Cubital tunnel syndrome — Review of current literature on causes, diagnosis and treatment

Cubital tunnel syndrome is common, but not fully understood. Fortunately, most cases of ulnar nerve compression improve with nonsurgical treatment and large majority get better with surgical decompression. The fact that most people get better with and without surgical treatment is likely the reason that multiple studies have failed to show improved results with different types of decompressions for mild cubital tunnel syndrome. Transposition surgeries have been shown to yield better results with more severe cases and patients who failed previous simple releases, likely secondary to release of other compression sites that were missed by the initial surgery. Knowing more about pathology of the cutbital tunnel syndrome such as compression versus traction injury and having better modalities for evaluation of the nerve should help us to better tailor treatment for the patients in the future.     

胃肠手术后胃肠减压负压吸引器的最佳压力值研究

目的 探讨一次性负压吸引器在胃肠道术后患者使用过程中的适当压力值.方法 将212例腹部手术患者随机分为观察组与对照组各106例.术后患者回病房即常规接负压吸引器,观察组压力值调整为-7～-5 kPa,对照组为-14～-8kPa.结果 两组不同时间胃内容物引流量比较,差异无统计学意义(均P>0.05);两组引流管堵塞发生率比较,差异有统计学意义(P<0,05).结论 胃肠道术后患者一次性负压吸引器压力值调整为-7～-5 kPa,不仅能有效引流胃内容物,且能避免引流管堵塞.     

Cost-effectiveness analysis for trigeminal neuralgia: Cyberknife vs microvascular decompression

BACKGROUND/AIMS: We present the preliminary results of a cost-effectiveness analysis of cyberknife radiosurgery (CKR) versus microvascular decompression (MVD) for patients with medically unresponsive trigeminal neuralgia. METHODS: Direct healthcare costs from hospital's perspective attributable to CKR and MVD were collected. Pain level caused by trigeminal neuralgia was measured through the Barrow Neurological Institute pain intensity scoring criteria, at admission and after an average of 6 months follow-up. RESULTS: 20 patients for both arms were enrolled, for a total of 40 patients. The two procedures resulted equally effective at 6 month follow-up, with different resources consumption: CKR reducing hospital costs by an average of 34% per patient. The robustness of these results was confirmed in appropriate sensitivity analyses. CONCLUSION: CKR resulted to be a cost-saving alternative compared with the surgical intervention.     

Time Course of Symptom Disappearance after Microvascular Decompression for Hemifacial Spasm

Objective

This study is to investigate time course of symptom disappearance in patients whose spasm relieved completely after microvascular decompression (MVD).

Methods

Of 115 patients with hemifacial spasm (HFS) who underwent MVD from April 2003 to December 2006, 89 patients who had no facial paralysis after operation and showed no spasm at last follow-up more than 1.5 years after operation were selected. Symptom disappearance with time after MVD was classified into type 1 (symptom disappearance right after operation), type 2 (delayed symptom disappearance) and type 3 (unusual symptom disappearance). Type 2 was classified into type 2a (with postoperative silent period) and type 2b (without silent period).

Results

Type 1, type 2a, type 2b and type 3 were 38.2%, 48.37%, 12.4% and 1.1%, respectively. Delayed disappearance group (type 2) was 60.7%. Post-operative symptom duration in all cases ranged from 0 to 900 days, average was 74.6 days and median was 14 days. In case of type 2, average post-operative symptom duration was 115.1 days and median was 42 days. Five and 3 patients required more than 1 year and 2 years, respectively, until complete disappearance of spasm. In type 2a, postoperative silent period ranged from 1 to 10 days, with an average of 2.4 days.

Conclusion

Surgeons should be aware that delayed symptom disappearance after MVD for HFS is more common than it has been reported, silent period can be as long as 10 days and time course of symptom disappearance is various as well as unpredictable.     

经鼻肠梗阻导管在急性肠梗阻治疗中的应用

目的探讨经鼻肠梗阻导管行小肠内减压在急性肠梗阻保守治疗中的作用。方法38例急性肠梗阻患者,采用经鼻肠梗阻导管减压治疗的19例为导管组,在X线透视下经鼻置入3000mm肠梗阻导管至Treitz韧带远端20cm以上,观察其治疗效果,并与另19例经鼻胃管减压患者（胃管组）比较。结果与胃管组比较,导管组置管24h后腹围缩小的程度、置管24h后减压量、立位腹部平片中液气平面消失时间、开始排气、排便时间和中转手术比例,均优于胃管组（P〈0．05）。结论经鼻肠梗阻导管在急性肠梗阻保守治疗中具有明显优势,可能会使部分急性肠梗阻患者避免手术,有临床应用价值。     

脊髓型颈椎病前后路手术远期疗效的比较

目的比较脊髓型颈椎病前路和后路手术的远期疗效,探讨脊髓型颈椎病外科治疗时应该如何合理选择手术入路。方法总结了67例经三年以上长期随访的脊髓型颈椎病手术病例,将前、后路手术的手术疗效结合病变的范围进行统计学分析比较。结果单节段病变,23例前路手术术后均改善明显,1例后路手术术后病情恶化;双节段病变,15例前路手术的疗效明显好于11例后路手术（P〈0．05）;三节段病变,6例前路手术和6例后路手术的疗效无显著差别（P〉0．05）;四节段病变,5例后路手术疗效均佳。结论脊髓型颈椎病病变累及单节段和双节段时,采用前路手术比较合理;三节段病变,前路和后路手术均可采用;四节段病变,采用后路手术比较合理。     

Paraplegia of late onset in adolescents with healed childhood caries of dorsal spine: A cause of pressure on the cord and treatment

Background:

Paraplegia of late onset in adolescents with caries of dorsal spine is considered to be due to the reactivation of infection. Internal salient at the level of acute kyphotic deformity of the dorsal spine is formed by posterior cartilaginous remains of grossly destroyed vertebral bodies. The author presents a study of eight adolescent patients with paraplegia of late onset associated with severe kyphotic deformity of dorsal spine with observations on the cause of paraplegia, the final neurological outcome following anterior decompression and its prevention.

Materials and Methods:

Eight adolescent patients mean age 14.4 yrs 6 males and 2 females with healed childhood caries of dorsal spine, having a mean kyphotic angle of 80° (range 60°–140°) presented with paraplegia of late onset. Of these patients, two had medical research council grade 0 muscle power; four had grade 2 muscle power, and two others had grade 3 muscle power in the lower limbs and were unable to walk unaided. One patient with 140° kyphoscoliotic deformity with grade 3 muscle power had post-polio residual paralysis (PPRP) in addition. All patients were subjected to thorough anterior spinal decompression through transthoracic, transpleural thoracotomy from the left side.

Results:

In six of the eight patients, the spine at the site of deformity being very rigid, the deformity could not be corrected and the intervertebral gap was bridged with appropriate autogenous tricortical cortico cancelluous bone graft. In one patient (case 4), the kyphotic deformity could be corrected by 50%. In one patient with 140° kyphosis and PPRP, the gap after the decompression of cord, could not be bridged with bone graft and was given a custom made, well molded plastic black shell to wear while walking and, in particular, while traveling in a vehicle. In all seven patients, bone grafts took six months for bridging the intervertebral gaps. All patients recovered to grade 4 muscle power 6–12 months after surgery.

Conclusion:

In adolescents with healed caries of dorsal spine with acute kyphosis and paraplegia, the treatment of choice is anterior surgical decompression of the cord and bridging the gap thus created with bone graft.     

Sequential Change of Facial Nerve Motor Function after Microvascular Decompression for Hemifacial Spasm: An Electrophysiological Study

Hemifacial spasm (HFS) patients occasionally present with preoperative facial weakness (PFW) or develop delayed facial palsy (DFP) after microvascular decompression (MVD). This study is aimed to evaluate the neurophysiology underlying facial nerve motor dysfunction in HFS patients preoperatively and postoperatively. In all, 54 HFS patients without prior botulinum toxin injection who underwent MVD were retrospectively reviewed. The compound muscle action potential (CMAP) amplitude ratios of the affected and unaffected facial nerves, measured at 4 time points from preoperation to 1 year post-surgery, were aggregated. Clinical outcomes and the CMAP amplitude ratios were evaluated. Six patients (11.1%) presented with PFW, which correlated with advanced age (p = 0.007) and symptom duration (p = 0.001). The average duration to achieve PFW relief was 2.67 months postoperatively. The preoperative CMAP amplitude ratios of PFW patients were lower than those of patients without PFW (85.3% vs 95.7%). The ratios showed the lowest value at 1-week post-surgery in both groups (70.3% vs 90.9%), had a tendency toward improvement at 1 month, and finally recovered to almost the same level as that before the surgery at 1 year. Three patients (5.6%), whose CMAP ratios showed a persistent decrease from 1 week (56.5%) to 1 month (31%) after MVD, developed DFP. This study illustrates PFW in HFS patients reflects facial nerve axonal stress. MVD is effective in resolving spasm and PFW, without long-term damage to the facial nerve in most patients. In DFP patients, the direct and subsequent secondary axonal disorder develops on the postoperative facial nerve.     

前路减压植骨钢板内固定术治疗脊髓型颈椎病14例临床分析

目的观察颈前路减压植骨融合钢板内固定术治疗脊髓型颈椎病的临床疗效。方法对2006年3月至2008年9月在我院行颈前路减压植骨融合钢板内固定术的14例脊髓型颈椎病患者的临床资料及随访情况进行回顾性分析。结果本组14例病例均获得随访,平均15个月。所有植骨在3~4个月内融合,融合率100%。术后6个月日本骨科学会评分平均为15.3分。平均改善率为82.6%,其中优12例,良2例。结论颈前路减压植骨钢板内固定治疗脊髓型颈椎病,是一种实用,且疗效满意的外科手术方法。