腕管综合征手术方式的选择和治疗效果分析

目的回顾性分析不同类型腕管综合征（carpal tunnel syndrome,CTS）的手术方式选择并初步分析其临床疗效。 方法84例（108侧）诊断为CTS并实施手术治疗的患者,术式为腕管切开减压神经松解术或内镜下腕横韧带切断术,随访时根据患者术前是否有夜间因麻木、疼痛而醒来的病史将患者分为滑膜型CTS和卡压型CTS,并根据Kelly标准对术后疗效进行评价。 结果滑膜型CTS患者45例（59侧）,卡压型CTS患者39例（49侧）,滑膜型CTS腕管切开减压术中可见大量滑膜增生及正中神经明显充血水肿,且滑膜组织病理检查可见大量淋巴细胞浸润,而卡压型CTS腕管切开减压术中见正中神经以机械性压迫改变为主,未见大量滑膜增生。74例（98侧）患者获得随访,随访时间平均（30±19.2）个月,疗效根据Kelly标准评估,所有行腕管切开减压术患者随访时的优良率（94.9%）明显高于内镜手术患者（75.0%）（P=0.016）,其中行腕管切开减压术的滑膜型CTS和卡压型CTS患者随访时优良率分别为95.6%和93.9%,两组相比差异无统计学意义（P=0.749）,滑膜型CTS患者中行腕管切开减压术组优良率（95.6%）明显高于内镜手术组（62.5%）（P=0.020）,而卡压型CTS患者行腕管切开减压术组优良率（93.9%）与内镜手术组（83.3%）相比差异无统计学意义（P=0.286）,行内镜手术的两种类型CTS病例数虽均较少,但卡压型CTS组患者的优良率（83.3%）大于滑膜型CTS组（62.5%）。 结论腕管切开减压神经松解术是手术治疗CTS确实有效的方法,内镜下腕横韧带切断术对于卡压型CTS患者可以达到和腕管切开减压手术相近的临床疗效,但对于滑膜型CTS患者则疗效不佳,应慎重选择。     

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...     

内镜辅助治疗周围神经卡压综合征

目的 探讨应用内镜技术辅助松解术治疗周围神经卡压综合征的临床效果.方法 2003年3月至2006年3月,收治44例周围神经卡压综合征患者,男19例,女25例;年龄24～67岁,平均37.6岁.对27例32腕腕管综合征患者中的7例8腕行Okutsu法手术,15例18腕行Chow法手术,5例6腕行皮肤牵引法腕管外镜下腕横韧带切断术;8例9肘肘管综合征和7例腓总神经卡压患者通过CO2 充气皮下气腔法内镜下行肘部尺神经松解前置术和腓总神经松解术;2例四边孔综合征患者用自制的组织撑开器内镜辅助下行腋神经松解术.术后进行疗效观察.结果 44例患者均在镜下顺利完成手术,无一例发生神经、血管损伤等并发症,切口1～3 cm,随访时间6～36个月,平均18.5个月.感觉功能在1～3个月内恢复,达S4级.43例患者运动功能在6～12个月内恢复至4～5级,未见复发病例;1例腓总神经卡压患者随访至24个月时,因伸踝、趾肌力恢复至2级停止而二期行肌腱转位术.除1例腓总神经卡压患者外,43例患者均于术后12个月复查肌电图,结果 显示神经传导速度正常,神经所支配肌肉重收缩呈单纯一混合相或混合相.结论 内镜辅助治疗部分周围神经卡压综合征安全实用,不仅能达到与常规开放手术相同的疗效,而且更微创、美观,但由于其手术适应证的局限性,开放手术仍是目前治疗周围神经卡压的常规方法 .     

两点法内镜下治疗腕管综合征

腕管综合征常规手术是将皮肤与腕管横韧带之间的组织完全切断,直视下切开腕横韧带,然后行神经松解。开放性手术的缺点是手术创伤较大,术后手部功能恢复期较长,手的握力和捏力明显下降;手掌部的皮肤切开易损伤正中神经的掌皮支,形成神经瘤而产生疼痛;切口持续性疼痛,活动时加重;易发生弓弦状屈肌腱、神经与皮肤和肌腱粘连、外形不够美观等并发症。尽管开放手术的手术切口不断改良,但最终难免在手掌部残留有痛性或肥厚性瘢痕。日本Okutsu1986年首先应用内镜治疗腕管综合征,通过前臂1cm     

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。     

腕管综合征的治疗方法选择与疗效评价

目的 评价不同方法治疗腕管综合征(CTS)的疗效,为提高CTS的诊治水平提供依据.方法 回顾性分析2005年5月至2009年9月收治的162例CTS患者,其中轻度CTS 96例,重度CTS 54例,正中神经完全损伤型CTS 12例.针对不同类型患者分别采用保守治疗、单纯腕管松解手术治疗、腕管+掌腱膜完全松解手术治疗.比较治疗前后患者的临床表现、神经电生理检测、Chen W-S腕部正中神经损害疗效评分等指标.结果 162例患者治疗后获6～36个月(平均15个月)随访.轻度CTS:3种治疗方法均有效,临床症状改善明显,经治疗后Chen W-S评分由(73.1±6.5)分提高到(94.9±8.7)分,手术治疗较保守治疗效果无明显优势.重度CTS:3种治疗方法均有效,保守治疗患者治疗后Chen W-S评分提高了(9.9±1.4)分,单纯腕管松解手术后Chen W-S评分提高了(24.6±8.2)分,腕管+掌腱膜完全松解手术后Chen W-S评分提高了(33.9±7.5)分,腕管+掌腱膜完全松解手术的疗效优于单纯腕管松解手术,而二者均优于保守治疗.正中神经完全损伤型CTS:治疗后临床症状改善不明显.结论 早期发现、及时治疗并去除发病诱因是促进CTS患者恢复的有效措施.针对CTS的不同损伤程度,采用不同的治疗方法可促进手部功能恢复.     

小双切口治疗腕管综合征15例体会

目的 介绍应用小双切口作腕管切开治疗腕管综合征的方法及临床效果。方法 在掌长肌腱尺侧，平行远侧腕横纹作1．5cm长的横切口，腕横纹以远2．5cm为中心沿鱼际肌纹作1cm长的纵切口，分别显露腕横韧带远近缘及指屈肌腱及正中神经，直视下将腕横韧带完全切开，正中神经外膜松解3例，鱼际肌支松解1例。结果 术后2周，15例症状完全消失，拇、示、中3指指腹两点辨别觉恢复正常。术后1年随访，术前大鱼际肌萎缩5例，肌萎缩明显改善，拇指对掌功能恢复正常。全部病例无1例产生腕掌部瘢痕疼痛及尺神经、掌浅弓损伤等并发症。结论 小双切口行腕管松解术，可操作窄间大，并发症少，术后美观。是治疗腕管综合征的有效方法。     

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。     

关节镜镜视下行腕横韧带切开术

目的 介绍在关节镜镜视下行腕横韧带切开术治疗腕管综合的方法。方法 1999年3月以来，对15例（18侧）腕管综合征采用Chow两点法在关节镜镜视下行腕横韧带切开术。腕管入口位于腕横纹近端2－3cm，掌长肌腱尺侧缘。腕关节背伸位时，将带槽套管自腕管入口处对准第3指蹼方向插入，从腕管远端穿出。在关节镜监控下用钩刀切开腕横韧带。结果 术后随访2－16上月，平均7个月。术后桡侧3指半的感觉已恢复正常。3例有拇指对掌功能和大鱼际肌萎缩者，术后3－6个月均恢复正常。无血管神经损伤和感染等并发症发生。结论 关节镜镜视下切开腕横韧带治疗腕管综合征是安全有效的微创手术。     

小切口神经松解治疗腕管综合征疗效分析

目的评价小切口显微神经松解与传统手术神经松解治疗腕管综合征的疗效。方法本研究为前瞻性随机对照研究,把50例腕管综合征患者分为小切口组及传统组,每组各25例,术前及术后2年对所有病例症状严重程度进行GSS评分(GlobalSymptomScore)。并观察两组腕掌部瘢痕痛发生率。结果小切口组及传统组术前、术后评分差值分别为19.1±5.7、13.3±6.3,小切口组术后症状改善优于传统组(P<0.05)。小切口组无1例发生腕掌部瘢痕痛,传统组发生15例(60%)。结论小切口直视下显微神经松解术治疗腕管综合征疗效优于传统神经松解且术后并发症更少。     

CT-scanning study of cross-sectional area of the carpal tunnel in cases of carpal tunnel syndrome

The cross-sectional area, transverse and anteroposterior diameter of the carpal tunnel were investigated by CT scanning in 68 cases of carpal tunnel syndrome (CTS) and in 100 normal controls of both sexes. The cross-sectional areas of the carpal tunnel in idiopathic CTS of both sexes were significantly smaller, whereas those in secondary CTS were larger than in normal controls. In female wrists with idiopathic CTS narrowing of distal carpal tunnel was attributed to short transverse diameter in wrists with normally shaped hook of the hamate, or to decreased anteroposterior diameter in wrists with abnormally short hook of the hamate. The smallest cross-sectional area in both types of CTS and in normal controls is located at the proximal border of distal carpal tunnel (D 1 level). This coincides with the thickest portion of the flexor retinaculum and, together with our operative findings, supports the conclusion that the essential compression on the median nerve takes place at the D 1 level in idiopathic CTS.     

透明外导管行Chow法内镜治疗腕管综合征

目的探讨内镜下采用透明外导管双入口Chow法施行腕横韧带松解术治疗腕管综合征的疗效及安全性。方法选取2008年7月至2013年3月在北京大学第一医院以透明外导管行双入口Chow法治疗腕管综合征的27例患者38个腕关节。其中男4例,女23例;年龄25~66岁,平均52.81岁;右腕12例,左腕4例,双腕11例。根据术前症状按滨田分类法分级,Ⅰ级9腕,Ⅱ级6腕,Ⅲ级23腕。手术采用局麻、止血带,腕部小切口引入透明导管,在透明外导管内可分辨出肌腱、韧带、神经的情况下切开腕横韧带,松解正中神经。结果术后随访2~47个月,平均17.67个月。失访6例,共随访32个腕关节。单腕平均手术时间15 min,出血0 mL。术后1例出现疼痛、麻木加重,无正中神经、血管、肌腱损伤及神经黏连等并发症,无二次手术者。无皮肤深浅感觉障碍、无切口瘢痕疼痛者。握力及捏力均不同程度改善。术后Kelly分级评定,优18腕,良9腕,一般4腕,差1腕,优良率为84.3%。分级为一般及差的5例均出现在术前滨田分类Ⅲ级的患者中。结论关节镜下用可视的透明外套管行"双孔道"Chow法腕横韧带松解术结合了Chow法与Okutsu法的优点,皮肤切口小,组织创伤轻,手术时间短,术后不需石膏外固定,不残留大的手术瘢痕。此方法是一种有效且操作安全性高的微创术式。     

内窥镜Chow法治疗腕管综合征

目的探讨内窥镜镜视下Chow法行钩刀或推刀切断腕横韧带,解除正中神经压迫的手术方法和疗效。方法2004年5月-2009年8月,对76例（85侧）腕管综合征患者采用Chow法在内窥镜镜视下行腕横韧带切开术。结果经2～18月随访,伤口均一期愈合,无血管神经损伤,无手掌部疼痛,无伤口感染,多数患者术后夜麻即消失,术后4周桡侧三个半指感觉恢复正常,麻木、疼痛症状明显缓解,10周左右拇对掌功能恢复。Kelly分级评定：优（症状完全消失）58侧,良（明显缓解）21侧,一般（症状轻度减轻）5侧,差（症状不变或加重）1侧,优良率92．94％。结论Chow法内窥镜镜视下切开腕横韧带治疗腕管综合征是安全有效的微创手术。     

Failed endoscopic carpal tunnel release. Operative findings and results of open revision surgery.

From 1994 to 1997, 22 patients (24 wrists) underwent open revision carpal tunnel release for persistent carpal tunnel syndrome after a primary endoscopic release. The age range was from 21 to 77 years. At the time of revision surgery, 22 wrists had an incomplete release of the flexor retinaculum and two patients had median nerve transection (one partial and one complete). One patient had release of Guyon's canal and not the carpal tunnel. After the open revision carpal tunnel release, 20 patients returned to work with five patients returning to jobs of lighter duty. In addition, these 20 patients had significant improvement in symptoms. The remaining two patients had sustained a median nerve injury and did not return to work. One of these patients developed a painful neuroma in continuity of the median nerve which required vein wrapping with a saphenous vein graft. This study indicates that endoscopic release of the flexor retinaculum holds the same risks and complications as open release. Based on our study we believe that patients with persistent carpal tunnel syndrome after failed endoscopic flexor retinaculum release can be successfully treated with open release.     

Carpal tunnel pressure in patients with carpal tunnel syndrome due to long-term hemodialysis

We studied carpal tunnel pressure and outcome of endoscopic carpal tunnel release in 42 patients (53 hands) with carpal tunnel syndrome (CTS) and receiving long-term hemodialysis. We compared these results with those of 41 patients (49 hands) with idiopathic CTS. Pressure was measured peroperatively: first, before dilation of the carpal tunnel; second, after dilation but before release of the transverse carpal ligament; and third, after completion of the release. In patients receiving long-term hemodialysis, the highest pressures were 76.9, 56.0, and 7.8 mmHg respectively. In patients with idiopathic CTS, pressures were 68.8, 44.1, and 4.0 mmHg respectively. The clinical outcome was inferior in patients receiving long-term hemodialysis.     

Endoscopic versus open carpal tunnel release: A short-term comparative study

Objective:

To compare the results of endoscopic carpal tunnel release (CTR) with open CTR in patients with idiopathic Carpal tunnel syndrome (CTS).

Materials and Methods:

Seventy-one patients with CTS were enrolled in a prospective randomized study from May 2003 to December 2005. All patients had clinical signs or symptoms and electro-diagnostic findings consistent with carpal tunnel syndrome and had not responded to nonoperative management. Sixty-one cases were available for follow-up. Endoscopic CTR was performed in 30 CTS patients and open CTR was performed in 31 wrists (30 patients). Various parameters were evaluated, including each patient''s symptom amelioration, complications, operation time, time needed to resume normal lifestyle and the frequency of revision surgery. All the patients were followed up for six months.

Results:

During the initial months after surgery, the patients treated with the endoscopic method were better symptomatically and functionally. Local wound problems in terms of scarring or scar tenderness were significantly more pronounced in patients undergoing open CTR compared to patients undergoing endoscopic CTR. Average delay to return to normal activity was appreciably less in group undergoing endoscopic CTR. No significant difference was observed between the endoscopic CTR group and open CTR group in regard to symptom amelioration, electromyographic testing and complications at the end of six months.

Conclusion:

Short-term results were better with the endoscopic method as there was no scar tenderness. Results at six months were comparable in both groups.     

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.