Bartels R H, Menovsky T, Van Overbeeke J J, Verhagen W I
Department of Neurosurgery, University Hospital Nijmegen, The Netherlands.
J Neurosurg. 1998 Nov;89(5):722-7. doi: 10.3171/jns.1998.89.5.0722.
Surgical treatment for cubital ulnar nerve compression includes medial epicondylectomy, simple decompression, or anterior transposition (subcutaneous, intramuscular, or submuscular). There is a dearth of prospective randomized studies on which to base guidelines for choosing one operative treatment over another. The authors review the literature on this subject and present their findings.
The authors reviewed the literature from January 1970 to July 1997. Two authors decided independently whether an article should be included for review based on previously formulated inclusion and exclusion criteria. In addition to demographic information, data concerning preoperative status and outcome were extracted. For statistical analyses chi-square and Kruskal-Wallis tests were performed. Irrespective of their preoperative status, patients with simple decompression had the best outcome, whereas those with anterior subcutaneous and submuscular transposition had the worst. If outcome was related to the patient's preoperative status, a significant difference was not found among the various groups for those patients with a preoperative McGowan Grade 2. However, for those with McGowan Grade 3 (severe) symptoms, patients with anterior intramuscular transposition had the best outcome followed by those with simple decompression and anterior submuscular transposition. Statistical analysis was not possible for patients with McGowan Grade 1 because of the small numbers of patients in several treatment modality groups.
Formulating a uniform guideline for operative treatment is not possible based on the results of this study. However, the authors believe that support is given to their policy, which is primarily to perform a simple decompression. Its surgical simplicity with preservation of the anatomy, especially the vascularization, and the possibility of rapid postoperative rehabilitation are also taken into consideration. If subluxation is found intraoperatively, anterior transposition is proposed.
治疗尺神经在肘部受压的手术方法包括内侧上髁切除术、单纯减压术或前移术（皮下、肌内或肌下）。目前缺乏前瞻性随机研究来为选择一种手术治疗方法而非另一种提供指导原则。作者回顾了关于该主题的文献并展示了他们的研究结果。
作者回顾了1970年1月至1997年7月的文献。两位作者根据先前制定的纳入和排除标准独立决定一篇文章是否应纳入综述。除了人口统计学信息外，还提取了有关术前状况和结果的数据。进行了卡方检验和克鲁斯卡尔 - 沃利斯检验。无论术前状况如何，接受单纯减压术的患者预后最佳，而接受皮下和肌下前移术的患者预后最差。如果预后与患者术前状况相关，对于术前麦高恩分级为2级的患者，不同组之间未发现显著差异。然而，对于麦高恩分级为3级（严重）症状的患者，肌内前移术患者的预后最佳，其次是单纯减压术患者和肌下前移术患者。由于几个治疗方式组中的患者数量较少，无法对麦高恩分级为1级的患者进行统计分析。
基于本研究结果，制定统一的手术治疗指南是不可能的。然而，作者认为这支持了他们的策略，即主要进行单纯减压术。还考虑到了其手术简单性、解剖结构（尤其是血管化）的保留以及术后快速康复的可能性。如果术中发现半脱位，则建议进行前移术。
