正中神经松解范围对重度腕管综合征术后疗效的临床研究

目的 研究临床上重度腕管综合征正中神经卡压的手术松解范围与术后疗效的关系.方法 根据病情及电生理检测分度,筛选出腕管综合征中重度压迫者,随机分为两组,每组20例,给予不同的手术神经松解范围,术后随诊2年,定期进行肌电图复查及临床体征、症状观察.结果 治疗Ⅱ组拇短展肌肌肉复合动作电位CMAP、示中环指感觉神经电位SNAP的潜伏期及波幅恢复更快,差异有统计学意义（P＜0.05）;临床体征、症状缓解更好.结论 手腕部腕横韧带、远端掌腱膜部＋卡压段神经外膜切开,正中神经松解术,既有效解除了正中神经主干、返支卡压,又最大限度地保存了神经外膜的连续性及神经自体血供,明显提高了CMAP、SNAP的恢复,从而促进神经传导运动、感觉的恢复,对重度腕管综合征疗效最好,并发症率、复发率最低.但对于卡压时间过长、拇短展肌已明显萎缩者,术后虽能明显促进末梢感觉恢复,但运动功能恢复欠佳,部分难以恢复.

Clinical research on influence of relaxation extent in median nerve on results of surgical treatment for serious carpal tunnel syndrome

Objective To explore the relationship between the scope of surgery to loosen median nerve entrapment with serious carpal tunnel syndrome and the curative effect after surgery. Methods Referencing to patients＇ condition and results of Electromyologram, we classified the serious ones from the patients with carpal tunnel syndrome. According to the patients＇ condition, they were randomly divided into 2 groups before the surgery. Every group had 20 cases. Every group had different scope of surgery. Follow- up evaluation was carried out after surgery. Electromyologram （EMG） was applied regularly, and then we observed the clinical symptoms. Results By comparison in the two groups, managed by t-test, there were significant differences in the two groups （P 〈 0.01）. Through the statistical analysis of the results, cases in group which were released transverse carpal ligament and nerve, displayed that the latency of compound muscle action potential （CMAP） in the abductor pollicis brevis and sensory nerve action potential （SNAP） of ring finger has recovered most quickly through the EMG. The way of group C relieving clinical symptoms was best. Conclusions The scope of surgery which were released transverse carpal ligament and nerve, not only released the median nerve effectively, but also protected the continuity of nerve and the blood supply of nerve. It enhanced the recovery of CMAP and SNAP obviously. It also promoted the recovery of the sense in the peripheral part and the motor functions of the nerve. It was a simple and effective therapy for severe carpal tunnel syndrome. But concerning the complete damage to the median nerve, with muscular atrophy of abductions, it can only promote the sense in the peripheral part after treatment, not the motor functions.