Simple Decompression Compared With Anterior Transposition For Treatment Of Cubital Tunnel Syndrome. A Meta-analysis Of Clinical Studies

Objective:To compare the clinical efficicency of simple decompression versus anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome. Methods:A compressive search was conducted in MEDLINE, Cochrane Library, EMBASE, OVID, VIP,CNKI, Wanfang and CBM and potential relevant surgical archives.Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Rreview of interventions. For binary outcomes, the risk ratio(RR) and 95% confidence intervals(CI) were calculated, while mean difference(MD) and associated 95%CI were calculated for continuous outcomes. If outcome measurements in included studies were not conducted on the same scale, we used standardized mean difference(SMD) and 95% CI for continuous outcomes. The level of statistically significance was set at P <0.05. Heterogeneity among the included studies was assessed using Cochrane Handbook’s Q test and I2 statistics. A P<0.05 or I2>50% was considered significant heterogeneity. The metaanalysis was applied by using the fixed-effect model if there was no significant heterogeneity(p≥0.05, I2≤50%). Otherwise, the random effect model was used or the possible reasons were explored for the significant heterogeneity(P<0.05, I2>50%). When data could not be collected for performing a meta-analysis, the data from these studies were evaluated as descriptive data and still considered in the results of the review. Results:Four studies with a total of 357 participant were identified, the clinically relevant improvement and motor conduction were primary outcomes. Our meta-analysis revealed that(1) no significant difference were observed between two compression groups in terms of postoperative improvement in thoese studies [RR=1.18(1.02,1.36),P<0.05];( 2) significant difference were observed between two compression groups in terms of the incidence of postoperative complications, [RR=0.41(0.19,0.89),P<0.05](3) no significant difference were observed between two compression groups in terms of postoperative motor nerve conduction velocity, [SMD=0.24(-0.15,0.63),P>0.05];(4) no significant difference were observed between two compression groups in terms of postoperative improvement in those studies, [SMD=0.03(-0.22,0.27),P<0.05], the two procedures show no statistically significant differences in scores of postoperative clinical function. Conclusion:The results of the present study showed that simple decompression can significantly decrease the rate of postoperative complication. This meta-analysis of randomized, controlled trials suggests that simple decompression of the ulnar nerve is a reasonable alternative to anterior transposition for the surgical management of ulnar nerve compression at the elbow in patients with no prior traumatic injury or surgical procedure involving the affected elbow.