Bülent EROL, Cihangir TETİK, Evrim ŞİRİN

Kubital tünel sendromunda minimal medial epikondilektomi ve dekompresyon uygulamasının orta dönem sonuçları

Amaç: Kubital tünel sendromu tanısıyla minimal medial epikondilektomi ve dekompresyon uygulanan hastalarda orta dönem izlem sonuçları değerlendirildi. Çalışma planı: Kubital tünel sendromu tanısıyla minimal medial epikondilektomi ve in situ dekompresyon uygulanan 15 hastanın (9 kadın, 6 erkek; ort. yaş 45; dağılım 35-63) 17 dirseği geriye dönük olarak incelendi. Tanı, tüm hastalarda öykü, fizik muayene ve elektrodiagnostik testlerle kondu. Tüm hastalarda ameliyattan önce en az altı ay süreyle uygulanan çeşitli konservatif tedavi yöntemlerinden yarar sağlanamamıştı. Ulnar sinir tutulumu 13 hastada tek taraflı, iki hastada iki taraflı idi. Tutulum 11 dirsekte dominant taraftaydı. Ameliyat anına kadar şikayetlerin ortalama süresi 14 aydı (dağılım 8-36 ay). Ameliyat öncesinde, McGowan sistemine göre üç hastada (%20) derece I, 11 hastada (%73.3) derece II, bir hastada (%6.7) derece III si¬nir sıkışması vardı. Cerrahi tedavinin sonuçlan Wilson-Krout ölçütleriyle değerlendirildi. Hastalar ortalama 32 ay (dağılım 25-64 ay) süreyle izlendi. Sonuçlar: Tüm hastalarda semptomatik iyileşme sağlandı. Sonuçlar 11 dirsekte (%64.7) mükemmel, beş dirsekte (%29.4) iyi, bir dirsekte (%5.9) orta olarak değerlendirildi. Hiçbir olguda ulnar sinirde paralizi veya subluksasyon, medial dirsek instabilitesi ve pronator-fleksör tutunma yerinde zayıflık gözlenmedi. Dört dirsekte osteotomi bölgesinde gelişen ağrı ve hassasiyet ortalama üç ay sonra kayboldu. Çıkarımlar: Minimal medial epikondilektomi ve dekompresyon uygulaması, kubital tünel sendromunun tedavisinde güvenilir, etkili ve komplikasyon oranı düşük bir yöntemdir.

Anahtar Kelimeler:

Sinir sıkışması sendromları, Dirsek, Kübital tünel sendromu, Dekompresyon, Humerus, Hareket açıklığı, eklem, Ulnar sinir sıkışması sendromları

The mid-term results of minimal medial epicondylectomy and decompression for cubital tunnel syndrome

Objectives: We evaluated the mid-term follow-up results of patients who were treated by minimal epicondylectomy and decompression for cubital tunnel syndrome. Methods: The study included 17 elbows of 15 patients (9 females, 6 males; mean age 45 years; range 35 to 63 years) who underwent minimal medial epicondylectomy and in situ decompression for cubital tunnel syndrome, which was diagnosed through history, physical examination, and electrodiagnostic tests. Before surgery, all the patients received various conservative treatments for at least six months, with no beneficial effect. Thirteen patients had unilateral, two patients had bilateral involvement, with 11 elbows on the dominant side. The mean duration of symptoms was 14 months (range 3 to 36 months). Preoperative grading of nerve compression according to the McGowan system was as follows: three patients (20%) grade I, 11 patients (73.3%) grade II, and one patient (6.7%) grade III. The results of surgical treatment was evaluated according to the Wilson-Krout criteria. The mean follow-up was 32 months (range 25 to 64 months). Results: Symptomatic improvement was achieved in all the patients. The results were excellent in 11 elbows (64.7%), good in five elbows (29.4%), and fair in one elbow (5.9%). None of the patients developed ulnar nerve palsy or subluxation, medial elbow instability, or weakness of the flexor-pronator origin. Pain and tenderness detected at the osteotomy site in four elbows disappeared after a mean of three months. Conclusion: Minimal medial epicondylectomy and decompression was found to be a safe and effective method with a low complication rate in the treatment of cubital tunnel syndrome.

Keywords:

Nerve Compression Syndromes, Elbow, Cubital Tunnel Syndrome, Decompression, Humerus, Range of Motion, Articular, Ulnar Nerve Compression Syndromes,

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