Anterior transposition of vascularized ulnar nerve for the treatment of severe cubital tunnel syndrome

Objective To evaluate the effect of vascularized ulnar nerve sub-fascial transposition in the treatment of severe cubital tunnel syndrome.Methods Anatomical dissection of 5 embalmed adult upper limb cadaver specimens was carried out to observe the blood supply of the ulnar nerve around the elbow.The accompanying length of its feeding vessels was measured.Thirty-eight cases of severe cubital tunnel syndrome were divided into two groups.In group 1 the ulnar nerve was transposed under the fascia with its feeding blood vessel.In group 2 the ulnar nerve was transposed without the blood vessel.The treatment effect was evaluated using the upper limb function evaluation criteria issued by the Chinese Medical Association,the Lascar classification method and electmphysiologic studies.Results Them were 3 vessels that accompany the ulnar nerve around the elbow.The length of the vessel accompanying the ulnar nerve was (145.0 ± 4.3) mm for superior ulnar collateral artery,(48.6 ± 8.2) mm for inferior ulnar collateral artery,and (65.2 ± 9.3) mm for the posterior branch of ulnar recurrent artery.The excellent and good rate was 89.5％ in group 1 and 68.4％ in group 2.The difference was statistically significant.Nerve conduction study showed an increase in motor nerve conduction velocity (MNCV) from (22.3 ± 4.4) m/s preoperatively to (45.2 ± 6.0) m/s postoperatively in group 1,and from (23.3 ± 3.6) m/s preoperatively to (37.5 ± 5.2) m/s postoperatively in group 2.The difference between the two groups was statistically significant.Conclusion Vascularized ulnar nerve subfascial transposition is a reliable treatment for severe cubital tunnel syndrome.The surgical procedure is simple and effective Key words: Cubital tunnel syndrome;  Surgical procedures, operative;  Treatment outcome