37例肘管综合征尺神经前置术式及疗效分析

目的分析不同尺神经前置术式治疗肘管综合征的依据及疗效。方法 54例肘管综合征患者术中进行肘部尺神经电生理刺激测量,根据尺神经运动神经传导速度(Motor Nerve Conduction Velocity,MNCV)进行尺神经损伤分度并分别对应采用尺神经外膜松解加皮下前置术、尺神经束膜松解加肌下前置术、尺神经束膜松解加尺神经筋膜下前置术三种不同手术方式,37例术后6个月～3年获随访,其中行皮下前置24例,肌下前置5例,筋膜下前置8例。结果随访37例肘管综合征病例,34例明显改善,运动感觉均获恢复,2例感觉有恢复,运动无恢复,1例3度损伤无恢复,二期手术行人工神经移植。手术疗效优良率为83.7%。结论术中尺神经电生理定量分析可作为尺神经前置术式选择的重要依据,结合显微外膜及束膜松解疗效较好。     

带血供尺神经松解前置术治疗肘管综合征56例临床分析

目的探讨带血供尺神经松解前置术治疗肘管综合征的临床效果。方法对56例肘管综合征患者显微镜下施行带血供尺神经松解前置术,术后随访观察其疗效。结果按中华医学会手外科学会上肢功能评定试用标准进行评价,优62．5％（35例）,良25．0％（14例）,可8．9％（5例）,差3．6％（2例）,优良率87．5％,无并发症。结论带血供尺神经松解前置术是治疗肘管综合征的一种有效方法。     

手术治疗肘管综合征24例临床体会

目的探讨手术治疗肘管综合征的疗效。方法对笔者所在医院收治的24例肘管综合征患者采用尺神经松解术、筋膜下前置术进行治疗,观察疗效。结果术后第1天,7例、环小指麻木减轻。术后随访6至24个月。优14例,良8例,差2例,优良率91.7％。结论尺神经松解术、筋膜下前置术可以避免肌内前置术易造成的粘连、卡压现象,治疗效果理想。     

神经外膜减压与束间松解治疗肘管综合征疗效对比分析

目的比较神经外膜减压与束间松解治疗肘管综合征的临床效果，探讨治疗肘部尺神经卡压更有效的松解方法。方法选择60例中、重度肘管综合征的患者随机分成对照组（A组）和试验组（B组），每组30例，A组单纯行尺神经外膜切开减压松解，并选择筋膜下前置法；B组在A组手术方法的基础上，选择显微镜下行神经束间松解法。结果术后1周内持续5d环、小指麻木、疼痛症状较术前加重者，A组5例，B组26例，两组症状比较差异有统计学意义（χ^2=29．43，P〈0．01）；体征检查小指尖刺痛觉较术前神经敏感性降低者，A组9例，B组18例，两组体征比较差异有统计学意义（χ^2=5．45，P〈0．05）；术后5周检查环、小指感觉异常者，A组21例，B组3例，两组比较差异有统计学意义（χ^2=22．50，P〈0．01）；术后1年肌萎缩恢复情况检查，A组未恢复者22例，B组未恢复者13例，两组比较差异有统计学意义（χ^2=5．55，P〈0．05）；术后3年A组优良率66．7％，B组优良率90．0％，两组比较差异有统计学意义（χ^2=4．81，P〈0．05）。结论显微镜下行神经束间松解法，能及早改善受卡压神经的微循环，能使神经功能更快、更好地恢复，是治疗肘管综合征的有效方法之一。     

神经外膜减压与束间松解治疗肘管综合征疗效对比分析

目的比较神经外膜减压与束间松解治疗肘管综合征的临床效果,探讨治疗肘部尺神经卡压更有效的松解方法。方法选择60例中、重度肘管综合征的患者随机分成对照组(A组)和试验组(B组),每组30例,A组单纯行尺神经外膜切开减压松解,并选择筋膜下前置法;B组在A组手术方法的基础上,选择显微镜下行神经束间松解法。结果术后1周内持续5d环、小指麻木、疼痛症状较术前加重者,A组5例,B组26例,两组症状比较差异有统计学意义(χ2=29.43,P<0.01);体征检查小指尖刺痛觉较术前神经敏感性降低者,A组9例,B组18例,两组体征比较差异有统计学意义(χ2=5.45,P<0.05);术后5周检查环、小指感觉异常者,A组21例,B组3例,两组比较差异有统计学意义(χ2=22.50,P<0.01);术后1年肌萎缩恢复情况检查,A组未恢复者22例,B组未恢复者13例,两组比较差异有统计学意义(χ2=5.55,P<0.05);术后3年A组优良率66.7%,B组优良率90.0%,两组比较差异有统计学意义(χ2=4.81,P<0.05)。结论显微镜下行神经束间松解法,能及早改善受卡压神经的微循环,能使神经功能更快、更好地恢复,是治疗肘管综合征的有效方法之一。     

小心肘管综合征

案例 李大爷今年63岁,2013年年末,他突然发现自己的小手指出现了麻木的状态。起初他并没有太在意,以为是自己平日压力过大,没有休息好所致。但这种手指麻木的症状并未减轻,且不断加重,甚至连臂肘和其他手指都不那么灵活了。最近,他连拿笔写字都很困难。李大爷以为自己是脑血栓复发,但用药治疗了几个月后症状仍然没有缓解。一位有经验的神经内科医生建议他去手外科看看。没想到,李大爷的病根还真就在手外科被查了出来,原来他是患了“肘管综合征”。     

可吸收医用膜与尺神经肌膜瓣下前置联用对肘管综合征患者疗效及神经电生理的影响

目的探讨可吸收医用膜与尺神经肌膜瓣下前置联用对肘管综合征患者的疗效及神经电生理的影响。方法选择2016年2月至2018年12月医院诊治的肘管综合征患者84例作为研究对象,通过抽签法将其等分成试验组及对照组,每组42例。对照组予以尺神经肌膜瓣下前置治疗,试验组则于对照组的基础上增用可吸收医用膜治疗,分别评价两组临床疗效、治疗前后神经电生理变化情况、并发症控制效果。结果试验组总有效率高于对照组(P<0.05);治疗后试验组及对照组小指展肌引出CMAP波幅均高于治疗前,且试验组高于对照组(P<0.05);试验组与对照组在切口血肿、切口附近感觉减退、瘢痕增生发生率方面对比差异均无统计学意义(P>0.05)。结论可吸收医用膜与尺神经肌膜瓣下前置联用可显著提高肘管综合征患者的疗效。     

首饰厂工人肘管综合征的护理研究

目的：研究首饰厂工人肘管综合征的临床护理,以期提高治疗效果。方法：随机抽取某首饰厂患工人肘管综合征的1000例工人,在进行现场流行病学调查后按照电脑随机将其分为观察组和对照组各500例,观察组给予系统的护理干预,对照组采取常规护理干预,比较两组患者的护理效果。结果：此次调查对象的男女比例为1．31：1,平均（39．12±1．21）岁,在工作中,每日保持双肘内侧肘管部位直接压迫于工作台上的姿势达8h以上的占87．2％。两组护理干预前在生活质量评价上比较差异无统计学意义（P〉0．05）,而护理干预后,观察组的患者生活质量评价明显高于对照组,比较差异有统计学意义（P〈0．05）。结论：通过现场流行病学调查可以最大限度地了解首饰厂工人肘管综合征的临床特点,根据患者的实际情况采取系统性的综合护理干预,可以有效控制病情发展,提高治疗效果。     

肘管综合征患者用单纯尺神经松解前置术分析

目的探讨肘管综合征(CTS)患者应用单纯尺神经松解前置术的效果。方法选取2016年5月-2017年5月宝坻区人民医院收入治疗的CTS患者100例,随机分为对照组和研究组各50例,对照组应用带血管蒂尺神经前置术治疗,研究组应用单纯尺神经松解前置术治疗。观察比较治疗效果。结果手术后两组感觉功能评分、肌力、尺神经传导速度评分高于同组手术前,且手术后研究组高于对照组;两组VAS评分手术后低于手术前,且手术后研究组低于对照组,差异均有统计学意义(P0.05)。对照组术后不良反应总发生率为36.0%,高于研究组的8.0%,差异有统计学意义(P0.05)。结论 CTS患者应用单纯尺神经松解前置术相比带血管蒂尺神经前置术治疗的效果比较好,不良反应的发生率低,临床上应当进一步推广应用。     

小心“肘管综合征”

肘管综合征对人体的危害在于：日益加重的麻木、疼痛严重影响患者生活质量,手精细动作变差、抓握力弱影响患者日常生活,晚期可导致手废用、爪形手、顽固性溃疡形成。     

Predicting outcomes of conservative treatment for patients with carpal tunnel syndrome: Group- and individual-based rehabilitation

ObjectiveTo identify predicting factors of treatment outcomes of a two stage group-based and then individual-based intervention programme for patients with carpal tunnel syndrome (CTS).MethodsA prospective cohort study where patients diagnosed with CTS were recruited from an out-patient occupational therapy clinic to join the two-stage CTS programme. The Stage-One programme consisted of splinting and educational talks in a group format, while the Stage-Two programme consisted of four weekly individual sessions providing psychosocial support, reinforcing correct ergonomics and mobilization. Baseline assessment on six potential predicting factors and four outcome measures was done for all patients. Patients were re-assessed at the end of the Stage-One and the Stage-Two programme. Analysis was done by binary logistic regression adjusted for baseline covariates.ResultsOne hundred and sixty-six patients completed the Stage-One programme and 46 patients also completed the Stage-Two programme. Results showed that the Chinese Symptom Severity Scale (SSS) baseline score was the only significant predictor for the Stage-One programme outcomes (AUC for ROC was 0.708) with an optimum cut-off score of 23.5. On the other hand, the Chinese QuickDASH baseline score was the only significant predictor for the Stage-Two programme outcomes (AUC for ROC was 0.801) with an optimum cut-off score of 27.4.ConclusionsThe significant predictor for the Stage One Programme was the Chinese SSS baseline score and that for the Stage Two Programme was the Chinese QuickDASH baseline score. The optimum cut-off scores identified may be applied clinically to guide client-centered treatment planning.     

Syndromes from segmental vibration and nerve entrapment: observations on case definitions for carpal tunnel syndrome

Objectives The purpose of this paper is to assess the overlap and stability of two different case definitions of carpal tunnel syndrome CTS. The analysis considers the association between different case definitions and objective tests (sensory nerve conduction velocities, SNCVs and vibrotactile perception thresholds, TTS), and the natural history of CTS, in the context of two vibration-exposed cohorts. Methods Clinical CTS cases were defined in two ways: (1) by the study physician using fixed criteria, and; (2) by questionnaire and hand diagram. SNCV in median and ulnar nerves was measured for digital, transpalmar, and transcarpal segments, and conventionally as from wrist-digit. Skin temperature was assessed as a point measurement by thermistor and regionally by thermal imaging. VTTs were determined at the bilateral fingertips of the third and fifth digits using a tactometer meeting the requirements of ISO 13091-1 (ISO 2001). The subjects were cohorts of shipyard workers in 2001 and 2004, and dental hygienists in 2002 and 2004. Results Results are reported for 214 shipyard workers in 2001 and 135 in 2004, and for 94 dental hygienists in 2002 and 66 in 2004. In 2001, 50% of shipyard workers were diagnosed as CTS cases by at least one of the diagnostic schemes, but only 20% were positive by both criteria. Among study physician diagnosed cases, 64% were CTS negative in 2001, 76% were negative in 2004, 13% were positive in both years, 22% became negative after being positive, and 11% became positive after being negative. For only study physician diagnosed CTS did VTTs differ between cases differ and non-cases in digit 3; there was no such distinction in digit 5. The dental hygienists had little CTS. Conclusion Clinical case definitions of CTS based on diagrams and self-assessment, and clinical evaluation have limited overlap. Combining clinical criteria to create a more narrow or specific case definition of CTS does not appear to predict SNCV. The natural history of CTS suggests a protean disorder with considerable flux in case status over time.     

Levels of agreement of nerve conduction studies and symptoms in workers at risk of carpal tunnel syndrome

Objective: Information is required on levels of agreement between different sets of median nerve conduction studies (NCS) and symptoms of carpal tunnel syndrome (CTS) in at-risk subjects. Methods: We performed a reanalysis of an extensive data set from a population of 114 highly exposed meat workers (without prior diagnosis of CTS), who were interviewed for the presence of current symptoms typical of CTS and systematically submitted to median NCS. Results: Agreement between presence/absence of symptoms and NCS normal/abnormal findings ranged from 81% for wrist sensory latency (WSL) to 49% for motor conduction velocity wrist-to-palm (MCV-WP) in the nondominant hands (from 60% to 50%, respectively, in the dominant hands). Mean values of WSL, sensory conduction velocity-WP (SCV-WP), wrist motor latency, MCV-WP, and the SCV-WP/SCV-elbow-to-wrist ratio all showed significant differences between symptomatic and asymptomatic workers. In nondominant hands, these parameters all reached significant P values at chi-squared tests for coefficients of agreement, the best coefficients being 0.57 for WSL and 0.40 for SCV-WP. However, in the dominant hand only SCV-WP reached significance ( coefficient=0.20). Conclusions: Given the importance of the dominant hand in working populations, these data support use of SCV-WP (or WSL) as an informative NCS parameter for occupational studies on CTS.     

A comparison of data sources for the surveillance of work-related carpal tunnel syndrome in Massachusetts

BACKGROUND: This study examined whether a state surveillance system for work-related carpal tunnel syndrome (WR-CTS) based on workers' compensation claims (Sentinel Event Notification System for Occupational Risks, SENSOR) and the Annual Survey of Occupational Injuries and Illnesses (SOII) identified the same industries, occupations, sources of injury, and populations for intervention. METHODS: Trends in counts, rates, and female/male ratios of WR-CTS during 1994-1997, and age distributions were compared across three data sources: SENSOR, Massachusetts SOII, and National SOII. SENSOR and National SOII data on WR-CTS were compared by industry, occupation, and injury source. FINDINGS: Due to small sample size and subsequent gaps in available information, state SOII data on WR-CTS were of little use in identifying specific industries and occupations for intervention. SENSOR and National SOII data on the frequency of WR-CTS cases identified many similar occupations and industries, and both surveillance systems pointed to computer use as a risk factor for WR-CTS. Some high rate industries identified by SENSOR were not identified using National SOII rates even when national findings were restricted to take into account the distribution of the Massachusetts workforce. CONCLUSIONS: Use of national SOII data on rates of WR-CTS for identifying state industry priorities for WR-CTS prevention should be undertaken with caution. Options for improving state SOII data and use of other state data systems should be pursued.     

丹红注射液对肾病综合征患者肾血流动力学及血液黏稠状态的影响研究

目的探讨丹红注射液对肾病综合征患者肾血流动力学及血液黏稠状态的影响。方法选取2008年7月～2010年12月于某院进行治疗的64例初发原发肾病综合征患者为研究对象,将其随机分为对照组和观察组各32例,对照组采用泼尼松联合双嘧达莫进行治疗,观察组在对照组的基础上加用丹红注射液进行治疗,后将两组患者治疗前及治疗后4周的肾动脉血流动力学及血液流变学指标进行对比。结果治疗后观察组的肾动脉血流动力学及血液流变学指标的改善幅度均大于对照组,治疗后两组上述检测项目比较,P均﹤0.05,差异均有统计学意义。结论丹红注射液在改善肾病综合征患者肾血流动力学及血液黏稠状态方面均发挥着积极的作用,对于改善肾脏血液循环效果明显。     

Sensory nerve conduction velocities of median,ulnar and radial nerves in patients with vibration syndrome

OBJECTIVE: The present study aimed to clarify the range of involvement for hand-arm vibration syndrome (VS) in the median, ulnar and radial nerves of the hand. METHODS: Sensory nerve conduction velocities (SCVs) for 3 nerves in the hands and arms were examined for 34 patients with VS and 23 age-matched controls. Neuropathy types were classified by possible carpal tunnel syndrome (CTS), Guyon's syndrome and digital neuropathy in three nerves. RESULTS: SCV in the median nerve (middle finger, wrist-elbow) and ulnar nerve (little finger, wrist-elbow), and amplitudes of the median nerve (wrist-proximal and distal parts of the middle finger), ulnar nerve (wrist-proximal and distal parts of the little finger; forearm-proximal part of the little finger; upper arm-proximal part of the little finger) and radial nerve (dorsal side of the hand-thumb) were significantly reduced in VS patients compared with controls. According to subject classifications based on the results of SCV and amplitude of nerve action potential, 52.9% of VS patients displayed multi-focal neuropathy including digital neuropathy, possible CTS and/or Guyon's syndrome. CONCLUSION: These findings suggest that VS affects all three nerves in the hand. According to classification results, the main disorders of peripheral nerves comprise digital neuropathy.     

黔南州苗族和布依族女性代谢综合征患者血液指标的比较

目的:探讨黔南州苗族和布依族女性代谢综合征患者血压、血糖及血脂达标率的现况。方法:2009年1月～2011年8月收集1 425例女性代谢综合征患者为研究对象,按民族分为苗族组657例和布依族组768例,分别进行问卷调查、体格检查及生化指标检测,并对影响两民族代谢综合征患者血压、血糖及血脂达标率的危险因素进行分析。结果:①苗族组血压达标率(36.83%)高于布依族组(27.08%)(P<0.01);②苗族组血脂达标率为68.94%,布依族组为48.05%,两组比较差异有统计学意义(P<0.01);苗族组血脂达标率随着年龄的增加而升高,与布依族组比较,差异有统计学意义(P<0.01);③苗族组血糖达标率为86.91%,布依族组为80.34%,两组比较差异有统计学意义(P<0.01);④影响两民族代谢综合征患者血压达标的危险因素均为高体重指数(BMI)、高血压史、利尿剂;影响血脂达标的相关因素为血脂异常史、吸烟、治疗性生活方式改变;影响血糖达标的相关因素分别为糖尿病史和口服降糖药。结论:黔南州两民族女性MS患者的血压、血脂和血糖达标率均较低,尤其是血压及血脂达标率亟待提高。应针对影响黔南州女性MS患者血压、血脂及血糖达标的相关因素,积极规范进行降压、调脂及降糖治疗,加强对女性人群的综合管理,提高达标率。     

Course of symptoms and median nerve conduction values in workers performing repetitive jobs at risk for carpal tunnel syndrome

BACKGROUND: Carpal tunnel syndrome (CTS) is a common occupational disorder associated with repetitive manual work. Little information exists about the possible relation between the variation of biomechanical hand/wrist exposure and the development of symptoms and median nerve conduction values. AIMS: To investigate the prevalence of CTS in a group of workers exposed to intensive use of the hands and the course of symptoms and median nerve conduction values after a period of reduced exposure to biomechanical risk factors. METHODS: CTS was assessed in assembly and non-assembly line workers by means of clinical examinations and nerve conduction studies (NCS). Ergonomic analysis was conducted for each assembly line workstation. RESULTS: Prevalence of CTS was significantly higher in assembly line workers compared to non-assembly line workers but there was a high prevalence of median nerve conduction abnormalities in both groups (60/102 hands and 40/110 hands, respectively). In a sizable proportion of both groups there was no relationship between symptoms and electrodiagnostic findings (45 hands and 48 hands in assembly and non-assembly line workers, respectively). When assembly line workers were re-examined after 2 years following a period of reduced work schedule, a significant proportion reported resolution of symptoms or had reverted to having normal NCS. CONCLUSIONS: In our study, repetitive work was associated with a higher level of CTS and abnormal NCS. These findings appeared to be reversible following a period of less repetitive work. Overall, there was generally poor correlation between symptoms and electrodiagnostic findings.     

年轻患者宫颈癌根治术中阴道延长及卵巢移位术的应用及意义

目的:观察宫颈癌根治术同时行阴道延长和卵巢移位术对年轻宫颈癌患者生存质量的改善情况。方法:选择年轻的早期宫颈癌患者15例作为研究组,在行宫颈癌根治术的同时行阴道延长和卵巢移位术;取同期常规宫颈癌根治术15例作为对照组,并设正常妇女15例为正常组。结果:延长后的阴道长度为(9.03±0.17)cm,与对照组(5.57±0.41)cm相比差异有统计学意义(P<0.05)。采用化学发光法测定研究组术后及正常组的FSH、E2水平,保留卵巢组术后3个月FSH、E2值分别为(8.23±3.81)mIU/ml和(60.6±7.49)pg/ml,与正常组相比差异无统计学意义(P>0.05)。结论:阴道延长和卵巢移位术可明显改善年轻宫颈癌患者的生存质量。     

胸腰椎结核的一期前路内固定治疗效果观察

目的探讨一期前路内固定治疗胸腰椎结核的疗效。方法自1999年2月~2004年10月,对67例胸腰椎结核患者进行一期前路病灶清除植骨融合Z—plate内固定。结果术后切口均一期愈合。平均随诊2.5年,67例患者均愈合,无一例复发,植骨均获融合,融合时间平均4个月。结论一期内固定治疗脊柱结核,可以重建脊柱稳定性,减少手术并发症,是一种安全有效的外科治疗方法。