Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia; Neurosurgery Department, Cabrini Health, Melbourne, Victoria, Australia.
Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Australia.
J Clin Neurosci. 2021 May;87:8-16. doi: 10.1016/j.jocn.2021.01.044. Epub 2021 Mar 5.
Submuscular transposition (SMT) for treatment of ulnar nerve entrapment is commonly performed, however published comparisons of surgical techniques exclude a high proportion of the at-risk population encountered in real world practice. To examine the influence of risk factors on the clinical outcome following SMT we performed a retrospective review of all patients who underwent SMT, including patient self-reported outcome and Louisiana State University Medical Centre ulnar nerve grading scale. A total of 403 ulnar nerves were operated, with follow-up data available for 385 cases (359 patients). Risk factors (including smoking, diabetes, previous elbow trauma/pathology, subluxation, workers' compensation) were reported in 266 of 385 surgeries (69.09%). SMT was the primary procedure in 339 nerves (88.05%), revision procedure in 46 nerves (11.95%). At last follow up 91.05% reported symptomatic improvement. Nerve grade improvement in 71.09% of primary and 67.39% revision surgery (p = 0.605). No significant difference in improvement was identified between demographic and risk categories, except for patient reported improvement in those without peripheral neuropathy (90.59% vs 73.33%, p = 0.027), and those not improved were on average older than those improved (62.94 vs. 55.68 years, p = 0.012). Superficial infection occurred in 2.6% and there were no deep infections. Application of published exclusion criteria would have resulted in exclusion of ½-⅔ of our cohort. SMT in patients with a history of elbow trauma, diabetes, workers compensation, smoking history, nerve subluxation or revision surgery have similar outcomes compared to those without these factors, whilst improved results were observed in younger patients and those without peripheral neuropathy.
肌肉下转位（SMT）常用于治疗尺神经卡压，但发表的手术技术比较研究排除了实际实践中遇到的高比例高危人群。为了研究危险因素对 SMT 后临床结果的影响，我们对所有接受 SMT 的患者进行了回顾性研究，包括患者自我报告的结果和路易斯安那州立大学医学中心尺神经分级量表。共对 403 根尺神经进行了手术，其中 385 例（359 名患者）可获得随访数据。266 例（69.09%）手术报告了危险因素（包括吸烟、糖尿病、既往肘部创伤/病变、半脱位、工人赔偿）。339 根神经（88.05%）为初次手术，46 根神经（11.95%）为翻修手术。末次随访时，91.05%的患者报告症状改善。初次手术神经分级改善率为 71.09%，翻修手术为 67.39%（p=0.605）。除了无周围神经病变的患者（90.59%比 73.33%，p=0.027）和未改善的患者平均年龄大于改善的患者（62.94 比 55.68 岁，p=0.012）外，在人口统计学和危险因素类别之间未发现改善程度有显著差异。发生率为 2.6%的浅表感染，无深部感染。应用发表的排除标准，我们的队列中有一半到三分之二会被排除。有肘部创伤、糖尿病、工人赔偿、吸烟史、神经半脱位或翻修手术史的 SMT 患者与无这些因素的患者相比，结果相似，而年轻患者和无周围神经病变的患者结果更好。
