Surgical management of cubital tunnel syndrome: A systematic review and meta-analysis of randomised trials

被引:3
作者
Abourisha, Eslam [1 ]
Srinivasan, Ananth S. [1 ,2 ]
Barakat, Ahmed [1 ]
Chong, Han Hong [1 ]
Singh, Harvinder P. [1 ]
机构
[1] Univ Hosp Leicester NHS Trust, Trauma & Orthopaed Dept, Leicester LE1 5WW, England
[2] Leicester Royal Infirm, Trauma & Orthopaed Dept, Infirm Sq, Leicester LE1 5WW, England
关键词
Cubital tunnel syndrome; Surgical decompression; Open; Endoscopic; Anterior transposition; Outcomes; Network meta-analysis; REGIONAL BLOOD-FLOW; ULNAR NERVE; SIMPLE DECOMPRESSION; ANTERIOR TRANSPOSITION; SUBMUSCULAR TRANSPOSITION; IN-SITU; NEUROPATHY; ELBOW;
D O I
10.1016/j.jor.2024.02.041
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Cubital tunnel syndrome (CUTS) is a common upper limb compression neuropathy with significant consequences when left untreated. Surgical decompression remains gold-standard treatment for moderate to severe disease, however the optimal operative technique remains unclear. This network meta-analysis (NMA) of Level I and II randomised prospective studies aims to discern superiority between open in-situ, endoscopic and anterior transposition (subcutaneous or submuscular techniques) with respect to the primary outcome of response-to-treatment and secondary outcomes which include complications, post-operative chronic pain VAS scale, return to work and re-operation. Methods: This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Web of Science, Cochrane Central, Science direct and Embase were searched. The MESH database was further searched with the terms 'cubital tunnel' to improve sensitivity of the search. Data pertaining to the primary and secondary outcomes were pooled for NMA. Results: Following abstract and full-text screening, 10 randomised prospective trials were included. There was no statistical difference in the response-to-treatment between the four studied techniques. Endoscopic decompression conferred a significantly higher complication rate compared to open decompression (Odds Ratio [OR], 4.21; 95% CI, 1.22-14.59). Endoscopic decompression had a statistically significant lower risk of post-operative chronic pain compared to open in-situ decompression (OR, 0.03, 95% CI, 0.00-0.32). There were no differences between techniques with respect to return to work or re-operation rates. Conclusion: Response-to-treatment was similar between the four operative techniques for CUTS. Endoscopic decompression was found to be more hazardous when compared to open-in situ decompression but conferred significantly less post-operative chronic pain. There was significant heterogeneity in reported outcomes between the included articles. The authors suggest conducting more high-quality research with standardised outcome reporting to facilitate comparison. Level of evidence: ii: Systematic Review and Meta-analysis of Randomised Prospective Trials- Therapeutic study.
引用
收藏
页码:41 / 48
页数:8
相关论文
共 30 条
[1]   Comparison of range-of-motion constraints provided by splints used in the treatment of cubital tunnel syndrome - A pilot study [J].
Apfel, Eileen ;
Sigafoos, Gloria T. .
JOURNAL OF HAND THERAPY, 2006, 19 (04) :384-391
[2]   Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1 [J].
Bartels, RHMA ;
Verhagen, WIM ;
van der Wilt, GJ ;
Meulstee, J ;
van Rossum, LGM ;
Grotenhuis, JA .
NEUROSURGERY, 2005, 56 (03) :522-529
[3]   The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis [J].
Basson, Annalie ;
Olivier, Benita ;
Ellis, Richard ;
Coppieters, Michel ;
Stewart, Aimee ;
Mudzi, Witness .
JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 2017, 47 (09) :593-615
[4]   Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition [J].
Biggs, M ;
Curtis, JA .
NEUROSURGERY, 2006, 58 (02) :296-303
[5]   A systematic review and meta-analysis comparing open versus endoscopic in situ decompression for the treatment of cubital tunnel syndrome [J].
Byvaltsev, Vadim A. ;
Stepanov, Ivan A. ;
Kerimbayev, Talgat T. .
ACTA NEUROLOGICA BELGICA, 2020, 120 (01) :1-8
[6]   Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: A meta-analysis [J].
Chen, Hong-wei ;
Ou, Shan ;
Liu, Guo-dong ;
Fei, Jun ;
Zhao, Gang-sheng ;
Wu, Li-jun ;
Pan, Jun .
CLINICAL NEUROLOGY AND NEUROSURGERY, 2014, 126 :150-155
[7]   Endoscopic cubital tunnel decompression - Review of the literature [J].
Fok, Margaret Woon Man ;
Cobb, Tyson ;
Bain, Gregory, I .
JOURNAL OF ORTHOPAEDIC SURGERY, 2021, 29 (01)
[8]   Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: A prospective randomized study [J].
Gervasio, O ;
Gambardella, G ;
Zaccone, C ;
Branca, D .
NEUROSURGERY, 2005, 56 (01) :108-117
[9]  
Heikenfeld R., 2013, Arthrosc J Arthrosc Relat Surg, V29, pe98, DOI DOI 10.1016/J.ARTHRO.2013.07.110
[10]  
Jaddue Dhia A K, 2009, Open Orthop J, V3, P78, DOI 10.2174/1874325000903010078