。
在原发性特发性CuTS的手术治疗中，总体翻修率较低（2.8%）。本研究发现SD和AT之间的翻修率无显著差异，但总体翻修手术风险与年龄较小、神经传导速度增加和症状持续时间缩短有关。
这是一项治疗性III级研究。
