甲钴铵对轻中度腕管综合征治疗的有效性研究

目的 探讨甲钴铵治疗轻、中度腕管综合征的有效性.方法 随访24例口服三联药组(A组:地巴唑、维生素B1、维生素B6)及24例口服四联药(B组:甲钴铵、地巴唑、维生素B1、维生素B6)的轻中度腕管综合征患者.于入组时、治疗后3个月及6个月采集患者临床症状,填写症状评分表.入组及治疗6个月时,检测腕部正中神经电生理.结果 A及B组患者临床症状、症状总评分及腕部正中神经电生理均有明显恢复,B组恢复更佳.结论 甲钴铵可促进轻中度腕管综合征恢复.     

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。     

超声引导下正中神经阻滞对腕管综合征治疗效果的影响

目的观察超声引导下正中神经阻滞治疗腕管综合征的临床效果。方法选择40例(69个患腕)腕管综合征患者,性别不限,年龄33~61岁,ASAⅠ或Ⅱ级。随机分为超声组(U组)和对照组(C组),每组20例。U组采用超声引导下正中神经阻滞,C组采用解剖标志定位正中神经阻滞,两组每次阻滞药物均为布比卡因4.5mg、曲安奈德5mg、维生素B12 100μg混合液3ml。通过Boston腕管问卷调查表(BCTQ)评估患者治疗前后手症状和功能;记录治疗前后正中神经电生理参数;记录二次治疗及不良反应情况。结果与治疗前比较,治疗后1个月两组BCTQ评分中的症状严重程度评分(SSS)和功能状态评分(FSS)明显降低(P0.05),且U组SSS明显低于C组(P0.05),两组FSS差异无统计学意义。与治疗前比较,治疗后1个月两组运动潜伏期(MDL)、感觉潜伏期(SDL3)明显缩短(P0.05),感觉神经传导速度(SNCV)明显增快(P0.05),而运动神经传导速度(MNCV)差异无统计学意义。治疗后1个月,U组SNCV明显快于C组(P0.05),其余神经电生理参数两组差异无统计学意义。U组二次治疗及不良反应明显少于C组(P0.05)。结论采用超声引导下神经阻滞治疗腕管综合征能显著改善患者的手部症状,减少并发症。     

轻中度腕管综合征保守治疗进展

腕管综合征为临床最常见的周围神经卡压疾病之一,轻中度腕管综合征以保守治疗为主。多数研究表明局部封闭治疗或口服类固醇类药治疗最有效,腕夹板治疗次之,非类固醇类抗炎药、利尿剂、激光、超声的疗效不明显,而维生素B6和肉毒杆菌B无效。过敏型腕管综合征即使是重度,亦先予保守治疗。该文就轻中度腕管综合征保守治疗研究进展作一综述。     

急性重症腕管综合征的非手术处理

腕管综合征(Carpal tunnel syndrome)也称正中神经挤压症,指正中神经在腕管内受压缺血而产生的以桡侧三个半手指感觉异常为特征的症候群[1].笔者自1998年以来,采用休息、腕管内注射确炎舒松A 2%利多卡因,辅以维生素B1、B6口服治愈了大部分病例,其中有10例病例症状非常严重,疼痛难忍,经过综合治疗成功控制症状,减轻痛苦,避免了手术.现报告如下:     

中度腕管综合征的体外冲击波治疗效果研究

目的评估体外冲击波(extracorporeal shock wave therapy,ESWT)这一新型的无创性方法对中度腕管综合征(carpal tunnel syndrone,CTS)的治疗效果。方法选取2014年6月-2016年6月收治的CTS患者80例,随机分为A、B两组(n=40)。A组给予ESWT治疗,每周一次,疗程共4周;B组给予口服塞来昔布(200 mg)和维生素B1片(300 mg),2次/d,疗程共4周。两组夜间均采用腕部支具固定。在治疗前和治疗后1、3、6个月采用视觉模拟评分(VAS)、波士顿问卷量表评分(BCTQ)以及中华医学会手外科学会上肢功能评定标准评价患者的临床疗效。结果两组在治疗后1、3、6个月的VAS评分均较治疗前显著改善(P<0.05),但A组的改善程度较同期B组更为显著(P<0.05);A组的Boston SYMPT评分和FUNCT评分均较治疗前显著改善,而B组的Boston SYMPT评分和FUNCT评分仅在治疗后3个月有明显差别,并且均低于同期A组;A组在治疗6个月后的各项评分几乎保持不变,基本趋于稳定,而B组的各项评分却明显增加;随访终末期评价,虽然两组有效率相比差异无统计学意义(P>0.05),但A组的优良率明显高于B组(P<0.05),复发率也明显低于B组(P<0.05)。结论在临床上可以推荐ESWT作为中度CTS患者的一种保守治疗手段。     

内窥镜下探查腕管正中神经变异二例报道

例1女,53岁。双手桡侧3指半麻木6个多月,有夜间麻醒史并伴大鱼际肌萎缩。2004年9月到我院就诊。局部检查:桡侧3指半刺痛感减退,拇对掌功能受限。Phalentest( )。肌电图提示为双侧腕管综合征(carpaltunnelsyndrome,CTS)。结合临床诊断为双侧腕管综合征。择期手术:在远侧腕横纹以     

改良小切口手术结合罗哌卡因鞘内注射治疗腕管综合征

目的探讨采用改良小切口手术结合罗哌卡因鞘内注射治疗腕管综合征的临床疗效。方法自2014年6月至2016年12月甘肃省人民医院骨三科采用改良小切口结合罗哌卡因鞘内注射治疗腕管综合征患者70例,参照手术前后波士顿腕管量表(boston carpal tunnel questionnaire,BCTQ)、视觉模拟评分(visual analogue scale,VAS)和神经电生理检测指标进行疗效评估。结果所有患者手术顺利,随访时间2个月,手术优良率为94.3%,手术时间平均(15.18±2.36)min;住院天数平均(3.45±0.69)d;恢复工作时间平均(28±1.62)d;VAS评分由术前平均(4.21±0.54)分降到术后平均(1.29±0.23)分;BCTQ症状评分由术前平均(3.93±0.34)分降到术后平均(1.75±0.62)分;正中神经运动潜伏期由术前平均(5.54±1.27)ms降到术后平均(2.28±0.74)ms;感觉传导速度由术前平均(40.17±4.92)m/s增加到术后平均(48.33±1.21)m/s;感觉波幅由术前平均(9.26±1.2)mv增加到术后平均(11.36±1.43)mv,手术前后比较差异均具有统计学意义(P0.05)。结论改良小切口结合罗哌卡因鞘内注射治疗腕管综合征能显著改善术后近期患者的临床症状,提高手术满意率,值得临床推广。     

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...     

痛风石致腕管综合征的病例分析

目的 探讨痛风石导致的腕管综合征的临床特点,以期指导其诊断和治疗.方法 回顾性分析2008年1月至2010年10月收治的6例腕管综合征患者,病程1～6个月,平均(3.0±0.6)个月.6例均为单发,除腕部外的身体其他部位均未发现痛风石.在行腕管切开减压时,发现腕管内有痛风石生长,痛风石侵犯指屈肌腱和正中神经.术中刮除痛风石,切开腕横韧带,解除周围组织对正中神经的压迫,行正中神经外膜或束膜松解术.结果 6例患者伤口均Ⅰ期愈合,手指麻木症状减轻.术后发现5例患者血尿酸升高,1例患者血尿酸正常.随访10～ 25个月,平均(17.0±5.3)个月,腕管综合征症状消失4例,缓解2例,未见新的痛风石出现.结论 痛风石导致的腕管综合征好发于男性,多伴有血尿酸升高,腕部B超、CT或MRI检查对其有诊断意义;腕横韧带切开,痛风石清除和正中神经外膜松解术是治疗痛风石导致的腕管综合征的有效方法.     

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。     

Endoscopic carpal tunnel release in patients receiving long-term hemodialysis

This study evaluated the clinical results of endoscopic carpal tunnel release in carpal tunnel syndrome caused by long-term hemodialysis and compared the results with that of idiopathic carpal tunnel syndrome. Operations were done in 32 patients (60 hands) with idiopathic carpal tunnel syndrome and in eight patients (15 hands) with carpal tunnel syndrome resulting from long-term hemodialysis. There was no significant difference in findings of preoperative evaluations and postoperative clinical results between the two groups, except for a difference with the patient satisfaction score with surgery on a visual analogue scale. The mean satisfaction score was 9.0 at 6 months, 9.3 at 1 year, and 9.5 at the 2-year followup in the group of patients with idiopathic carpal tunnel syndrome. However, in the group of patients with carpal tunnel syndrome resulting from long-term hemodialysis, the mean satisfaction score was 8.5 at 6 months, 8.2 at 1 year, and 6.5 at the 2-year followup. The score began to decrease at an average of 17.2 months after surgery. Long-term hemodialysis related carpal tunnel syndrome showed satisfactory short-term clinical results until approximately 1.5 years after the operation. After that time, the symptoms tended to deteriorate in 50% of the patients who received hemodialysis continuously.     

Towards development of a nonhuman primate model of carpal tunnel syndrome: performance of a voluntary, repetitive pinching task induces median mononeuropathy in Macaca fascicularis.

This study investigated changes in median sensory nerve conduction velocity (SNCV) over several weeks of exposure to a voluntary, moderately forceful, repetitive pinching task performed for food rewards by a small sample of young adult female monkeys (Macaca fascicularis). SNCV, derived from peak latency, decreased significantly in the working hands of three of the four subjects. The overall decline in NCV was 25%-31% from baseline. There was no decrease in SNCV in the contralateral, nonworking hands. Several weeks after being removed from the task, SNCV returned to within 87%-100% of baseline. MRI showed enlargement of the affected nerves near the proximal end of the carpal tunnel, at the time of maximal SNCV slowing. This new animal model demonstrates a temporally unambiguous relationship between exposure to a moderately forceful, repetitive manual task and development of median mononeuropathy at the wrist, and recovery of SNCV following termination of task exposure. This study contributes to the pattern of evidence of a causal relationship between manual work, median mononeuropathy, and carpal tunnel syndrome in humans. In the future, this new animal model could be used to characterize dose-response relationships between risk factors and carpal tunnel syndrome.     

结核性腱鞘滑膜炎所致腕管综合征的手术治疗

目的 总结腱鞘结核所致的腕管综合征的临床表现,观察手术治疗的效果.方法 对11例术前不能明确病因的腕管综合征患者行手术治疗,广泛切除腱鞘滑膜上病灶组织,经病检确诊为结核性腱鞘滑膜炎,术后行抗痨治疗.通过随访观察症状的改善、神经肌电图的变化来评估手术疗效.结果 11例随访6～18个月,9例术后1周神经症状缓解,1个月后麻木症状消失.术后6个月临床症状和神经传导较术前明显改善,结核未复发,手指功能恢复良好,未产生并发症.结论 结核性腱鞘滑膜炎好发于腕部屈肌腱,是引起腕管综合征病因之一.手术切除病灶,加上抗痨治疗和早期功能锻炼,疗效满意.     

Outcomes of Mini-Open Carpal Tunnel Release in Patients With Unrecordable Preoperative Nerve Conduction Potentials at a Minimum of 5 Years

Background: The aim of this study is to assess the outcomes of carpal tunnel release (CTR) in a cohort of patients with preoperatively unrecordable median nerve sensory and motor potentials in comparison with historical controls at minimum 5-year follow-up. Methods: We retrospectively identified 1297 patients who underwent CTR at a tertiary care referral center from July 2008 to June 2013. After exclusion criteria and review of available preoperative nerve conduction studies, 24 patients who underwent CTR with preoperative unrecordable sensory and motor nerve potentials were identified. Fifteen living, mentally capable patients were contacted by telephone for follow-up. Our primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Secondary outcome measures included Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain on a 0 to 10 Likert scale, and satisfaction on a 0 to 10 Likert scale. Results: Our response rate was 80% (12 out of 15) of eligible patients. Mean follow-up was 6.9 years in our study (range, 5.4-9.5 years). The mean BCTQ symptom score was 1.4, and the mean BCTQ functional score was 1.8. Mean DASH score was 15.2. On average, patient-reported pain was 0.3 and satisfaction was 8.3. No difference was found in outcomes of CTR in patients with end-stage carpal tunnel syndrome compared with historical means. Conclusions: Patients with end-stage carpal tunnel syndrome do not have worse long-term patient-reported outcomes after CTR compared with the general population. Unrecordable nerve potentials are not a contraindication for CTR.     

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。     

Carpal tunnel syndrome with thenar atrophy: evaluation of the pinch and grip strength in patients undergoing surgical treatment

This aim of this study was to evaluate the progression of grip, tip pinch, key (lateral) pinch, and tripod pinch strengths in patients suffering from carpal tunnel syndrome with thenar atrophy following surgery. Between October 2008 and May 2010, 46 patients (49 hands) with carpal tunnel syndrome associated with thenar atrophy underwent surgery. Thenar atrophy was assessed by clinical inspection. Evaluations for grip strength and for tip, key, and tripod pinch strengths were made using a hydraulic hand dynamometer grip and a hydraulic pinch gauge, respectively. These measurements were taken before surgery and at 3 and 6 months after the procedure. When we compared the averages of all forces measured in the affected hand before the surgery with all forces measured at 3 months postoperative, we found no significant differences. However, after 6 months, we found significant differences for all four strength tests as compared with those measurements taken preoperatively and at the 3 month time point. Our results suggest that patients with thenar atrophy show increased grip strength and pinch strength by the sixth month after surgical treatment.     

腕管综合征在内窥镜视下手术与常规手术的疗效比较

目的 对腕管综合征在内窥镜视下手术与常规手术的疗效进行比较。方法 内窥镜组４０例４４腕,常规手术组４０例４４腕。术前按滨田分类方法分为３类。两组分别在术后１个月、３个月、１２个月进行随访。根据Ｋｅｌｌｙ功能评定标准对各型进行功能评价。结果内窥镜组各型患者术后１个月时,功能恢复速度稍慢于常规手术组,３个月两后两组功能则完全相同。结论 两组的手术入路不同,但术后３个月时的疗效却相同。但内窥镜组具有皮     

Carpal tunnel syndrome treated with guided brain plasticity: a randomised,controlled study

Introduction: Guided plasticity, induced by cutaneous forearm anaesthesia, improves hand sensibility in patients with nerve injury and vibration-induced neuropathy. This study investigated whether patients with carpal tunnel syndrome (CTS) would benefit from cutaneous forearm anaesthesia.

Methods: Seventy patients with clinical and electroneurography-verified CTS were randomised to sensory training combined with either an anaesthetic cream (EMLA^®) (n?=?34) or a placebo cream (n?=?36) on the volar part of the forearm. The treatment was repeated at increasing intervals over 8 weeks. The primary outcome was the Boston carpal tunnel questionnaire (BCTQ) symptom severity scale after 8 weeks. Secondary outcomes included activity limitations, sensory function, and nerve conduction. This study compared the longitudinal changes between the two groups, and with correction for multiple comparisons it also compared the longitudinal change within the groups.

Results: There were no significant differences in primary or secondary outcomes between the groups. However, the BCTQ symptom severity scale improved significantly within the EMLA^® group over the 8-week period (p?=?0.001). Apart from this, no significant improvements in activity limitations, sensory function, or nerve conduction were seen in the two groups compared to baseline. Altogether, 47% of patients in the EMLA^® group and 61% in the placebo group had been operated on with carpal tunnel release by 12 months.

Conclusion: An 8-week treatment protocol with cutaneous forearm anaesthesia to guide brain plasticity gave no significant subjective or objective improvements in hand function compared to placebo.