| Aim: At present,the research on clinical decision-making of cubital tunnel syndrome with ulnar nerve subluxation is in its infancy.The treatment of ulnar nerve subluxation during the operation is still a difficult problem.This study analyzed the clinical efficacy of in situ release of ulnar nerve and subcutaneous preposition of ulnar nerve in the treatment of patients with mild to moderate ulnar nerve subluxation cubital tunnel syndrome,hoping to provide suggestions for future clinical decision-making in the treatment of ulnar nerve subluxation cubital tunnel syndrome.Methods: This study was a single-center,prospective,case-control study.Patients with mild to moderate ulnar nerve subluxation elbow canal syndrome(30 patients,36 cases)who attended a hospital for parallel surgical treatment from December 2020 to December 2021 were collected and divided into ulnar nerve in situ release group(n=16)and ulnar nerve subcutaneous anterior group(n=20)depending on the treatment modality.The following measures were monitored and evaluated in both groups: baseline information,including gender,age,duration of illness,length of hospital stay,duration of surgery,incision length,affected hand,dominant hand,whether they smoked,whether they consumed alcohol,degree of ulnar nerve dislocation,and Mc Gowan grading.Sensory measures,including: single-filament sensation and two-point discrimination in the ring and little finger preoperatively and one year postoperatively.Strength measurements included: pinch strength and grip strength of the affected hand before and one year after the operation of the ring finger and little finger.The Chinese Medical Association upper limb peripheral nerve function assessment criteria were used for postoperative recovery evaluation.All examination results were analyzed,and P < 0.05 was considered a statistically significant difference.Results: In the baseline data,all patients were right-hand dominant.The proportion of mild ulnar nerve dislocation was higher in both the subcutaneous anterior group and the in situ release group;the proportion of Mc Gowan III was higher in the subcutaneous anterior group and the proportion of Mc Gowan II was higher in the in situ release group;the difference between the two groups was not statistically significant(P > 0.05).There was no statistical difference in age,sex composition ratio,or duration of disease between the two groups(P > 0.05).The mean values of hospital stay were 6.9±0.7 and 6.6±0.6;the mean values of operative time were 30.8±2.8 and 29.6±1.6;and the mean values of incision length were 8.9±0.7 and 8.7±0.6 in the two groups,respectively.The hospital stay and operative time were shorter and the incision length was shorter in the in situ release group,but the difference between the two groups was not statistically significant(P>0.05).Some patients in both groups had bad habits such as smoking and drinking,and the difference between the two groups was not statistically significant(P > 0.05).The preoperative measurement indexes were analyzed for both groups of patients.It was found that there was no statistical difference between the sensory and strength measurements of the ring and little fingers of the two groups such as single filament sensation,two-point discrimination,pinch strength,and grip strength of the affected hand(P > 0.05).The results of the subcutaneous anterior group were analyzed: preoperative ring finger monofilament sensation,two-point discrimination,and pinch force were 4.38±1.03,10.45±3.39,and 1.66±0.68,respectively.1 year postoperatively,ring finger monofilament sensation,two-point discrimination,and pinch force were 4.12±0.92,10.35±2.7,and 1.84±0.74,respectively.preoperative ring finger monofilament sensation,two-point discrimination,and pinch force were 4.83±1.10,13.10±2.85,and 0.82±0.56,respectively.Grip strength was 19.60±8.50 and 20.30±8.49 before and one year after surgery,respectively.There was improvement in ring finger little finger sensation and strength at 1 year compared to preoperative,but the difference was not statistically significant(P > 0.05).The surgical results of the in situ release group were analyzed.preoperative ring finger monofilament sensation,two-point discrimination,and pinch strength were 4.01±0.87,9.56±2.06,and 1.83±0.68,respectively.1 year postoperatively,they were 3.83±0.86,8.69±1.74,and 2.45±2.08,respectively.preoperative little finger monofilament sensation,two-point discrimination,and pinch strength were 4.53±1.10,12.19±1.83,and 0.80±0.36,respectively.The preoperative and postoperative grip strengths were 20.26±4.56 and 22.43±5.29,respectively.1 year postoperatively compared to the preoperative ring finger little finger sensation and strength were improved,but the difference was not statistically significant(P> 0.05).When the postoperative results of the two groups were compared,the postoperative ring finger little finger monofilament sensation was 3.83±0.86 and 4.30±0.98 in the in situ release group and 4.12±0.92 and 4.76±1.16 in the subcutaneous anterior group,respectively,with no statistical difference between the two groups(P>0.05).The postoperative ring finger little finger discrimination sensation was 8.69±1.74 and 10.44±2.34 in the in situ release group and 10.35±2.74 and 12.55±2.06 in the subcutaneous anterior group,respectively,which were statistically different(t=-2.213,P=0.034;t=-2.878,P=0.007).There was no statistically significant difference in postoperative ring finger pinky pinch strength and grip strength between the in situ release group and the subcutaneous anterior group(P > 0.05).The in situ release group had more sensory recovery than the subcutaneous anterior group.The excellent rates of the Chinese Medical Association upper limb peripheral nerve function assessment criteria were 68.8%(in situ release group)and 65.0%(subcutaneous anterior group),respectively.In terms of postoperative complications,one case of sensory numbness was observed in the in situ release group,while two cases of postoperative hematoma and five cases of sensory numbness were observed in the subcutaneous anterior group,which was statistically different(c2=4.251,P=0.039).Conclusions: In the treatment of mild to moderate primary cubital tunnel syndrome,the therapeutic effect of in situ release of the ulnar nerve is better than that of subcutaneous preposition of the ulnar nerve,which is beneficial to the sensory recovery of patients,proving that in situ release can be used in clinical treatment of mild to moderate primary cubital tunnel syndrome. |
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