Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Case Western Reserve University School of Medicine, Cleveland, OH.
J Orthop Trauma. 2024 Nov 1;38(11):622-628. doi: 10.1097/BOT.0000000000002898.
To describe subperiosteal elevation of the ulnar nerve and compare to anterior transposition and in situ decompression techniques.
Retrospective comparative study.
Urban Level 1 trauma center.
Distal humerus fractures (Orthopaedic Trauma Association/AO 13) treated with open reduction internal fixation between 2014 and 2022.
Rate of preoperative and postoperative neuritis grouped by the management of the ulnar nerve. During subperiosteal elevation, the ulnar nerve was identified and raised off the ulna subperiosteally and mobilized submuscularly anterior to the medial epicondyle to protect the nerve. The nerve was released only laterally off the triceps, and the medial soft tissue attachment is maintained. The main outcome measurements was rate of neuritis documented within physical examination.
Within the 125 patients, 35 underwent subperiosteal elevation (mean age of 56 ± 21 years, 57% female), 63 in situ decompression (mean age of 60 ± 18 years, 46% female), and 27 anterior transposition (mean age of 55 ± 20 years, 59% female). Preoperative ulnar neuritis was present in 34%, 21%, and 33% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively ( P = 0.26). At postoperative evaluation, symptom resolution occurred in 100%, 69%, and 33% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively ( P = 0.003). New cases of postoperative ulnar neuritis occurred in 6%, 8%, and 26% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively ( P = 0.054). Subperiosteal elevation outperformed anterior transposition regarding postoperative ulnar neuritis ( P = 0.019) and symptom resolution ( P = 0.002) and performed similarly to in situ decompression ( P > 0.05). On multiple regression analysis, anterior transposition was an independent risk factor for postoperative neuritis (OR = 5.2, P = 0.023).
Subperiosteal elevation is an effective way to minimize postoperative neuritis and similar to an in situ decompression during distal humerus fracture fixation. Based on the results of this cohort, authors recommended that anterior transposition of the ulnar nerve be used with caution due to its association with postoperative ulnar neuritis.
Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.
描述骨膜下尺神经抬高，并与前移位和原位减压技术进行比较。
回顾性比较研究。
城市一级创伤中心。
2014 年至 2022 年期间接受切开复位内固定治疗的远端肱骨骨折（骨科创伤协会/ AO 13）。
根据尺神经处理方式分组的术前和术后神经炎发生率。在骨膜下抬高过程中，识别并抬高尺神经骨膜下，在肱二头肌前向内侧髁下移位，以保护神经。仅在外侧松解肱三头肌，维持内侧软组织附着。主要结局测量是体检记录的神经炎发生率。
在 125 例患者中，35 例行骨膜下抬高（平均年龄 56±21 岁，57%为女性），63 例行原位减压（平均年龄 60±18 岁，46%为女性），27 例行前移位（平均年龄 55±20 岁，59%为女性）。接受骨膜下抬高、原位减压和前移位治疗的患者术前尺神经炎发生率分别为 34%、21%和 33%（P=0.26）。术后评估时，分别有 100%、69%和 33%接受骨膜下抬高、原位减压和前移位治疗的患者症状缓解（P=0.003）。分别有 6%、8%和 26%接受骨膜下抬高、原位减压和前移位治疗的患者出现新的术后尺神经炎（P=0.054）。骨膜下抬高在术后尺神经炎（P=0.019）和症状缓解（P=0.002）方面优于前移位，与原位减压效果相当（P＞0.05）。多元回归分析显示，前移位是术后神经炎的独立危险因素（OR=5.2，P=0.023）。
骨膜下抬高是一种有效减少术后神经炎的方法，在治疗远端肱骨骨折时与原位减压效果相似。根据本队列研究结果，由于与术后尺神经炎相关，作者建议谨慎使用尺神经前移位。
治疗性，III 级。有关证据水平的完整描述，请参见作者说明。
