ABSTRACT
OBJECTIVE: The authors report the results of a clinical series of selected patients with severe cubital tunnel syndrome. The degree of ulnar nerve compression was evaluated by use of a grading system that includes measurements of motor and sensitive function. The submuscular transposition with flexor-pronator mass Z lengthening was compared with simple decompression through a prospective randomized study. METHODS: From February 1998 to June 2003, 70 patients with severe cubital tunnel syndrome were included in this study: 35 patients were submitted to simple decompression (Group A), and 35 patients were treated by anterior deep submuscular transposition (Group B). The preoperative status was determined by use of Dellon's classification. The selected patients had Dellon's Grade 3 (severe syndrome). The mean follow-up period after surgery was 47 months for Group A and 46.94 months for Group B. RESULTS: Postoperative clinical and electrophysiological outcomes were assessed 6 months after surgery in all 70 patients. According to the Bishop scoring system, 19 patients (54.3%) of Group A were clinically graded as excellent, 9 (25.7%) were graded as good, and 7 (20%) were graded as fair; in Group B, 18 patients (51.43%) were graded as excellent, 11 (31.43%) as good, and 6 (17.14%) as fair. Neither severe complications nor recurrences were observed in the two groups. CONCLUSION: No statistically significant difference was found between the two groups with regard to the clinical or the electrophysiological outcome. The surgical treatment gains in Group A and B were 80% and 82.86%, respectively (good to excellent results).
Subject(s)
Cubital Tunnel Syndrome/surgery , Decompression, Surgical , Ulnar Nerve/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Neurosurgical Procedures , Prospective Studies , Severity of Illness IndexABSTRACT
OBJECTS: Our retrospective study was carried out to demonstrate the value of, indications for, and results of use of the posterolateral approach (PLA) with decompression and instrumental stabilisation in paediatric patients with unstable vertebral body fractures at the thoracic-lumbar junction. METHODS: Fourteen patients aged 7-14 years were operated on from 1990 to 2000. All these patients were admitted with unstable vertebral body fractures at the thoracic-lumbar junction with incomplete spinal injuries and were operated on within 24 h after sustaining the trauma: a PLA was used to achieve unilateral or bilateral spinal canal decompression and instrumental stabilisation with the Cotrel-Dubousset instrumentation. RESULTS: A good neurological recovery was noted in 13 patients (4/13 Frankel D and 9/13 Frankel E) during 1 year of follow-up. The postoperative anterior-posterior diameter of the spinal canal was evaluated by percentile referred to an average value between the measurements at the superior and inferior levels. The radiographic control estimated the vertebral alignment. An important tendency to hyperkyphosis in 1 patient necessitated surgical correction after 1 month in the interests of a good vertebral alignment. CONCLUSIONS: The PLA makes if possible to define a proper surgical corridor to accomplish all surgical goals in the treatment of spinal fractures in children: decompression, spinal alignment and stabilisation minimising the surgical stress, that are essential in paediatric surgery. It allows early mobilisation and an early start on the rehabilitative treatment, which is very important in children and is difficult to reconcile with bracing and a long period of bed rest as recommended for conservative treatment.
