Fortschr Neurol Psychiatr 2007; 75(3): 168-171
DOI: 10.1055/s-2006-955004
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Sulcus-ulnaris-Syndrom: Einfache Dekompression oder subkutane Vorverlagerung?

Cubital Tunnel Syndrome - Simple Nerve Decompression or Decompression with Subcutaneous Anterior Transposition?A.  Nabhan1 , J.  Kelm2 , W.  I.  Steudel1 , K.  Shariat1 , L.  Sova3 , F.  Ahlhelm4
  • 1Neurochirurgische Universitätsklinik, Universitätsklinikum des Saarlandes, Homburg/Saar (Direktor: Prof. Dr. W. Steudel)
  • 2Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar (Direktor: Prof. Dr. D. Kohn)
  • 3Abteilung für Neurochirurgie, Bundeswehrkrankenhaus Ulm (Leiter: PD Dr. U. Kunz)
  • 4Neuroradiologische Universitätsklinik, Universitätsklinikum des Saarlandes, Homburg/Saar (Direktor: Prof. Dr. W. Reith)
Further Information

Publication History

Publication Date:
17 January 2007 (online)

Zusammenfassung

Ziel dieser prospektiven, randomisierten und kontrollierten Studie war die Evaluierung verschiedener operativer Techniken (subkutane ventrale Vorverlagerung oder die einfache Dekompression) zur Behandlung des Sulcus-ulnaris-Syndroms. Die Studie inkludierte 66 Patienten mit einem klinisch (Schmerzen mit und ohne neurologische Defizite) und elektrophysiologisch nachgewiesenen Sulcus-ulnaris-Syndrom. Bei 32 Patienten erfolgte eine Dekompression des N. ulnaris ohne Vorverlagerung, bei 34 Patienten eine Dekompression mit subkutaner ventraler Vorverlagerung. Die Nachuntersuchungen (3, 9 und 24 Monate Follow-up) beinhalteten die Schmerzevaluation mittels Visueller Analog Skala (VAS), sowie die Erhebung motorischer (Medical Research Council Scale) und sensibler (Sensory-Scale) Defizite. Die postoperativen, klinischen und elektrophysiologischen Ergebnisse zeigten keinen signifikanten Unterschied zwischen den beiden Operationstechniken (p > 0,05).

Abstract

The purpose of this prospective, randomised and controlled study was to evaluate which kind of operative technique for treatment of cubital tunnel syndrome is favourable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/either neurological deficits with clinically and electrographically proven cubital tunnel syndrome. 32 patients underwent nerve decompression without transposition, whereas 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities were performed three, nine and 24 months postoperatively. Irrespectively of operative procedures (simple decompression vs. subcutaneous anterior transposition) there were no significant differences between the outcomes of the two groups at either postoperative follow-up examination (p > 0.05).

Literatur

  • 1 Bartels R H, Menovsky T, Overbeeke J J van, Verhagen W IM. Surgical management of ulnar nerve compression at the elbow: an analysis of the literature.  Journal of Neurosurgery. 1998;  89 722-727
  • 2 Pellieuz S, Fouquet B, Lastfargues G. Ulnare nerve tunnel syndrome of the elbow and an occupational disorder. Analysis of socio-professional and physical parameter.  Ann Readapt Med phys. 2001;  44 213-220
  • 3 Posner M A. Compressive ulnar neuropathies at the elbow: Etiology and diagnosis.  J Am Acad Orthop Surg. 1998;  6 282-288
  • 4 Richardson J K, Green D F, Jamieson S C, Valentin F C. Gender body mass and age as risk factors for ulnar mononeuropathy at the elbow.  Muscle Nerve. 2001;  24 551-554
  • 5 Sharma R R, Pawar S J, Delmendo A, Mahapatra A K. Symptomatic epineural ganglion cyst of the ulnar nerve in the cubital tunnel: a case report and brief review of the literature.  J Clin Neurosci. 2000;  7 542-543
  • 6 Tomaino M M, Brach P J, Vansickle D P. The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome.  J Hand Surg [Am]. 2001;  26 1077-1081
  • 7 Osborne G V. The surgical treatment of tardy ulnar neuropathy.  Journal of Bone joint Surgery. 1957;  39B 782
  • 8 Osborne G. Compression neuritis of the ulnar nerve at the elbow.  The Hand. 1970;  2 10-13
  • 9 Black B T, Barron O A, Townsend P F, Glickel S Z, Eaton R G. Stabilized subcutaneous transposition with immediate range of motion.  The Journal of Bone and Joint surgery. 2000;  82A 1544-1551
  • 10 Learmonth J R. A technique for transplanting the ulnar nerve.  Surgery Gynecology and Obstetrics. 1943;  75 792-793
  • 11 King T, Morgan F P. Late results of removing the medial humeral epicondyle for traumatic ulnar neuritis.  J Bone Joint Surg [Br]. 1959;  41B 51-55
  • 12 Poncet M A. Luxation pathologique en avant du nerf cubital droit.  La Semaine Médicale. 1888;  8 93
  • 13 Chehrazie B, Wagner Jr F C, Collins Jr W F, Freeman Jr D H. A scale for Evaluation of spinal cord injury.  Journal of Neurosurgery. 1981;  54 310-315
  • 14 Medical Research Council .Aids to the examination of the peripheral nervous system. Memorandum No. 45. London: Her Majesty Stationary Office 1976
  • 15 Downie W W, Leatham P A. et al . Studies with pain rating scales.  Annals of the Rheumatic Diseases. 1978;  37 378-381
  • 16 Price D D, Bush F M. et al . A comparison of pain measurement characteristics of mechanical visual and simple numerical rating scales.  Pain. 1994;  56 217-226
  • 17 Langley G B, Sheppeard H. The visual analogue scale: its use in pain Measurement.  Rheumatol Int. 1985;  5 145-148
  • 18 Fillipi R, Farag S, Reish R, Grunert P, Böcher H. Cubital Tunnel Syndrome. Treatment by Decompression without Transposition of Ulnar Nerve.  Minimal Invasive Neurosurgery. 2002;  45 164-168
  • 19 Assmus H. Die operative Behandlung des Kubitaltunnelsyndroms und der Ulnarisspätparese durch einfache Dekompression.  Neurochirurgia (Stuttg). 1984;  27 181-185
  • 20 Paine K WE. Tardy ulnar palsy.  Canadian Journal of Surgery. 1970;  13 255-261
  • 21 Ogata K, Manske P R, Lesker P A. The effect of surgical dissection on regional blood flow to the ulnar nerve in the cubital tunnel.  Clinical Orthopaedics and related research. 1985;  193 195-198
  • 22 Ogata K, Shimon S, Owen J, Mansker P R. Effects of Compression and devascularisation on ulnar nerve function.  Journal of Hand Surgery. 1991;  16B 104-108
  • 23 Messina A, Messina J C. Transposition of the ulnar nerve and its vascular bundle for the entrapment syndrome at the elbow.  Journal of Hand Surgery. 1995;  20B 638-648
  • 24 Osterman A L, Davis C A. Subcutaneous transposition of the ulnar nerve for treatment of the cubital tunnel syndrome.  Hand Clinics. 1996;  12 421-433
  • 25 Harrison M JG, Nurick S. Results of anterior transposition for ulnar nerve for Ulnar neuritis.  British Medical Journal. 1970;  1 27-29
  • 26 Levy D M, Apfelberg D B. Results of anterior transposition for ulnar neuropathy at the elbow.  American Journal of Surgery. 1972;  123 304-308
  • 27 Amadio P C, Beckenbaugh R D. Entrapment of the ulnar nerve by the deep flexor-pronator aponeurosis.  Journal of Hand Surgery. 1986;  11A 83-87
  • 28 Broudy A S, Leffert R D, Smith R J. Technical problems with ulnar nerve transposition at the elbow: findings and results of reoperation.  Journal of Hand Surgery. 1978;  3 85-89
  • 29 Gerl A, Thorwirth V. Ergebnisse der Ulnarisverlagerung.  Acta Neurochirurgie (Wien). 1974;  30 227-246
  • 30 Höllerhage H C, Stolke D. Results of volar transposition of the ulnar nerve in cubital tunnel syndrome.  Neurochirurgia (Stuttg). 1985;  28 64-67
  • 31 Millesi H, Meissel G, Berger A. The Intrafascicular Nerve Grafting of the median and Ulnar Nerves.  J Bone Joint Surg Am. 1972;  58 (2) 209-218
  • 32 Prevel C D, Matloub H S, Ye Z, Sanger J R, Yousif N J. The extrinsic blood supply of the ulnar nerve at the elbow: an anatomic study.  Journal of Hand Surgery. 1993;  18A 433-438
  • 33 Balogh B, Vass A, Piza-Katzer A. Ist eine Vorverlagerung des N. ulnaris beim Sulcus nervi ulnaris-Syndrom wirklich indiziert?.  Handchirurgie, Mikrochirurgie, Plastische Chirurgie. 1997;  29 133-138

Dr. med. Abdullah Nabhan

Neurochirurgische Universitätsklinik · Universitätsklinikum des Saarlandes

66421 Homburg

Email: dr_a_nabhan@hotmail.com

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