From the Division of Plastic Surgery, Department of Surgery, University of Alberta; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine; Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University; and Department of Orthopedic Surgery, University of North Carolina School of Medicine.
Plast Reconstr Surg. 2022 Jul 1;150(1):115e-126e. doi: 10.1097/PRS.0000000000009255. Epub 2022 May 10.
Current classifications for cubital tunnel syndrome have not been shown to reliably predict postoperative outcomes. In this article, the authors introduce a new classification that incorporates clinical and electrodiagnostic parameters, including compound muscle action potential amplitude, to classify the preoperative severity of cubital tunnel syndrome. The authors compare this to established classifications and evaluate its association with patient-rated improvement.
The authors reviewed 44 patients who were treated surgically for cubital tunnel syndrome. Patients were retrospectively classified using their proposed classification and the Akahori, McGowan-Goldberg, Dellon, and Gu classifications. Correlation of grades was assessed by Spearman coefficients and agreement was assessed by weighted kappa coefficients. Patient-reported impairment was assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire before and after surgery.
The classifications tended to grade patients in a similar way, with Spearman coefficients of 0.60 to 0.85 ( p < 0.0001) and weighted kappa coefficients of 0.46 to 0.71 ( p < 0.0001). Preoperative Disabilities of the Arm, Shoulder, and Hand scores increased with severity grade for most classifications. In multivariable analysis, the authors' classification predicted postoperative Disabilities of the Arm, Shoulder, and Hand score improvement, whereas established classifications did not.
Established classifications are imperfect indicators of preoperative severity. The authors introduce a preoperative classification for cubital tunnel syndrome that incorporates electrodiagnostic findings in addition to classic signs and symptoms.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, III.
目前的肘管综合征分类法并未被证明能可靠地预测术后结果。在本文中，作者介绍了一种新的分类方法，该方法结合了临床和电诊断参数，包括复合肌肉动作电位幅度，用于对肘管综合征的术前严重程度进行分类。作者将其与已建立的分类方法进行了比较，并评估了其与患者自评改善的相关性。
作者回顾了 44 例接受手术治疗的肘管综合征患者。患者采用作者提出的分类法和 Akahori、McGowan-Goldberg、Dellon 和 Gu 分类法进行回顾性分类。采用 Spearman 系数评估等级间的相关性，采用加权 kappa 系数评估一致性。采用臂肩手功能障碍问卷（Disabilities of the Arm, Shoulder, and Hand Questionnaire）评估患者术前和术后的功能障碍。
这些分类方法倾向于以相似的方式对患者进行分级，Spearman 系数为 0.60 至 0.85（p<0.0001），加权 kappa 系数为 0.46 至 0.71（p<0.0001）。大多数分类方法中，术前臂肩手功能障碍问卷评分随严重程度分级增加而增加。在多变量分析中，作者的分类方法预测了术后臂肩手功能障碍问卷评分的改善，而已建立的分类方法则没有。
现有的分类方法不能准确地预测术前严重程度。作者提出了一种新的肘管综合征术前分类方法，该方法除了经典的体征和症状外，还结合了电诊断发现。
临床问题/证据水平：诊断，III 级。
