Analysis Of The Causes And Treatment Of The Revision Surgery After Anterior Subcutaneous Transposition Of The Ulnar Nerve

Objective:To analyze the reasons for the failure of the first anterior subcutaneous transposition of the ulnar nerve,to summarize the technical points during the revision surgery,and to evaluate its efficacy.Methods:Revision surgery was performed on 32 patients with cubital tunnel syndrome who failed the first operation from April 2008 to April 2018.The causes of ulnar nerve compression during the operation were observed and analyzed,the technical points during the revision surgery were summarized,and the follow-up of the degree of postoperative recovery was used to evaluate its efficacy.Results:1.During the operation,the main reasons for the failure of the first anterior subcutaneous transposition of the ulnar nerve were found as follows:(1)The abnormal ulnar nerve walking path leads to the formation of newborn entrapment points,accounting for 40.00%;(2)the adhesion of scar around the ulnar nerve and the ulnar neuropathy,accounting for 30.59%;(3)the lack of exploration of common compression points of the ulnar nerve,accounting for 15.29%;(4)After the ulnar nerve was anterior,the path of the newly created ulnar nerve was abnormal,accounting for 9.41%;(5)The injury of MABC resulted in new symptoms on the inner elbow,accounting for 4.71%;2.After an average follow-up of 12.5 months,the overall excellent and good rate of the revision operation was 81.25%,The VAS score of neuropathic pain in the ulnar innervation area of the elbow decreased from an average of 7.6 to an average of 2.6,The patients were satisfied with the revision operation.Conclusion:1.The reason for the failure of the first anterior subcutaneous transposition of the ulnar nerve is mainly due to technical non-standardization and improper handling of technical details,which can be improved by improving technical capabilities;2.The purpose of anterior subcutaneous transposition of the ulnar nerve is not only to solve its original entrapment problem,but also to prevent new entrapment points that are formed due to the change in the walking path of the posterior ulnar nerve,which often leads to postoperative recurrence;3.The overall excellent rate and satisfaction of the revision surgery after anterior subcutaneous transposition of the ulnar nerve are high,so once the recurrence is confirmed,the revision surgery should be actively performed.