Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431 South Korea.
Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431 South Korea.
Injury. 2023 Dec;54(12):111061. doi: 10.1016/j.injury.2023.111061. Epub 2023 Sep 26.
Although cubital tunnel syndrome is the second most common type of compressive neuropathy in the upper extremities, the indication and optimal surgical method for recurrent or refractory cubital tunnel syndrome remains controversial. This study evaluates the functional outcomes of revision surgery for cubital tunnel syndrome.
MATERIAL & METHODS: This study was a retrospective observational multicenter single-institution study including 660 patients who underwent surgery for cubital tunnel syndrome from 2010 to 2019. Among the 660 patients, 42(6.4%) received revision surgery due to remaining or recurrent symptoms confirmed with electromyography(EMG). After excluding those with concurrent elbow fracture, dislocation, osteoarthritis and wound infection, a total of 24 patients were included in the study. The patients were evaluated of disease severity, revision surgical method, time interval to recurrence, underlying diseases and postoperative functional outcomes.
All patients received ulnar nerve subfascial anterior transposition for the initial cubital tunnel syndrome surgery. Among the 24 patients (3.7%) who received revision surgery, nine received in situ neurolysis, 12 received submuscular transposition, and three received subcutaneous transfer. 21 patients (88%) reported improved mean VAS score of 4.3, while three patients complained of remaining symptoms that did not improve even after revision surgery. The patients with remaining symptoms all had underlying diabetes mellitus and were treated with subcutaneous transfer. The difference of surgical outcomes between the in situ neurolysis group and the nerve transfer groups were non-significant (p = 0.23). The most common cause of recurrent or persistent symptoms was adhesion and fibrosis at sling area. The mean follow up period before revision surgery was 26.3 months and postoperative follow up period after revision surgery was 8.5 months.
The outcomes of this study imply that in-situ neurolysis may be as effective as anterior submuscular transfer of ulnar nerve for refractory cubital tunnel syndrome after anterior subfascial transfer.
尽管肘管综合征是上肢最常见的第二类压迫性神经病，但对于复发性或难治性肘管综合征的适应证和最佳手术方法仍存在争议。本研究评估了肘管综合征翻修手术的功能结果。
本研究为回顾性观察性多中心单中心研究，纳入 2010 年至 2019 年期间因电生理检查（EMG）证实存在残留或复发症状而接受手术治疗的 660 例肘管综合征患者。在这 660 例患者中，42 例（6.4%）因残留或复发症状接受翻修手术。排除伴有肘部骨折、脱位、骨关节炎和伤口感染的患者后，共有 24 例患者纳入本研究。对患者的疾病严重程度、翻修手术方法、复发时间间隔、潜在疾病和术后功能结果进行评估。
所有患者初次接受肘管综合征手术时均接受尺神经皮下前置术。在接受翻修手术的 24 例患者（3.7%）中，9 例行原位神经松解术，12 例行肌下移位术，3 例行皮下转移术。21 例（88%）患者报告平均视觉模拟评分（VAS）改善 4.3，3 例患者诉残留症状，即使在翻修手术后仍未改善。残留症状的患者均有潜在的糖尿病，采用皮下转移术治疗。原位神经松解组和神经转移组的手术效果差异无统计学意义（p=0.23）。复发或持续症状的最常见原因是吊带区的粘连和纤维化。在初次手术前接受翻修手术的平均随访时间为 26.3 个月，翻修手术后的平均随访时间为 8.5 个月。
本研究结果表明，在初次皮下前置术后发生难治性肘管综合征时，原位神经松解术可能与尺神经肌下前置术同样有效。
