Comparison of Subcutaneous Anterior Transposition and In Situ Decompression Techniques of Ulnar Nerve Surgery in Cubital Tunnel Syndrome

Öz

Purpose: This study aims to compare two prevalent surgical techniques for cubital tunnel syndrome (CuTS): ulnar nerve in situ decompression (ISD) and subcutaneous anterior transposition (SAT), with an emphasis on clinical outcomes, surgical period, and complications. Material Methods: Sixty-nine patients who underwent surgery for CuTS between 2018 and 2023 and were followed up for a minimum of 12 months were retrospectively evaluated. Patients whose diagnosis was confirmed by electromyography and who had symptoms that persisted despite conservative treatment were included in the study. Patients were divided into two groups based on the surgical technique used: ISD (Group 1, n = 37) and SAT (Group 2, n = 32). The groups were compared in terms of demographic characteristics, preoperative Dellon classification, surgical duration, complications, and clinical outcomes at the last follow-up. Clinical evaluation was performed using the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Bishop score, and range of motion (ROM) of the elbow. Results: The mean age of the patients was 42.36±12.16 years, and the mean follow-up period was 48.36±24.47 months. No significant differences were found between the groups in terms of age, gender, affected side, dominant extremity distribution, and preoperative Dellon stages (p>0.05). The mean surgical time was significantly shorter in the ISD group compared to the SAT group (34.76±8.65 min vs. 55.41±13.25 min; p<0.001). At the last follow-up, no statistically significant differences were observed between the groups in terms of QuickDASH, VAS, Modified Bishop score, and elbow ROM values (p>0.05 for all). Complication rates were 8.1% in the ISD group and 6.3% in the SAT group, with no significant difference between the groups. Conclusion: In cubital tunnel syndrome surgery, ISD and SAT techniques provide similar results in terms of clinical efficacy. However, ISD stands out as a practical and effective surgical option in the appropriate patient group due to its shorter surgical time and limited surgical dissection requirements. The choice of surgical technique should be individualized according to the patient's specific clinical and anatomical characteristics. Level of Evidence: Level III, Retrospective comperative study

Anahtar Kelimeler

• Cubital tunnel syndrome
• ulnar nerve
• in situ decompression
• subcutaneous anterior transposition
• peripheral nerve surgery

Kubital Tünel Sendromunda Ulnar Sinir Cerrahisi için Subkutan Anterior Transpozisyon ve In Situ Dekompresyon Tekniklerinin Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı, kübital tünel sendromu (KüTS) cerrahisinde sık kullanılan iki teknik olan ulnar sinirin in situ dekompresyonu (ISD) ile subkutan anterior transpozisyonunun (SAT) klinik sonuçlar, cerrahi süre ve komplikasyonlar açısından karşılaştırılmasıdır. Materyal ve Method: 2018–2023 yılları arasında KüTS tanısıyla opere edilen ve minimum 12 ay takip edilen 69 hasta retrospektif olarak değerlendirildi. Elektromiyografi ile tanısı doğrulanmış ve en az 3 ay konservatif tedaviye yanıt vermeyen hastalar çalışmaya dahil edildi. Hastalar uygulanan cerrahi tekniğe göre ISD (Grup 1, n=37) ve SAT (Grup 2, n=32) olmak üzere iki gruba ayrıldı. Gruplar demografik özellikler, preoperatif Dellon sınıflaması, cerrahi süre, komplikasyonlar ve son takipte elde edilen klinik sonuçlar açısından karşılaştırıldı. Klinik değerlendirmede Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Bishop skoru ve dirsek hareket açıklığı (ROM) kullanıldı. Bulgular: Hastaların ortalama yaşı 42,36±12,16 yıl olup ortalama takip süresi 48,36±24,47 aydı. Gruplar arasında yaş, cinsiyet, etkilenen taraf, dominant ekstremite dağılımı ve preoperatif Dellon evreleri açısından anlamlı fark saptanmadı (p>0,05). Ortalama cerrahi süre ISD grubunda SAT grubuna kıyasla anlamlı derecede daha kısa bulundu (34,76±8,65 dk vs. 55,41±13,25 dk; p<0,001). Son takipte QuickDASH, VAS, Modified Bishop skoru ve dirsek ROM değerleri açısından gruplar arasında istatistiksel olarak anlamlı fark izlenmedi (tümü için p>0,05). Komplikasyon oranları ISD grubunda %8,1, SAT grubunda %6,3 olup gruplar arasında anlamlı fark bulunmadı. Sonuç: Kübital tünel sendromu cerrahisinde ISD ve SAT teknikleri klinik etkinlik açısından benzer sonuçlar sağlamaktadır. Bununla birlikte ISD, daha kısa cerrahi süresi ve sınırlı cerrahi disseksiyon gerektirmesi nedeniyle uygun hasta grubunda pratik ve etkili bir cerrahi seçenek olarak öne çıkmaktadır. Cerrahi teknik seçimi, hastaya özgü klinik ve anatomik özellikler doğrultusunda bireyselleştirilmelidir. Kanıt Düzeyi: Seviye III, Retrospektif karşılaştırmalı çalışma

Anahtar Kelimeler

• Kübital tünel sendromu
• ulnar sinir
• in situ dekompresyon
• subkutan anterior transpozisyon
• periferik sinir cerrahisi

Kaynakça

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