UNE Treatment

Background: Ulnar neuropathy at the elbow (UNE) is primarily caused by entrapment in the cubital tunnel (CTE) or by external compression in the retrocondylar groove (RGC). This study examines the utility of surgery in UNE due to entrapment and external compression in a randomized controlled trial. Methods: Consecutive UNE patients referred to a single referral centre were categorized into CTE and RGC groups. Each group was randomly assigned to either surgery or conservative treatment by throwing the dice. After a one-year follow-up, their clinical, electrodiagnostic (EDx), and ultrasonographic (US) outcomes were compared. The primary outcome measure was the percentage of patients with markedly improved symptoms. Examiners were blinded to group assignment. We anticipated better results in surgically treated CTE patients, but expected no differences among the RGC groups. Findings: There were 32 CTE–surgery, 33 CTE–conservative, 33 RGC–surgery, and 32 RGC–conservative UNE patients analysed. The proportion of patients reporting markedly improved symptoms did not differ significantly across the four groups. However, among the CTE surgery patients, the percentage of individuals with decreased clinical severity, improved small finger abduction strength, increased motor nerve conduction velocity, and reduced maximal nerve cross-sectional area significantly improved compared to the CTE conservative group. In the RGC groups, no consistent difference in improvement was found. Interpretation: Although the primary outcome measure did not achieve statistical significance, several positive secondary outcomes in the CTE surgery arm support the preference for surgical intervention over conservative treatment for UNE patients with CTE. In contrast, the findings do not favour surgery for RGC patients.

背景：肘部尺神经病变（UNE）主要由肘管（CTE）内卡压或髁后沟（RGC）处外部压迫引起。本研究通过随机对照试验探讨手术在CTE卡压及RGC外部压迫所致UNE中的应用价值。方法：连续纳入某单一转诊中心的UNE患者，分为CTE组和RGC组。每组通过掷骰子随机分配至手术组或保守治疗组。经过1年随访，比较各组患者的临床、电诊断（EDx）及超声（US）结局。主要结局指标为症状显著改善的患者百分比。检查者对分组情况设盲。我们预期CTE手术组患者的结果更佳，但RGC各组间无差异。结果：共分析了32例CTE手术患者、33例CTE保守治疗患者、33例RGC手术患者及32例RGC保守治疗患者。四组中症状显著改善的患者比例无显著差异。然而，与CTE保守治疗组相比，CTE手术组患者的临床严重程度降低、小指外展肌力改善、运动神经传导速度增加及最大神经横截面积减小的比例显著更高。RGC各组间未发现一致的改善差异。结论：尽管主要结局指标未达到统计学显著性，但CTE手术组的多项阳性次要结局支持对CTE所致UNE患者优先选择手术干预而非保守治疗。相反，研究结果不支持对RGC患者进行手术治疗。