Mujadzic Tarik, Bian Julia, Martinez Carlos, Mujadzic Mirza M, Botonjic Hata, Friedman H I, Mujadzic Mirsad
From the Division of Plastic and Reconstructive Surgery.
Department of Internal Medicine, Prisma Health-Midlands/University of South Carolina School of Medicine, Columbia, SC.
Ann Plast Surg. 2025 Jun 1;94(6S Suppl 4):S526-S530. doi: 10.1097/SAP.0000000000004382.
Cubital tunnel syndrome, the second most common compression neuropathy of the upper extremity, has several surgical treatment options including simple (in situ) decompression, decompression with medial epicondylectomy (ME), or anterior transposition to a subcutaneous, submuscular, or subfascial position. The existing literature does not clearly establish the superiority of one procedure over the other. This study aims to compare two techniques, ME combined with an adipofascial flap versus anterior subcutaneous transposition, in terms of outcomes including resolution of neurological deficits, surgical site discomfort, recurrence, and reoperation.
This was an IRB-approved retrospective chart analysis on patients who had primary ulnar nerve decompression via either ME or subcutaneous anterior transposition. Outcomes recorded were tenderness at operative site, resolution of neurological deficits, recurrence rate, and need for secondary surgery.
Patients undergoing ME (n = 48) were classified into mild (n = 1, 2%), moderate (n = 11, 23%), and severe (n = 36, 75%) categories. For this group, complete resolution of neurological symptoms was recorded as <6 weeks (n = 10, 21%), 6 weeks to 3 months (n = 8, 16.6%), and >3 months (n = 13, 27%). Incomplete resolution was documented as improved (n = 15, 31.2%), unchanged (n = 2, 4.1%), or worse (0%). Surgical site discomfort was documented as lasting <3 weeks (n = 30, 62.5%), 3 to 6 weeks (n = 15, 37.5%), and 6 weeks to 3 months (n = 3, 6.3%), and there were no patients who had unresolved pain. The recurrence rate was 2/48 (4.1%). The secondary surgery rate was 1/48 (2%).Patients undergoing subcutaneous anterior transposition (n = 54) were classified into mild (n = 6, 11%), moderate (n = 26, 48%), and severe (n = 22, 41%) categories. For this group, complete resolution of symptoms was recorded as <6 weeks in (n = 13, 24%), 6 weeks to 3 months (n = 10, 18.5%), and >3 months (n = 12, 22.2%). Incomplete resolution was documented as improved (n = 13, 24.1%), unchanged (n = 4, 7.4%), or worse (n = 2, 3.7%). Surgical site discomfort was documented as lasting <3 weeks (n = 41, 76%), 3 to 6 weeks (n = 2, 4%), and 6 weeks to 3 months (n = 1, 2%), and 10 patients (18%) had unresolved pain. The recurrence rate (n = 13, 24%) and need for a second surgery (n = 19, 18.5%) were also recorded.
Medial epicondylectomy with adipofascial flap is effective in treating cubital tunnel syndrome and has a lower potential for persistent surgical site pain and recurrence than subcutaneous transposition.
肘管综合征是上肢第二常见的压迫性神经病变，有多种手术治疗方案，包括单纯（原位）减压、内侧上髁切除术（ME）减压或前移至皮下、肌下或筋膜下位置。现有文献并未明确证实一种手术方式优于另一种。本研究旨在比较两种技术，即ME联合脂肪筋膜瓣与皮下前移术，在神经功能缺损的恢复、手术部位不适、复发及再次手术等方面的疗效。
这是一项经机构审查委员会批准的回顾性图表分析，研究对象为接受原发性尺神经减压术（采用ME或皮下前移术）的患者。记录的结果包括手术部位压痛、神经功能缺损的恢复情况、复发率及二次手术需求。
接受ME手术的患者（n = 48）分为轻度（n = 1，2%）、中度（n = 11，23%）和重度（n = 36，75%）三类。该组患者神经症状完全缓解的时间记录为<6周（n = 10，21%）、6周至3个月（n = 8，16.6%）和>3个月（n = 13，27%）。不完全缓解的情况记录为改善（n = 15，31.2%）、无变化（n = 2，4.1%）或恶化（0%）。手术部位不适持续时间记录为<3周（n = 30，62.5%）、3至6周（n = 15，37.5%）和6周至3个月（n = 3, 6.3%），且无患者疼痛未缓解。复发率为2/48（4.1%）。二次手术率为1/48（2%）。接受皮下前移术的患者（n = 54）分为轻度（n = 6，11%）、中度（n = 26，48%）和重度（n = 22，41%）三类。该组患者症状完全缓解的时间记录为<（n = 13，24%）、6周至3个月（n = 10, 18.5%）和>3个月（n = 12，22.2%）。不完全缓解的情况记录为改善（n = 13，24.1%）、无变化（n = 4，7.4%）或恶化（n = 2，3.7%）。手术部位不适持续时间记录为<3周（n = 41，76%）、3至6周（n = 2，4%）和6周至3个月（n = 1，2%），10例患者（18%）疼痛未缓解。还记录了复发率（n = 13，24%）及二次手术需求（n = 19，18.5%）。
内侧上髁切除术联合脂肪筋膜瓣治疗肘管综合征有效，与皮下前移术相比，手术部位持续疼痛和复发的可能性更低。
