Güray ALTUN, Tuhan KURTULMUŞ, İsmail OLTULU, Necdet SAĞLAM

Kübital Tünel Sendromu Tedavisinde in Situ Dekompresyon

Amaç: Bu çalışmamızda, kübital tünel sendromu (KTS) tanısı ile insitu ulnar sinir dekompresyonu yapılan hastaların fonksiyonel sonuçlarınıdeğerlendirdik.Gereç ve Yöntem: Ocak 2006 ile Aralık 2010 tarihleri arasında 43hastadan yeterli takibi yapılan ve çağrıya cevap veren 32 hasta geriyedönük olarak değerlendirildi. Hastaların ameliyat öncesi klinik durumlarıMcGowan derecelendirme sistemine göre ve ameliyat sonrasıdurumları ise Wilson&Krout derecelendirme sistemine göre belirlendi.Çalışmaya muayene ve elektromiyelografiyle (EMG) kübital tünelsendromu tanısı konulan, en az 6 ay konservatif olarak tedaviye cevapvermeyen, in situ dekompresyon prosedürü uygulanan, daha öncekübital tünel sendromu nedeniyle ameliyat edilmeyen hastalar dahiledildi.Bulgular: Ameliyat öncesi 24 hastada evre 2, 8 hastada evre 3 nöropatimevcuttu. Ameliyat sonrası 22 hastada mükemmel, 7 hastada iyi,2 hastada makul, 1 hastada kötü sonuç elde edildi. Kötü sonuç eldeedilen tek hastanın ameliyat öncesi evre 3 nöropatisi mevcuttu. Şikayetlerinintekrarlaması sebebiyle hiçbir hastaya tekrar cerrahi tedaviuygulanmadı.Sonuç: Kübital tünel sendromunda in situ dekompresyon ulnar sinirbütünlüğü korunmuş ve ulnar sinir subluksasyonu görülmeyen olgulardadüşük komplikasyon oranlarıyla etkili, basit, güvenilir bir yöntemdir.

In Situ Decompression in the Treatment of Cubital Tunnel Syndrome

Objective: We have evaluated the functional scores of in situ ulnar nerve decompressed cubital tunnel sendrome patients. Materials and Methods: Between january 2006 and december 2010, 32 cubital tunnel syndrome patients operated in our clinic with ulnar neuropathy were evaluated retrospectively from 43 patients. All patients were diagnosed with clinically and electromyography, follow up period was at least 3 years. And also any patient have surgical history about cubital tunnnel syndrome before. McGowan’s classification was used for preoperative scoring and the Wilson Krout classification for postoperative clinical evaluation.Results: Preoperatively 24 patient were degree 2, 8 patients were degree 3. There were excellent results in 22 patients (%), good in 7 (%), fair in 2 (%), and poor in one (%). Any of patients re-opereted cause of complaints. Conclusion: In situ decompression is an effective, simple and safe methode for cubital tunnel syndrome without ulnar nerve subluxation and with nöral continuity is intact.

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Foster RJ, Edshage S. Factors related to the outcome of surgically managed compressive ulnar neuropathy at the elbow level. J Hand Surg 1981;6(2):181–92.
Sarris I, Gobel F, Gainer M, Vardakas DG, Vogt MT, Sotereanos DG. Medial brachial and antebrachial cutaneous nerve injuries: effect on outcome in revision cubital tunnel surgery. J Reconstr Microsurg 2002;18:665–70.
Huang JH, Samadani U, Zager EL. Ulnar nerve entrapment neuropathy at the elbow: simple decompression. Neurosurgery 2004; 55 (5):1150-3.
Oertel J, Keiner D, R. Gaab M. Endoscopic decompression of the ulnar nerve at the elbow. Neurosurgery 2010; 66(4): 817-24.
Posner MA. Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis. J Am Acad Orthop Surg 1998;6(5):282-8.
Kleinman WB. Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg [Am] 1999;24:886-97.
Schnabl SM, Kisslinger F, Schramm A, Dragu A, Kneser U, Unglaub F ve ark. Objective outcome of partial medial epicondylecto my in cubital tunnel syndrome. Arch Orthop Trauma Surg 2010;130(12):1549-56
Cole RJ, Jemison DM, Hayes CW. Anterior elbow dislocation following medial epicondylectomy: a case report. J Hand Surg [Am] 1994;19:614-6.
Bednar SB, Blair SJ, Light TR. Complications of the treatment of cubital tunnel syndrome. Hand Clin 1994;10(1):83-92.
Kuschner SH. Cubital tunnel syndrome. Treatment by medial epicondylectomy. Hand Clin 1996;12(2):411-9.
Asamoto S, Böker D.K, Jödicke A. Surgical treatment of ulnar nerve entrapment at the elbow. Neurol Med Chir (Tokyo) 2005:45 (5);240-245
Lascar T, Laulan J. Cubital tunnel syndrome: a retrospective review of 53 anterior subcutaneous transpositions. J Hand Surg [Br] 2000;25(5);453-6.
Gelberman RH, Yamaguchi K, Hollstien SB, Winn SS, Heidenreich FP, Bindra RR, et al. Changes in interstitial pressure and cross sectional area of the cubital tunnel and of the ulnar nevre with flexion of the elbow. J Bone Joint Surg Am 1998;80(4):492-501.
Lundborg G. Structure and function of the intraneural microvessels as related to trauma, edema formation and nerve function. J Hand Surg [Am] 1975;57(7):938-48.
Vanderpool DW, Chalmers J, Lamb DW, Whiston TB. Peripheral compression lesions of the ulnar nerve. J Bone Joint Surg Br 1968;50 (4):792-803
Werner CO, Ohlin P, Elmqvist D. Pressure recorded in ulnar neuropathy. Acta Orthop Scand 1985;56(5):404-6.
Pechan J, Julius I. The pressure measurement in the ulnar nerve. A contribution to the pathophysiology of cubital tunnel syndrome. J Biomech 1975;8(1):75-9.
Macnicol MF. Extraneural pressures affecting the ulnar nerve at the elbow. Hand 1982;14 (1):5-11.
Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg 1973;51(1):76-81.
Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manupulative Physiol Ther 2005;28(5):345
Wilson DH, Krout R: Surgery of ulnar neuropathy at the elbow: 16 cases treated by decompression without transposition. Technical note. J Neurosurg. 1973 Jun;38(6):780-5
McGowan AJ: The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br 1950 Aug;32-B(3):293-301.
Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg 2006;31(1):23–9.
Neblett C, Ehni G. Medial epicondylectomy for ulnar nerve palsy. J Neurosurg 1970;32 (1):55– 62.
Kleinman WB, Bishop AT. Anterior intramuscular transposition of the ulnar nerve. J Hand Surg 1989;14(6):972–9.
Dellon AL, Coert JH. Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow. J Bone Joint Surg 2004;86A(Suppl 1, Pt 2):169 – 79.
Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg 1989;14(4):688–700.
Folberg CR, Weiss AP, Akelman E. Cubital tunnel syndrome. Part I: presentation and diagnosis. Orthop Rev 1994;23(2):136-44.
Bartels RH, Menovsky T, Van Overbeeke JJ, Verhagen WI. Surgical management of ulnar nerve compression at the elbow: an analysis of the literature. J Neurosurg 1998;89(5):722-7.