肌电生物反馈治疗分娩性臂丛神经麻痹术后腕背伸功能的疗效分析

目的 初步评价肌电生物反馈电刺激对臂丛神经移位术后分娩性臂丛神经麻痹(产瘫)患儿腕背伸功能的疗效.方法 根据纳入标准,选取30例行臂丛神经移位术后的产瘫患儿,在服用神经营养药物治疗和康复训练的基础上,给予患侧桡侧腕长伸肌肌电生物反馈电刺激治疗.在治疗前和治疗4周后评定患儿腕背伸主动关节活动度和桡侧腕长伸肌自发肌电均值,进行统计分析.结果 30例患儿全部获得随访,腕背伸主动关节活动度治疗前为(0.00±14.20)°,治疗后为(24.57± 13.79)°,两组差异有统计学意义(P＜0.01).桡侧腕长伸肌自发肌电均值治疗前为(69.57±39.57)μV,治疗后为(529.30±293.17)μV,两组差异有统计学意义(P＜0.01).结论 肌电生物反馈电刺激有助于改善臂丛神经移位术后产瘫患儿的腕背伸功能.     

腕管综合征术中神经电生理检测与手术疗效评价的初步探讨

目的 通过对腕管综合征术前、术中正中神经-拇短展肌复合肌肉动作电位(compound muscle action potential,CMAP)变化的观察,寻求检测手术效果的可靠指标和时机.方法 对15例腕管综合征行腕管切开正中神经松解术的患者,分别于术前(臂丛神经阻滞麻醉后)、正中神经松解术毕松止血带后即刻及1、3、5、7 min检测正中神经-拇短展肌CMAP潜伏期和波幅的动态变化,并与术前检测值进行统计学分析.方果 正中神经松解术毕松止血带后即刻至5 min,正中神经.拇短展肌CMAP的潜伏期和波幅随时间变化而有显著改变(P<0.05),5 min以后的变化差异无统计学意义(P>0.05).正中神经-拇短展肌CMAP的潜伏期比术前缩短,差异有统计学意义(P<0.05),但波幅与术前相比差异有明显统计学意义(P<0.01).方论 对腕管综合征行神经松解术后,拇短展肌CMAP的波幅比其潜伏期更能体现神经松解的疗效,而在松止血带5 min后进行神经电生理检测来评价手术效果更为可靠.     

经胸膈神经移位治疗臂丛神经损伤

目的 观察经胸膈神经移位到上臂中下段正中神经后组神经束的手术效果。方法 选择10例经术前的体征、肌电检查，并经术中肌电及探查，明确诊断为早期全臂丛根性撕脱伤的患者。在对其行经胸膈神经移位到上臂中下段正中神经后组神经束（含前骨间神经、掌长肌支、指深屈肌近侧支）的同时也行其它神经移位；包括健侧C7后股、健侧胸前神经等移位术，以恢复病人肩、肘、腕、手的功能。结果 10例患者术后随访6-28个月，其中最早手术的3例于术后2年已比较满意地恢复了有关功能，其余7例由于术后时间较短尚在恢复之中。结论 经胸膈神经移位术能恢复手的部分功能。术中同时修复膈神经远断端已成为可能。     

经桡侧腕屈肌入路解剖型锁定板内固定治疗桡骨远端骨折

目的观察经桡侧腕屈肌入路解剖型锁定板内固定治疗桡骨远端骨折的临床疗效。方法回顾性分析自2016-01—2018-12采用经桡侧腕屈肌入路解剖型掌侧锁定板内固定治疗的42例桡骨远端骨折,比较术前与术后即刻桡骨短缩距离、掌倾角、尺偏角,比较术前与末次随访时腕关节屈伸度、旋转度、内收外展活动度以及Fernandez评分。结果42例均顺利完成手术,术后切口愈合良好,未出现感染,未出现桡动脉、桡神经及正中神经牵拉和直接切割损伤等并发症。随访时间12~36个月,平均15个月,骨折均愈合,骨折愈合时间8~14,平均11周。末次随访时7例主动腕关节屈伸活动后感染酸胀。术后即刻桡骨短缩距离较术前减小,掌倾角、尺偏角较术前增加,末次随访腕关节屈伸度、旋转度以及尺、桡偏度较术前增加,Fernandez评分较术前提高,差异有统计学意义(P<0.05)。结论经桡侧腕屈肌入路解剖型锁定板内固定治疗桡骨远端骨折术入路清楚、术中无神经、血管损伤,可矫正骨折短缩、成角畸形,疗效满意。     

内窥镜治疗腕管综合征的疗效观察

目的：观察内窥镜治疗腕管综合征的临床疗效。方法2009年至今,利用内窥镜单切口入路,通过切开腕管、松解正中神经,治疗腕管综合征18例（30侧）。术前及术后3个月进行神经电生理测试,测定正中神经掌腕段感觉及运动传导速度。结果本组患者术后随访6个月,术后3个月正中神经感觉、运动神经传导速度明显较术前加快（P〈0.05）,患者肢体感觉基本恢复正常,未见复发。结论内窥镜治疗腕管综合征疗效确切,术后正中神经功能恢复明显。     

腕管综合征术前、后感觉神经动作电位与复合肌肉动作电位检测结果的比较

目的　比较腕管综合征术前和正中神经松解术后 (术中 )两者感觉神经动作电位 (sensorynerveactionpotential ,SNAP)与复合肌肉动作电位 (compoundmuscleactionpotential,CMAP)检测结果的差异。方法　对 2 0例腕管综合征患者 ,术中在切开屈肌支持带及正中神经松解术后 ,分别测定 (1)拇短展肌的CMAP ;(2 )刺激示、中指 ,于腕部记录正中神经的SNAP ;(3 )刺激环指 ,于腕部分别记录正中神经和尺神经的SNAP。将三者结果与术前的相应数据行统计学分析。结果　 (1)术前拇短展肌CMAP的潜伏期小于4 3ms ,术后其潜伏期、波幅与术前相比差异无统计学意义 (P >0 0 5 )。 (2 )术后 2～ 4指SNAP的潜伏期比术前平均缩短 5 %、波幅增加 13 %左右 ,两者相比差异均有统计学意义 (P <0 0 1)。结论　腕管综合征手术中 ,在正中神经松解术后行SNAP检测较CMAP检测的结果更为敏感和准确。     

微创切开减压联合正中神经显微松解术治疗腕管综合征的临床效果分析

目的 探讨分析微创切开减压联合正中神经显微松解术与传统腕掌部开放入路在治疗中、重度腕管综合征的临床疗效比较研究。方法 选取2018年6月至2022年6月收治的62例中、重度腕管综合征患者，按照术式不同分为观察组（微创切开减压联合正中神经显微松解术）30例、对照组（传统腕掌部开放入路）32例。比较两组患者一般资料，手术指标，术后并发症，术前、术后3个月的BCTQ评分、SSS评分、FSS评分及肌电图指标，末次随访的临床疗效。结果 两组在一般资料比较上无差异（P>0.05），具有可比性。观察组在手术时间、手术切口长度、术后住院时间均优于对照组（P<0.05）。两组术后并发症发生率比较存在差异（P<0.05）。两组术后3个月时波士顿腕管量表（Boston carpal tunnel questionnaire,BCTQ）评分、症状严重程度（symp-tom severity score,SSS）评分、功能状况（function scale score,FSS）评分较术前均有所下降（P<0.05），且观察组下降幅度优于对照组（P<0.05）。两组术后3个月时肌电图指...     

椎间盘镜手术与微创小切口手术治疗腰椎间盘突出症疗效比较

目的 比较椎间盘镜手术(MED)与微创小切口腰椎间盘手术(MTD)治疗腰椎间盘突出症的早、中期疗效.方法 将166例腰椎间盘突出症患者随机分为MED组83例和MTD组83例,分别行MED和MTD手术.对术中、术后反映手术创伤的指标进行监测和观察.结果 MED组在切口长度、术中出血及术后引流量均小于MTD组(P＜0.01).两组术后血清CRP均较术前增加,但术后MED组血清C-反应蛋白增加低于MTD组(P＜0.05).两组VAS术后评分均较术前改善(P＜0.01).患者均获随访,时间2～4年.按改良Macnab疗效评定标准:MED组优65例,良11例,可5例,差2例,优良率为91.6%;MTD组优66例,良13例,可4例,差0例,优良率为95.2%.结论 腰椎间盘突出症MED手术较MTD创伤小、术后恢复快,但两种方法早、中期疗效均较满意.     

椎旁肌间隙入路在胸腰椎骨折手术中的应用

目的 探讨经椎旁肌间隙入路在胸腰椎骨折手术的临床疗效.方法 对76例无神经症状、无需椎管减压的胸腰椎骨折患者手术治疗,采用椎旁肌间隙入路(A组)36例,后正中入路(B组)40例,比较两种术式的手术时间、术中出血量、术后引流量、术前术后Cobb角、疼痛视觉模拟量表(VAS)评分.结果 手术时间、术前术后Cobb角两组间差异无统计学意义(P>0.05),A组在术中出血量、术后引流量、术后VAS评分明显优于B组(P<0.05).结论 椎旁肌间隙入路治疗胸腰椎骨折,创伤小、出血少、恢复快、疗效好.     

体表定位法对腋入法臂丛神经阻滞效果的影响

目的 探讨神经体表定位对腋入法臂丛神经阻滞效果的影响.方法 120例拟行前臂、腕、手部手术的患者,随机均分为神经体表定位组(Ⅰ组)和神经刺激器组(Ⅱ组):Ⅰ组先经神经刺激器的体表定位后行穿刺定位,Ⅱ组借助神经刺激器直接穿刺定位.两组均采用0.45％罗哌卡因40 ml对所定位的桡神经、尺神经、正中神经、肌皮神经进行阻滞,其中桡、尺、正中神经各10 ml,肌皮神经5 ml,另5 ml皮下浸润上臂内侧的皮神经.臂丛神经阻滞成功被定义为注药30 min后,肘部远端5支神经(肌皮神经、桡神经、正中神经、尺神经和前臂内侧皮神经)支配区域的感觉阻滞完全.比较两组在臂丛神经阻滞成功率、操作时间、穿刺次数、血肿发生率和术后满意度等差异.结果 Ⅰ组阻滞成功率、术后满意度明显高于Ⅱ组(P＜0.05).Ⅰ组操作时间、穿刺次数、血肿发生率明显少于Ⅱ组(P＜0.05).结论 使用神经刺激器的神经体表定位,能明显提高阻滞成功率,缩短操作时间,减少穿刺次数,降低血肿的发生率,增加患者对麻醉的满意度.     

Endoscopic carpal tunnel release in the elderly.

The present study is aimed to clarify the postoperative outcome of endoscopic carpal tunnel release in elderly patients with carpal tunnel syndrome. Endoscopic carpal tunnel release was performed on 37 hands of 27 patients (2 men, 25 women) who were aged 70 years or older and clinically and electrophysiologically diagnosed with carpal tunnel syndrome. Mean age at the time of surgery was 74.5 years (range: 70-85 years). Mean postoperative follow-up was 35.5 months (range: 12-114 months). Pain was present preoperatively in 20 hands, but quickly resolved postoperatively in all cases. Numbness completely disappeared in 13 of 37 hands (35.1%), but some degree of numbness remained in the remaining cases. Preoperative severity of thenar muscle atrophy was none in 4 hands, mild in 7 hands, moderate in 12 hands and severe in 14 hands. Postoperative severity of thenar muscle atrophy at final follow-up was none in 13 hands, mild in 16 hands, moderate in 2 hands and severe in 6 hands, confirming that thenar muscle atrophy improves even in elderly patients. However, moderate or severe thenar muscle atrophy remained in 8 hands (21.6%). Endoscopic carpal tunnel release should be considered in the elderly, even though clinical symptoms may not improve substantially in advanced cases.     

Pre- and postoperative electromyographic evaluations in the carpal tunnel syndrome

Twenty-five cases of carpal tunnel syndrome in 20 patients were evaluated preoperatively and postoperatively by electromyography. Clinical improvement resulted in all cases following decompression of the median nerve, and only in a few instances did mild symptoms persist. Distal motor conduction time im proved postoperatively in 24 cases studied, 19 of which returned to normal range. Most of the obvious improvement occurred within the first 3 months and further improvement could be observed as late as 36 months. Although no definite correlation could be established between the preoperative severity of the carpal tunnel syndrome and the postoperative clinical and electrical im provement, there was a definite evidence of better recovery in the younger age group. There was a greater range of improvement and a return closer to normal postoperatively in cases with severe preoperative distal latency. All cases ex amined after 24 months had reached normal values.     

MRI evaluation of carpal tunnel morphology after carpal tunnel release by a retinaculum lengthening technique

AIM: The benefits of maintaining the pulley function of the flexor retinaculum in carpal tunnel release by lengthening or reconstructing it have been described. Quantitative MR imaging was used to investigate the morphological changes after open carpal tunnel release by such a retinaculum lengthening technique. METHOD: Ten patients had bilateral carpal tunnel MRI pre- and postoperatively. The MRI examinations were performed with a 1.5 Tesla imaging system and wrist coils. Carpal tunnel volume, carpal arch width, median nerve position and flexor tendon position in relation to the hamate-trapezial axis were recorded . RESULTS: Like other methods of carpal tunnel release with complete division of the flexor retinaculum, the retinaculum lengthening technique showed a significant postoperative increase of carpal tunnel volume. Carpal arch width increased only slightly. There was a significant palmar displacement of the median nerve but not of the flexor tendons. CONCLUSION: The findings support the hypothesis that maintenance of the pulley function of the retinaculum may lead to an early postoperative recovery of grip strength. In spite of some difficulties in application quantitative MR imaging may be a useful tool in evaluating the carpal tunnel morphology.     

A Controlled Trial Evaluating the Safety and Effectiveness of Ultrasound-Guided Looped Thread Carpal Tunnel Release

Background: Open carpal tunnel release typically requires several weeks of recovery. A less invasive, ultrasound-guided percutaneous technique of releasing the transverse carpal ligament using a thread (thread carpal tunnel release [TCTR]) has been described. To date, its clinical effectiveness and safety have been evaluated exclusively by the group that developed the technique, using a single outcome measure without a control comparison. The objective of this study was to independently evaluate the safety and effectiveness of TCTR using multiple outcome measures and a control comparison. Methods: A convenience sample of 20 participants with refractory moderate or severe carpal tunnel syndrome underwent TCTR of their most symptomatic hand. Outcome measures included pre-TCTR and 1-, 3-, and 6-month post-TCTR Boston questionnaire; pre-, 3-, and 6-month post-TCTR monofilament sensibility, strength, ultrasound, and electrodiagnostic testing; weekly post-TCTR phone interviews for 1 month; and satisfaction surveys at 3 and 6 months post-TCTR. Results: No complications were reported. During the month post-TCTR, significant prompt improvements in hand pain and dysfunction occurred. The following significant improvements were demonstrated in the treated versus control hand: Boston Questionnaire scores, median nerve distal motor latency, transcarpal tunnel motor and sensory conduction velocities and sensory nerve action potential amplitudes. No significant differences in sensibility, pinch or grip strength, median nerve cross-sectional area (CSA) at the carpal tunnel inlet, or wrist: forearm median nerve CSA ratio were documented between TCTR and control sides. Satisfaction with the TCTR procedure was high (85%-90%). Conclusions: This study supports previous reports that the TCTR procedure is safe and effective.     

Time course and predictors of median nerve conduction after carpal tunnel release

PURPOSE: To identify predictors of outcome and of electrophysiologic recovery in patients with carpal tunnel syndrome (CTS) treated by endoscopic carpal tunnel release using a nerve conduction testing system (NC-Stat; NEUROMetrix, Inc, Waltham, MA). METHODS: Validity of the automated nerve conduction testing system was shown by comparing presurgical distal motor latencies (DMLs) against a reference obtained by referral to an electromyography laboratory. The DML was evaluated in 48 patients with CTS. Measurements were obtained within 1 hour of surgery and at 2 weeks, 6 weeks, 3 months, and 6 months after carpal tunnel release. Presurgical and postsurgical DMLs were then compared and correlated with variables and possible predictors of outcome including age, body mass index, gender, and presurgical DMLs. RESULTS: The automated nerve conduction testing system DMLs matched those of reference electromyography/nerve conduction study values with high correlation. Sensitivity of the automated nerve conduction testing system when compared with a standardized CTS case definition was 89%, with a specificity of 95%. A significant correlation was found between the DML before release and the DML 1 hour after release. Moreover, maximal postsurgical DML improvement was highly dependent on the presurgical DML, with no improvement shown for the <4-ms group, mild improvement for the 4-to-6-ms group, and maximal improvement in the >6-ms group. Among the clinical variables of age, gender, and body mass index only age was mildly predictive of postrelease DML changes at 6 months. No other correlations between clinical variables and postsurgical DMLs were significant. In addition the predictive value of age was lost when combined with the presurgical DML in a multivariate analysis. CONCLUSIONS: Postsurgical changes in the median nerve DML were highly dependent on the prerelease latency. The sensitivity and specificity of a nerve conduction monitoring system in detecting and aiding in the diagnosis of CTS is useful in the long-term management of patients with CTS and can aid in determining the level of improvement in median nerve function after endoscopic carpal tunnel release.     

Measurement of carpal canal and median nerve pressure in patients with carpal tunnel syndrome

Carpal tunnel syndrome is a compression neuropathy wherein the median nerve is compressed inside of the carpal canal. Its diagnosis is made clinically, electrophysiologically, and sometimes by carpal canal pressure measurement. The objective of surgical management of this condition is the decompression of the median nerve. We usually measure carpal canal pressure preoperatively and postoperatively using a continuous infusion technique for diagnoses as well as for postoperative evaluation of decompression following our Universal Subcutaneous Endoscope system procedure. To evaluate whether our procedure effectively decompressed the median nerve, we measured intraneural pressure preoperatively and postoperatively in the resting position, with active power grip, and in the Okutsu test position. Correlation between the carpal canal pressure and intraneural median nerve pressure was statistically analyzed using the Kendall rank correlation coefficient (n = 157 hands). A significant correlation was present preoperatively in resting position and postoperatively with active power grip and in the Okutsu test position. Because of this correlation, we conclude that our endoscopic operative procedure effectively decompresses the median nerve and that simple carpal canal pressure measurement is sufficient to confirm diagnoses and to evaluate the status of postoperative decompression.     

Morphologic Analysis of the Carpal Tunnel and Median Nerve Following Open and Endoscopic Carpal Tunnel Release

Background: Endoscopic carpal tunnel release (ECTR) has purported advantages over open release such as reduced intraoperative dissection and trauma and more rapid recovery. Endoscopic carpal tunnel release has been shown to have comparable outcomes to open release, but open release is considered easier and safer to perform. Previous studies have demonstrated an increase in carpal tunnel volume, regardless of the technique used. However, the mechanism by which this volumetric increase occurs has been debated. Our study will determine through magnetic resonance imaging (MRI) analysis the morphologic changes that occur in both open carpal tunnel release (OCTR) and ECTR, thereby clarifying any morphologic differences that occur as a result of the 2 operative techniques. We hypothesize that there will be no morphologic differences between the 2 techniques. Methods: This was a prospective study to compare the postoperative anatomy of both techniques with MRI. Nineteen patients with clinical and nerve conduction study–confirmed carpal tunnel syndrome underwent either open or endoscopic release. Magnetic resonance imaging was performed preoperatively and 6 months postoperatively in all patients to examine the volume of the carpal tunnel, transverse distance, anteroposterior (AP) distance, divergence of tendons, and Guyon’s canal transverse and AP distance. Results: There was no significant difference in the postoperative morphology of the carpal tunnel and median nerve between OCTR and ECTR at 6-month follow-up on MRI. Conclusion: We conclude that there are no morphologic differences in OCTR and ECTR. It is an increase in the AP dimension that appears to be responsible for the increase in the volume of the carpal tunnel.     

The relationship between basal joint arthritis and carpal tunnel syndrome: an MRI pilot study

PURPOSE: This investigation explored 2 questions. First, does basal joint arthritis lead to morphologic alterations that significantly narrow the carpal tunnel? Second, does trapezial excision alter the morphology of the carpal tunnel and decompress the median nerve? METHOD: Four patients with basal joint arthritis alone were treated with ligament reconstruction and tendon interposition (LRTI) arthroplasty. Three patients with basal joint arthritis and carpal tunnel syndrome were treated with LRTI and carpal tunnel release. Preoperative and postoperative magnetic resonance imaging (MRI) scans were obtained to assess differences in carpal tunnel volume and morphology between the groups before and after surgery. RESULTS: The difference in preoperative carpal tunnel volume between groups was not significantly different. Carpal tunnel volume increased by 7% with LRTI and by 24% after LRTI and carpal tunnel release. The anteroposterior diameter of the carpal canal increased in both groups to allow a volar migration of the median nerve. CONCLUSION: LRTI increases the anteroposterior diameter and volume of the carpal tunnel. A larger comparative study would be necessary to determine whether LRTI is sufficient to decompress the carpal tunnel.     

Retrospective analysis of 242 patients whose carpal tunnels were released using a one-port endoscopic procedure: superior results of early intervention

Various approaches to endoscopic carpal tunnel release have been described, including the advantages of the open compared with the endoscopic technique. However recent results suggest that both are equal in terms of outcome and morbidity. The misconception about the potential morbidity and the hope of successful conservative treatment can sometimes delay operative release of the carpal tunnel. The aim of this study was to evaluate whether the preoperative duration of symptoms influences outcome and recovery. Patients who had endoscopic release of the carpal tunnel using a modified one-port method were included in this retrospective study. Patients' satisfaction and general outcome were analysed with a questionnaire. A total of 242 patients were included in the study, and the data of 170 endoscopic decompression operations were analysed (70%). There were no major operative complications, except the conversion to open release in one case. There was a significant association between the preoperative interval of symptoms and the return to everyday activities and normal function (p < 0.001). Patients with longer-lasting symptoms also had reduced recovery of postoperative strength, which was negatively associated with the duration of preoperative symptoms (p < 0.001). Operative decompression by the endoscopic one-port method is a low risk procedure with a low morbidity. The decision for operative decompression should be made as early as possible to avoid complications seen in patients with long-lasting symptoms and permanent nerve damage.     

Uniportal endoscopic surgery of carpal tunnel syndrome: technique and clinical results.

The endoscopic carpal tunnel release is a new minimally invasive method which has been used to decompress the median nerve in the carpal tunnel for the past decade. Advantages of this method should be a decreased postoperative morbidity and earlier return to work. Preoperative complaints, postoperative results and complications of the therapy for a total of 60 patients are presented. All endoscopic releases were performed using the Agee uniportal technique. The overall success rate in our study was 56/60 (93.3 %). 47/54 (87.0 %) patients were completely free of pain after endoscopic surgery. An improvement in preoperative pain was noted in 4/54 (7.4 %) patients. Hypesthesia and dysesthesia disappeared totally in 39/46 (84.8 %) patients. An improvement of the sensible disturbances was observed in 4/46 (8.7 %) cases. 10/13 (76.9 %) preoperative pareses recovered completely, 3/13 (23.1 %) remained unchanged. The complication rate in total in our series was 4/60 (6.7 %), thereof 3 cases of post-operative infection (5 %) and one serious median nerve injury (1.7 %). The mean time for return to work was 29 days. Summing up, it may be said that monoportal endoscopic carpal tunnel release appears to be an effective and safe minimally invasive method for the treatment of carpal tunnel syndrome.