Hu Tianyou, Bian Yujie, Wang Qiankun, Zhou Tao, Zhou Hongxiang
The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
J Orthop Surg Res. 2025 Aug 22;20(1):792. doi: 10.1186/s13018-025-06200-5.
Percutaneous external suturing has been proposed as an alternative approach to fascial flap fixation during anterior subcutaneous transposition for cubital tunnel syndrome (CuTS), with the aim of minimizing deep tissue disruption and reducing postoperative complications. This study compared short-term outcomes between percutaneous external fixation and traditional subcutaneous fixation of fascial flaps in CuTS surgery.
In this retrospective cohort study, 114 patients who underwent anterior ulnar nerve transposition with fascial flap coverage were enrolled between January 2020 and December 2023. Patients were grouped based on the method of fascial flap fixation: subcutaneous (n = 57) or percutaneous (n = 57). Clinical assessments-including Visual Analog Scale (VAS), Patient-Rated Ulnar Nerve Evaluation (PRUNE), and Cubital Tunnel Syndrome Functional Score-along with nerve conduction studies (CMAP, SNCV, MNCV), were performed preoperatively and at 6-month follow-up.
Compared to the subcutaneous group, the percutaneous group showed significantly greater improvement in VAS scores (VAS: -2.75 vs. -1.99, p < 0.001), PRUNE scores (PRUNE: -23.78 vs. -17.64, p < 0.001), and functional scores (Score: +3.58 vs. + 2.70, p = 0.0004). Increases in SNCV (16.45 m/s vs. 14.51 m/s, p = 0.035) and MNCV (18.55 m/s vs. 12.13 m/s, p < 0.001) were also more pronounced in the percutaneous group. Although CMAP improved in both groups, postoperative CMAP values were slightly higher in the subcutaneous group (6.02 ± 0.85 mV vs. 5.40 ± 0.51 mV, p = 0.002). No infections or wound complications occurred in either group; two reoperations for recurrent compression were required in the subcutaneous group.
Percutaneous external suturing may represent a safe and promising alternative for fascial flap fixation during CuTS surgery, with potential benefits in early postoperative pain relief, nerve conduction, and functional outcomes. However, longer-term studies are needed to assess durability and potential late complications.
This study was retrospectively registered with the Institutional Review Board of the First Affiliated Hospital of Anhui Medical University (Approval No. PJ2024-12-17).
对于肘管综合征（CuTS）行前皮下转位术时，经皮外部缝合已被提议作为筋膜瓣固定的一种替代方法，目的是尽量减少深部组织破坏并降低术后并发症。本研究比较了CuTS手术中经皮外部固定与传统皮下固定筋膜瓣的短期疗效。
在这项回顾性队列研究中，纳入了2020年1月至2023年12月期间114例行带筋膜瓣覆盖的尺神经前转位术的患者。患者根据筋膜瓣固定方法分组：皮下组（n = 57）或经皮组（n = 57）。术前及术后6个月进行临床评估，包括视觉模拟量表（VAS）、患者评定尺神经评估（PRUNE）和肘管综合征功能评分，以及神经传导研究（复合肌肉动作电位（CMAP）、感觉神经传导速度（SNCV）、运动神经传导速度（MNCV））。
与皮下组相比，经皮组在VAS评分（VAS：-2.75 vs. -1.99，p < 0.001）、PRUNE评分（PRUNE：-23.78 vs. -17.64，p < 0.001）和功能评分（评分：+3.58 vs. +2.70，p = 0.0004）方面改善更为显著。经皮组的SNCV（16.45 m/s vs. 14.51 m/s，p = 0.035）和MNCV（18.55 m/s vs. 12.13 m/s，p < 0.001）增加也更明显。虽然两组的CMAP均有改善，但皮下组术后CMAP值略高（6.02±0.85 mV vs. 5.40±0.51 mV，p = 0.002）。两组均未发生感染或伤口并发症；皮下组有2例因复发性压迫需再次手术。
经皮外部缝合可能是CuTS手术中筋膜瓣固定的一种安全且有前景的替代方法，在术后早期疼痛缓解、神经传导和功能结局方面具有潜在益处。然而，需要进行长期研究以评估其耐久性和潜在的晚期并发症。
本研究已在安徽医科大学第一附属医院伦理委员会进行回顾性注册（批准号：PJ2024 - 12 - 17）。
