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经皮超声引导下尺神经松解技术与开放技术的比较:一项尸体研究

Percutaneous ultrasound-guided ulnar nerve release technique compared to open technique: A cadaveric study.

作者信息

Mansour Jad, Ghanimeh Joe, Ghersi Abdelhamid, Moutinot Berenice, Coulomb Remy, Kouyoumdjian Pascal, Mares Olivier

机构信息

Centre Hospitalier Universitaire Nîmes-Caremeau, place du professeur Robert-Debré, 30029 Nîmes, France.

Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon.

出版信息

SICOT J. 2022;8:40. doi: 10.1051/sicotj/2022041. Epub 2022 Sep 26.

Abstract

OBJECTIVES

To evaluate the outcomes of a novel percutaneous ultrasound-guided technique for release of ulnar nerve entrapment at the elbow when compared to standard open release Methods: One single surgeon performed an ultrasound-guided percutaneous release of the cubital tunnel on a group of five cadaveric elbows and open release on five others. All procedures were timed, and incision lengths were recorded. Meticulous anatomic dissection was then performed to assess the complete release of the carpal tunnel and iatrogenic injuries.

RESULTS

No significant difference was found between the two groups in terms of complete release and iatrogenic injury, whereas Operative time was significantly shorter for the US-guided technique. Incomplete releases of the nerve were found only during the first two trials in each group, while the third, fourth, and fifth trials showed a complete ulnar nerve release in both series, highlighting a fast learning curve for both techniques. All of this through a significantly smaller incision in the US-guided technique.

CONCLUSIONS

This study highlights the similar effects of these two techniques in terms of complete release of the ulnar nerve, with no clear superiority of one over the other in terms of morbidity rate. Both have a fast learning curve for an ultrasound-trained surgeon, with the US-guided technique being a less traumatic and quicker alternative procedure.

摘要

目的

与标准开放松解术相比,评估一种新型经皮超声引导技术用于松解肘部尺神经卡压的效果。方法:由一名外科医生对五具尸体肘部进行超声引导下经皮肘管松解术,对另外五具尸体肘部进行开放松解术。记录所有手术的时间和切口长度。然后进行细致的解剖分离,以评估尺神经的完全松解情况和医源性损伤。

结果

两组在完全松解和医源性损伤方面无显著差异,而超声引导技术的手术时间明显更短。仅在每组的前两次试验中发现神经松解不完全,而第三次、第四次和第五次试验在两个系列中均显示尺神经完全松解,突出了两种技术的快速学习曲线。通过超声引导技术,所有这些均通过明显更小的切口完成。

结论

本研究强调了这两种技术在尺神经完全松解方面的相似效果,在发病率方面两者没有明显的优势。对于接受过超声培训的外科医生来说,两种技术都有快速的学习曲线,超声引导技术是一种创伤较小且更快的替代手术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5c1/9511962/754dce7fbb65/sicotj-8-40-fig1.jpg

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