Efficacy Of Ulnar Nerve Release Combined With End-to-side Nerve Transfer In The Treatment Of Severe Cubital Tunnel Syndrome

Objective:Cubital tunnel syndrome(CTS)is the second most common nerve compression disease in the upper limb after carpal tunnel syndrome.It is a series of sensory and motor disorders caused by the compression of ulnar nerve in the elbow.Severe cubital tunnel syndrome patients with hand muscle atrophy,leading to hand dysfunction,seriously affecting the patient’s work and life.There are many surgical methods in clinic,including in situ release of ulnar nerve,anterior transposition of ulnar nerve and resection of medial epicondyle of humerus.But for patients with severe cubital tunnel syndrome,the effect of any surgical intervention is not good,because the degree of atrophy of the hand muscle can not be improved.Recently,it has been suggested that end to side transposition of the pronator muscle branch of the anterior interosseous nerve to the motor branch of the ulnar nerve can effectively repair incomplete ulnar nerve injury.As to whether this operation is effective in the treatment of severe cubital tunnel syndrome,there are few clinical reports.In this paper,we explore the effect of end-to-side transposition of ulnar nerve motor branch of pronator muscle branch of anterior interosseous nerve on the basis of in situ ulnar nerve release in patients with severe cubital tunnel syndrome,and verify the application value of this scheme in the treatment of patients with severe cubital tunnel syndrome.Methods:From April 2017 to July 2020,15 patients with severe cubital tunnel syndrome were retrospectively analyzed,who received in-situ ulnar nerve release combined with end-to-side transposition of ulnar nerve motor branch of pronator muscle branch of anterior interosseous nerve.The changes of pain and numbness before and after operation were recorded;The degree of atrophy of hand muscle and the change of hand function;The recovery of ulnar neuropathy was evaluated according to Dellon grading;Patients’satisfaction with the operation was evaluated according to their residual symptoms,and their working status was described.SPSS 25.0 was used for statistical analysis±The standard deviation was expressed as a percentage of the postoperative efficacyχ~2test,P<0.05,with statistical significance.Results:13 patients were followed up and 2 were lost.After operation,67%of the patients’pain was relieved,and there was no difference in the degree of pain.The numbness of 92%patients was improved,and the change of numbness degree was statistically significant.In23%of the patients,the degree of hand muscle atrophy was improved,and 62%of the patients did not progress.The hand function of 54%patients was improved,and the degree of hand function change was statistically significant.The degree of ulnar neuropathy was reduced in only 15%of the patients,and there was no difference in the degree of ulnar neuropathy.85%of the patients were satisfied with the operation;Finally,39%of the patients were engaged in the original work,23%of the patients changed their jobs,and38%of the patients could not work.Conclusion:1.End to side nerve transfer in the treatment of severe cubital tunnel syndrome can theoretically shorten the nerve recovery distance from the compression position of ulnar nerve at the elbow to the internal hand muscle,supplement the motor axons to reinnervate the internal hand muscle,and retain the regeneration potential of ulnar nerve.2.Ulnar nerve release combined with end to side nerve transfer can delay the process of hand muscle atrophy in patients with severe cubital tunnel syndrome,and even improve the state of hand muscle in patients with mild hand muscle atrophy.3.Ulnar nerve release combined with end to side nerve transfer can improve the pain and numbness symptoms of patients with severe cubital tunnel syndrome,promote the recovery of hand function,and obtain good postoperative satisfaction.Large sample randomized controlled study is needed to further clarify the curative effect.