自制器械关节镜下单通道治疗腕管综合征的疗效观察

目的：探讨自制器械关节镜下单通道治疗腕管综合征的疗效。方法：将2014年1月至2019年12月收治的60例原发性腕管综合征病例，分为关节镜组和传统手术组，关节镜组30例，男12例，女18例，年龄（47.5±4.5）岁，病程（6.6±4.2）个月；传统手术组30例，男10例，女20例，年龄（48.5±3.5）岁，病程（5.6±4.4）个月。两组均为单侧。根据腕关节的解剖及治疗需要切断腕横韧带和关节镜的特点自行设计了器械，包括套管、内心、钩刀。将两组患者分别进行关节镜联合自制器械单通道治疗和传统腕横韧带切开减压手术治疗，对两组患者的切口长度、手术时间、术中出血量、住院费用、住院时间、恢复工作时间进行统计比较，采用波士顿腕管量表（Boston Carpal Tunnel Questionnaire，BCTQ）评分评估临床疗效。结果：关节镜组在切口长度、手术时间、术中出血量、住院时间方面均较传统手术组具明显优势，住院总费用增加。术后BCTQ评分，术后1个月两组功能评分差异有统计学意义，关节镜组优于传统手术组；术后3、6个月总分差异无统计学意义。结论：关节镜联合自制器械单通道治疗腕管综合征较开放性手术疗效可靠、微创、手术过程简化，但术前应明确诊断，选择合适病例才能取得满意的临床疗效。

Clinical observation of arthroscopic single channel treatment of carpal tunnel syndrome with self-made instruments

Objective: To investigate the efficacy of self-made arthroscopic single channel in the treatment of carpal tunnel syndrome.Methods: Sixty patients with primary carpal tunnel syndrome treated from January 2014 to December 2019 were divided into arthroscopic group and traditional open operation group. There were 30 cases in arthroscopic group,including 12 males and 18 females,aged (47.5±4.5) years and the course of disease was (6.6±4.2) months. There were 30 cases in the traditional operation group,including 10 males and 20 females,aged (48.5±3.5) years,and the course of disease was (5.6±4.4) months. Both groups were unilateral. According to the anatomy of wrist joint and the characteristics of transverse carpal ligament and arthroscopy,the instruments including cannula,inner heart and hook knife were designed. The patients in two groups were treated with decompression of transverse carpal ligament using arthroscopy combined with self-made instruments and traditional open sergery. The incision length,operation time,intraoperative bleeding,hospitalization cost,hospitalization time and recovery time of the two groups were observed and compared. Boston Carpal Tunnel Questionnaire (BCTQ) score was used to evaluate the clinical efficacy of arthroscopy combined with self-made instruments in the treatment of carpal tunnel syndrome.Results: Compared with the traditional group,the arthroscopic group had significant advantages in incision length,operation time,intraoperative bleeding and hospital stay,but the total cost of hospitalization was increased. The Boston score was significantly higher in the arthroscopic group than that in the traditional group at 1 month after operation,but not at 3 and 6 months after operation.Conclusion: Arthroscopy combined with self-made instruments in the treatment of carpal tunnel syndrome is more reliable,minimally invasive and simplified than open surgery,but the patients should be clearly diagnosed and appropriately selected before operation to achieve satisfactory clinical effect.