Campbell Benjamin R, Cohen Anne R, Alfonsi Samuel, Depascal Maura, Rengifo Santiago, Ilyas Asif M
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
J Hand Microsurg. 2024 Aug 13;16(5):100148. doi: 10.1016/j.jham.2024.100148. eCollection 2024 Dec.
The purpose of this study was to identify and characterize factors that may contribute to revision surgery following primary cubital tunnel release (CuTR) surgery.
A retrospective study was performed by reviewing all patients who underwent CuTR at a single institution between 2014 and 2021. Only primary CuTR surgeries were included. Exclusion criteria were any case of primary ulnar nerve transpositions or ulnar nerve decompression surgery related to pathology other than isolated ulnar neuropathy (ie. elbow fracture repair, medial epicondylitis debridement, etc.). Revision surgery was defined as return to the operating room by the index surgeon or another surgeon within the same practice for repeat ulnar nerve decompression and/or transposition. Patient demographics and surgical information was analyzed to determine factors that may be associated with revision surgery following primary ulnar nerve decompression.
A total of 1367 patients met inclusion criteria. Revision rate following primary CuTR was 1.2 % (n = 16). Of the factors evaluated, younger age (46.6 vs 57.0 years) and a history of cervical stenosis had a higher correlation with undergoing a revision. Patients who had revision surgery were more likely to have negative electrodiagnostic studies versus those who did not. Otherwise, there was no association between sex, race, tobacco use, medical comorbidities, symptom severity, bilateral symptoms, or concurrent surgery and the subsequent need for revision ulnar nerve decompression.
Following primary CuTR, younger age or a history of cervical stenosis may be at higher risk of undergoing revision surgery. Additionally, patients without electrodiagnostic evidence of ulnar neuropathy may have less reliable outcomes versus those who have a positive nerve study. Given the unpredictable nature of ulnar nerve surgery, further prospective data including diagnostic imaging and biomechanical evaluation of patients following ulnar nerve release may help provide a deeper understanding of this unique patient population.
Prognostic, level IV.
本研究旨在识别并描述可能导致原发性肘管松解术（CuTR）后翻修手术的因素。
通过回顾2014年至2021年在单一机构接受CuTR手术的所有患者进行了一项回顾性研究。仅纳入原发性CuTR手术。排除标准为任何原发性尺神经移位或与孤立性尺神经病变以外的病理相关的尺神经减压手术病例（即肘部骨折修复、内侧上髁炎清创等）。翻修手术定义为术者或同一医疗机构的另一位外科医生再次进入手术室进行重复尺神经减压和/或移位。分析患者人口统计学和手术信息，以确定可能与原发性尺神经减压术后翻修手术相关的因素。
共有1367例患者符合纳入标准。原发性CuTR后的翻修率为1.2%（n = 16）。在评估的因素中，年龄较小（46.6岁对57.0岁）和颈椎管狭窄病史与接受翻修手术的相关性更高。接受翻修手术的患者与未接受翻修手术的患者相比，电诊断检查结果更可能为阴性。此外，性别、种族、吸烟、内科合并症、症状严重程度、双侧症状或同期手术与随后进行尺神经减压翻修手术的需求之间没有关联。
原发性CuTR后，年龄较小或有颈椎管狭窄病史的患者接受翻修手术的风险可能更高。此外，与神经检查结果阳性的患者相比，没有尺神经病变电诊断证据的患者预后可能不太可靠。鉴于尺神经手术的不可预测性，包括尺神经松解术后患者的诊断性影像学和生物力学评估在内的进一步前瞻性数据可能有助于更深入地了解这一独特的患者群体。
预后性，IV级。
