内窥镜与常规开放手术治疗腕管综合征的疗效比较

目的对比研究内窥镜视下腕管松解术（endoscopic carpal tunnel release,ECTR）与常规腕管切开术（open carpal tunnel release,OCTR）治疗腕管综合征的临床疗效。方法对44例腕管综合征的患者，根据手术不同分为两组：ECTR组14例，OCTR组30例。观察术后患手创面愈合、瘢痕生长情况，“柱状”痛并发症的发生率，恢复工作时间和电生理检测等情况。结果术后随访时间为8～214个月，平均15．5个月。两组患者均未出现伤口感染及肌腱、神经、血管损伤等并发症。术后半年两组夜间疼痛症状全部消失，ECTR组和OCTR组手指麻木消失率分别为93．75％和91．18％，拇短展肌萎缩恢复率分别为57．14％和58．82％；“柱状”痛发生率分别为0％和23．53％，满意率分别为93．75％和67．65％，两组差异有统计学意义（P〈0．05）；术后1、3、6、12个月握力恢复率，ECTR组较OCTR组明显提高，差异有统计学意义（P〈0．05）；正中神经电生理检测两组差异无统计学意义。ECTR组在手术时间、恢复工作和住院时间均较OCTR组缩短。结论术后ECTR组在切口愈合较常规切开者美观、无“柱状”痛、握力恢复、缩短手术时间、平均住院日及恢复工作时间等方面优于OCTR组。     

腕管切开减压术与内镜下腕管减压术治疗腕管综合征的疗效对比研究

腕管切开减压术(OCTR)是治疗腕管综合征简单有效的手术方法,近年来采用内镜下腕管减压术(ECTR)治疗腕管综合征的数量逐渐增多,但是文献报道示两种手术方法在手术效果和安全性上不一致。该文作者对123例分别采用ECTR和OCTR治疗的腕管综合征病人进行了随访调查研究,即对91例ECTR病人和32例OCTR病人进行初级和次级随访。初级随访指标包括症状改善情况自报表和神经血管并发症发生率,次级随访指标包括McGill疼痛调查表、握力(采用指握力测定装置)、捏力(采用指捏力测定装置)、中指感觉域值测定(仪器均由NK生物技术公司提     

内窥镜辅助与开放腕管切开治疗腕管综合征疗效比较

目的比较内窥镜辅助下腕管切开减压术(endoscopic carpal tunnel release,ECTR)与传统开放腕管切开减压术(open carpal tunnel release,OCTR)治疗腕管综合征的疗效。方法自2013年1月至2015年9月收治的58例单侧腕管综合征患者,分别有30例行内窥镜辅助下腕管切开减压术(ECTR组),28例行手掌部开放正中神经探查松解术(OCTR组),其中男16例,女42例;年龄39~68岁,平均(51.2±5.9)岁;病程3~24个月,平均(11.5±2.8)个月。采用Kelly评分系统、两点分辨觉、术后并发症的发生情况以及术后恢复工作时间等作为随访评价指标,比较两种手术方法的疗效优劣。结果患者术后均获随访,随访时间14~30个月,平均24.3个月。末次随访时两组患者的Kelly评分、两点分辨觉等临床评价比较,差异无统计学意义(P0.05)。ECTR组患者手术耗时短、术后伤口小、恢复工作早、患者满意度较高。结论与传统腕管切开减压术相比,内窥镜辅助下腕管切开减压手术瘢痕小、手术耗时短、恢复工作早,其他方面则无明显优势。     

开放腕管松解术与关节镜下腕管松解术治疗腕管综合征的疗效比较

目的比较开放腕管松解术与关节镜下腕管松解术治疗腕管综合征的临床疗效。方法回顾性分析自2017-06—2020—07诊治的120例腕管综合征,60例采用关节镜下腕管松解术治疗(观察组),60例采用开放腕管松解术治疗(对照组),比较2组术后6个月疼痛VAS评分、BCTQ评分以及疗效,比较2组末次随访时屈伸活动度与尺桡活动度。结果120例均顺利完成手术并获得完整随访,随访时间1～9个月,平均5.3个月。观察组术后并发症情况较对照组优,手术时间、术中出血量、住院时间较对照组少,差异有统计学意义(P0.05);2组正中神经长宽比比较差异无统计学意义(P0.05)。术后6个月2组疼痛VAS评分、BCTQ评分、临床疗效比较差异无统计学意义(P0.05)。末次随访时观察组屈伸活动度、尺桡活动度较对照组大,差异有统计学意义(P0.05)。结论开放腕管松解术与关节镜手术治疗腕管综合征的远期疗效相当,但关节镜手术具有对腕关节功能破坏小、损伤轻、术中出血少、术后并发症少、术后恢复快等优点,值得临床应用推广。     

前鼻镜辅助双小切口腕管松解术12例

目的 探讨前鼻镜辅助下双小切口腕管松解术的临床应用. 方法 自2010年8月至2011年10月,行利前鼻镜辅助下双小切口腕管松解术12例(15例腕),随机抽取我科同期开放式腕管松解术(OCTR) 28例作为对照组.术后随访12～15个月.术前诊断包括临床症状、体征及肌电/神经传导检测阳性结果.研究组术前及随访期间行Levine腕管问卷调查,评测手指两点辨别觉、握力、捏力,数值以均数±标准差(x)(±s)表示,结果用SPSS 13.0统计软件行配对资料t检验.同时研究组与对照组问卷调查术后12个月内切口“瘢痕痛”的发生率、发生程度及恢复正常工作的时间,结果行组间计数资料x2检验和两样本均数t检验. 结果 研究组15侧均未出现松解不全和神经、血管损伤,术后12个月Levine评分值、感觉指数、握力、捏力值较术前均有显著改善,差异有统计学意义(P＜0.05).研究组切口“瘢痕痛”发生率(6.67％)、“瘢痕痛”评分值(0.067 ±0.258)、恢复正常工作时间(15.70 ±3.81)均低于对照组(42.85％、1.440±1.395、31.20±5.76),差异均具有统计学意义(P＜0.05). 结论 利用前鼻镜辅助双小切口腕管松解术是一种安全、有效的新术式,值得临床推广和应用.     

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...     

神经松解术结合健骨注射液治疗中老年腕管综合征的疗效观察

目的 观察神经松解术结合健骨注射液治疗中老年腕管综合征（carpal tunnel syndrome,CTS）的疗效.方法 将2007年4月-2009年5月,来我院治疗的符合病例选择标准的CTS患者共86例随机分成治疗组和对照组.治疗组49例,采用神经松解术结合健骨注射液治疗;对照组37例,采用单纯神经松解术治疗.对两组患者的疗效进行评价.结果 神经松解术结合健骨注射液治疗CTS的疗效优于单纯神经松解术的疗效（P 〈0.05）,差异有统计学意义.结论 采用神经松解术结合健骨注射液治疗中老年患者CTS的效果,优于单纯神经松解术的效果.     

微创光刀掌侧小切口腕管切开微创松解术的体会

目的 报道使用一种新型光刀结合掌侧小切口微创腕管切开松解减压术的方法及其疗效. 方法 2008年6月至2009年7月,对34例(39侧)腕管综合征,采用新型光刀结合掌侧小切口技术行微创腕管切开松解减压术,其中16例左手(41％),23例右手(59％).术后随访通过美国密歇根州手功能评价问卷调查(MHQ)评估手功能,并分别在术后2周、3个月和6个月时进行包括握力、捏力和手的灵巧度在内的定量测量的后续评估. 结果 术后所有患者均能立即正常使用患手.部分患者在术后2周出现轻至中度的瘢痕压痛及切口疼痛,均在术后6个月内完全消失.随访6个月所有病例未出现明显并发症.随访期间,通过MHQ量表对患者的调查显示,在疼痛缓解、患者满意度、手功能、日常活动以及工作绩效等方面都有了显著的改善.此外,手术后6个月观察到患者的握力和捏力有显著改善. 结论 使用新型光刀掌侧小切口微创腕管切开松解术取得了良好的术后功能和患者满意度.同时手术时间短、简单、经济、有效,治疗不需要进行神经外膜松解的轻中度腕管综合征患者.     

腕管综合征治疗研究进展

目的对腕管综合征(carpal tunnel syndrome,CTS)的治疗研究现状作一综述。方法查阅近年来国内外CTS治疗的相关文献,进行分析总结。结果腕夹板、类固醇适用于轻、中度CTS患者,近期效果显著;治疗后复发的CTS患者需采取手术治疗。主要术式为腕管松解术,包括腕管切开松解减压术(传统型和小切口型)、内镜下腕管松解减压术等。结论 CTS的最佳治疗方法尚无定论,部分学者推荐首选手术治疗。     

窥镜下腕管松解术

在腕管综合征的治疗中，窥镜下腕管松解术是一种新崛起的方法。在短短的几年中，它由于刨伤小、恢复快而得到广泛应用，但与传统术式相比其疗效究竟如何还少有评论，本文对此作一全面回顾。     

Surgical efficacy of carpal tunnel release for carpal tunnel syndrome in acromegaly: report of four patients

Although carpal tunnel syndrome is frequent in acromegaly, few acromegalics will be encountered by most hand surgeons. This paper considers the treatment of four cases of acromegaly in whom carpal tunnel syndrome arose, to discuss aspects of management of carpal tunnel syndrome in this patient group.     

Palmaris profundus tendon prohibiting endoscopic carpal tunnel release: case report

Palmaris profundus is an aberrant muscle of forearm and wrist anatomy. It has no discernible function, but its tendon has been implicated as a cause of carpal tunnel syndrome. Previously, all cases of palmaris profundus in the literature have been encountered during either open surgery or cadaveric dissection. We report a case of palmaris profundus encountered during attempted single-portal endoscopic carpal tunnel release, necessitating conversion to an open approach. There was a unique point of tendon insertion onto the undersurface of the transverse carpal ligament, more proximal than what has been previously described in the literature. There were other anomalies present as well, including a persistent median artery and bifid median nerve. Given the volar position of the structure, its proximal point of insertion, and its minimal bulk, we did not feel that this was the cause of our patient's carpal tunnel syndrome.     

Pressure–morphology relationship of a released carpal tunnel

We investigated morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament (TCL). However, the pressure–morphology relationship of the carpal tunnel after release of the TCL has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross‐sectional images were captured by an ultrasound system, and pressure measurements were recorded by a pressure transducer. Carpal tunnel pressure significantly affected carpal arch area (p < 0.001), with an increase of >62 mm² at 120 mmHg. Carpal arch height, length, and width also significantly changed with carpal tunnel pressure (p < 0.05). As carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure–morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact TCL. This change of structural properties as a result of transecting the TCL helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 616–620, 2013     

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.     

Carpal tunnel syndrome: Unusual contraindications to endoscopic release

Endoscopic carpal tunnel release has become an increasingly popular method of surgical treatment of carpal tunnel syndrome. Consequently, the contraindications to this technically challenging procedure continue to evolve. We describe two patients with carpal tunnel syndrome and unusual anomalies and pathology of the hook of the hamate that we believe represent relative or absolute contraindications to endoscopic carpal tunnel release.     

Ultrasound elastography for carpal tunnel pressure measurement: A cadaveric validation study

Carpal tunnel pressure is a key factor in the etiology of carpal tunnel syndrome. Numerous approaches have been conducted to measure carpal tunnel pressure. However, most techniques are invasive and take time and effort. We have developed an innovative approach to noninvasively assess the tunnel pressure by using the ultrasound surface wave elastography (USWE) technique. In a previous study it was shown that the shear wave speed in a tendon increased linearly with increasing tunnel pressure enclosed the tendon in a simple tendon model. This study aimed to examine the relationship between the carpal tunnel pressure and the shear wave speeds inside and outside the carpal tunnel in a human cadaveric model. The result showed that the shear wave speed inside the carpal tunnel increased linearly with created carpal tunnel pressure, while the shear wave speed outside the carpal tunnel remained constant. These findings suggest that noninvasive measurement of carpal tunnel pressure is possible by measuring the shear wave speed in the tendon. After fully establishing this technology and being applicable in clinic, it would be useful in the diagnosis of carpal tunnel syndrome. For that reason, further validation with this technique in both healthy controls and patients with carpal tunnel syndrome is required. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:477–483, 2018.     

Evaluation of Dynamic Carpal Arch Stability following Carpal Tunnel Release Using Four-Dimensional Computed Tomography

Introduction  This study aimed to assess the carpal arch dynamics during active finger and wrist motion following carpal tunnel release using four-dimensional computed tomography (4D-CT). Materials and Methods  Four patients who diagnosed with bilateral carpal tunnel syndrome and underwent unilateral carpal tunnel release were prospectively included. 4D-CT of the bilateral wrists during active finger and wrist motion was performed for 10 seconds at five frames per second. The distances between the tip of tuberosity of the scaphoid and the volar ridge of the pisiform (S–P distance) and volar ridge of trapezium and the tip of hook of hamate (T–H distance) were measured at each position and the values of S–P and T–H distances were compared between the postoperative and contralateral wrists. Results  During finger motion, the S–P and T–H distances were not different at any position between the postoperative side and contralateral side. Conversely, S–P and T–H distances gradually increased in the postoperative wrists. The differences between the sides of S–P distance were significant, with >0 degrees of wrist extension, and differences of T–H distance were significant with >15 degrees of wrist extension. Conclusion  This study demonstrated the carpal arch dynamics using 4D-CT and revealed that the carpal arch was widened with the wrist in extension after carpal tunnel release. This study suggests that the transverse carpal ligament plays an important role in maintaining carpal arch stability.     

腕管切开松解减压术

腕管切开松解减压术一直被认为是外科治疗腕管综合征的经典方法，于1913年由Marie和Foix最先提出。其术式甚多，优、缺点各异，操作也有简有繁。现结合腕部神经解剖特点，将每一种术式归纳复述如下。     

Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome

PURPOSE: This study was designed to test the hypothesis that patients with an initial diagnosis of cubital tunnel syndrome are more likely to present with muscle atrophy than patients with an initial diagnosis of carpal tunnel syndrome. METHODS: A list of patients presenting to the office of a single hand surgeon from January 2000 to June 2005 with an initial diagnosis of isolated, idiopathic carpal tunnel syndrome or cubital tunnel syndrome was generated from billing records. The medical records of 58 patients with cubital tunnel syndrome and 370 patients with carpal tunnel syndrome were reviewed for age, gender, diabetes, and presence of atrophy. RESULTS: Twenty-three of 58 patients with an initial diagnosis of cubital tunnel syndrome had atrophy compared with only 62 out 370 patients with an initial diagnosis of carpal tunnel syndrome. Multiple logistic regression revealed that age (odds ratio, 1.06; 95% CI, 1.04-1.08) and diagnosis (cubital tunnel patients were more likely than carpal tunnel patients to present with atrophy; odds ratio, 4.5; 95% CI, 2.7-8.6) were factors significantly associated with atrophy at presentation. CONCLUSIONS: Patients with carpal tunnel syndrome present earlier in the course of their disease than patients with cubital tunnel syndrome. Patients with cubital tunnel syndrome are more likely to present with muscle atrophy, reflecting advanced nerve damage that may not respond to surgery.     

Outcomes of open and endoscopic carpal tunnel release: a meta-analysis

Background

Currently, there are two genres of surgical treatment of carpal tunnel syndrome, open versus endoscopic. The goal of our study is to analyze published data by comparing outcomes of surgical treatment for carpal tunnel syndrome and determine if one approach is superior to the other (open versus endoscopic).

Methods

A meta-analysis of retrospective series of Carpal tunnel release including >20 patients, with results measuring outcomes based on at least six of the following nine parameters (paresthesia relief, scar tenderness, two-point discrimination, thenar muscle weakness, Semmes–Weinstein/SW monofilament testing, return to work time, grip and pinch strength, and complications).

Results

Endoscopic carpal tunnel approach showed statistically superior outcomes in eight of the nine categories investigated. Only in the category of complications (mean occurrence of 1.2 % in the open release versus 2.2 % in the endoscopic release group) was the endoscopic group inferior.

Conclusion

This suggests that the endoscopic release is superior to the open release, particularly in experienced hands.