Objective To discuss the curative effect of expanding ulnar nerve groove and interfascicular neurolysis under microscope in treating severe cubital tunnel syndrome (Cub Ts), and to compare with that of the forward moving of ulnar nerve and interfascicular neurolysis under microscope to find out the best way to treat severe Cub Ts. Methods From December 2002 to January 2007, 22 severe Cub Ts cases were treated with expansion of ulnar nerve groove and interfascicular neurolysis under microscope (treatment group), and other 22 cases were treated with forward moving of ulnar nerve and interfascicular neurolysis under microscope (control group). In treatment group, there were 17 males and 5 females, aged 21-66 years (mean 43.8 years). Pathogenic causes were elbow arthritis in 17 cases, ulnar nerve dislocation in 3 cases and elbow ectroption in 2 cases. The locations were left elbow in 8 cases and right elbow in 14 cases. Thecourse of disease was 6-69 months. In control group, there were 18 males and 4 females, aged 20-64 years (mean 42.1 years). Pathogenic causes were elbow in arthritis 16 cases, ulnar nerve dislocation in 3 cases, elbow ectroption in 1 case and narrowing and shallowing of ulnar nerve groove caused by abnormal heal ing of medial condyle fracture in 1 case. The locations were left elbow in 7 cases and right elbow in 15 cases. The course of disease was 5-67 months. Results For all patients of both groups, the wound healed by first intention, and all were followed up for 12-45 months. In treatment group, the numbness in l ittle finger was obviously rel ieved, or disappeared in 22 cases 1 day after operation. In control group, the numbness in l ittle finger was obviously rel ieved or disappeared in 22 cases 3-5 days after operation. EMG showed that conduction speed of ulnar nerve was normal. Evaluated by upper l imbs function standard of China Medical Association, Surgery Association and Lascar grades, the results were excellent in 21 cases and good in 1 case in treatment group; whilet excellent in 19 cases, good in 2 cases and fair in 1 case in control group. There was significant difference between treatment group and control group (P lt; 0.01). Conclusion Either expansion of ulnar nerve groove and interfascicular neurolysis or forward moving of ulnar nerve and interfascicular neurolysis is an effective method to treat severe Cub Ts, but the former is better than the latter.
Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis andminimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years (range, 18-47 years). All cases had numbness in l ittle finger and ring finger. The disease duration varied from 3 to 18 months (7 months on average). Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity (NCV) were slowed down at elbow, which was (27.0 ± 1.5) m/s. Results All incisions healed by first intention, and no compl ication occurred. Eleven cases were followed up 6-37 months (19 months on average). All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively (grade 4 in 7 cases and grade 3-4 in 4 cases). The postoperative electromyography showed that the NCV was obviously improved, which was (43.5 ± 9.5) m/s, showing significant difference when compared with preoperative one (P lt; 0.05). According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.
Objective To investigate the effectiveness of endoscopic-assisted median nerve decompression with one-stage extensor indicis proprius (EIP) tendon transfer for reconstruction of thumb abduction in patients with severe carpal tunnel syndrome (CTS). Methods The clinical data of 12 patients with severe CTS who met the selection criteria between December 2019 and December 2024 were retrospectively analyzed. There were 2 males and 10 females with an average age of 55.4 years ranging from 35 to 67 years. The affected side was the right in 10 cases and the left in 2, with a mean symptom duration of 48.7 months (range, 12-120 months) and a mean thenar muscle atrophy duration of 13.4 months (range, 6-48 months). The median nerve was released with the help of endoscope, and the EIP tendon was transferred to reconstruct the abduction function of the thumb. The operation time and complications were recorded. Two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, and pinch force of the thumb were measured and compared before and at last follow-up, and the effectiveness was evaluated by Kapandji score and Disabilities of the Arm, Shoulder and Hand (DASH) score. The satisfaction of the operation was evaluated at last follow-up. Results All surgeries were successfully completed with a mean operation time of 54 minutes (range, 45-68 minutes). All patients were followed up 6-50 months, with an average of 15.3 months. There were no complications such as wound infection, scar pain of wrist, and tendon rupture of transposition, and there were 3 cases of mild limitation of finger extension in the donor site of index finger. At last follow-up, two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, Kapandji score, and DASH score were significantly better than those before operation (P<0.05), but there was no significant difference in thumb pinch force between pre- and post-operation (P>0.05). The evaluation of surgical satisfaction showed that 7 cases were very satisfied and 5 cases were satisfied. Conclusion The combination of endoscopic-assisted median nerve decompression and one-stage EIP tendon transfer effectively improves hand function and quality of life in patients with severe CTS by restoring thumb abduction and alleviating neurological symptoms.
Objective To investigate the clinical therapeutic effect of the ulnar neurolysis and nerve anterior transposition with an immediate range of motionfor the cubital tunnel syndrome in the aged. Methods Forty-three patients (24males and 19 females, aged 60-81 years, averaged 67) admitted for the cubital tunnel syndrome from January 1999 to December 2004 were randomly divided into 2groups: Group A (n=20) and Group B (n=23), with an illness course of 2-10 months. All the patients underwent the ulnar neurolysis and the nerve anterior transposition. After operation the patients’ elbows in group A were immobilized with the plaster slab for an external fixation for 3 weeks; the patients’ elbows in group B did not use the external fixation, but began an immediate range of motion on the 2nd day after operation. The Bishop scoring system was used to evaluate the patients’ functional recovery in the 2 groups. Results The follow-up for 1-5 years showed that the ulnar nerve function of all the patients were improved but no significant differences were found between the 2 groups (P＞0.05). The patients in Group A returned to daily activities or work at 45.2±5.1 days, but the patients in Group B required 15.5±3.8 days, with a significant difference between the 2 groups (P＜0.05). According to Bishop scoring system, the resutls were excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 1 case in Group A, and 16, 4, 2 and 1 respectively in Group B. There was no significant difference between the two groups(P＞0.05). Conclusion The ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome can promote the ulnar function recovery of the oldaged patients. They can return to their daily activities or work at a more rapid speed when their elbows are mobilized immediately after operation.
ObjectiveTo investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study. Methods The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups (P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated. Results All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time (P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values (P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant (P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups (P<0.05). The 2-PD gradually improved over time, showing significant difference (P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant (P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation (P>0.05). Conclusion Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient’s quality of life.