腕管切开松解减压术

腕管切开松解减压术一直被认为是外科治疗腕管综合征的经典方法，于1913年由Marie和Foix最先提出。其术式甚多，优、缺点各异，操作也有简有繁。现结合腕部神经解剖特点，将每一种术式归纳复述如下。     

腕管切开减压术与内镜下腕管减压术治疗腕管综合征的疗效对比研究

腕管切开减压术(OCTR)是治疗腕管综合征简单有效的手术方法,近年来采用内镜下腕管减压术(ECTR)治疗腕管综合征的数量逐渐增多,但是文献报道示两种手术方法在手术效果和安全性上不一致。该文作者对123例分别采用ECTR和OCTR治疗的腕管综合征病人进行了随访调查研究,即对91例ECTR病人和32例OCTR病人进行初级和次级随访。初级随访指标包括症状改善情况自报表和神经血管并发症发生率,次级随访指标包括McGill疼痛调查表、握力(采用指握力测定装置)、捏力(采用指捏力测定装置)、中指感觉域值测定(仪器均由NK生物技术公司提     

掌部小切口减压治疗腕管综合征

目的:介绍掌部小切口横断腕横韧带治疗腕管综合征的方法,并评价其疗效及安全性。方法:自2006年1月至2007年9月,采用掌部纵形小切口,切断腕横韧带治疗腕管综合征15例(18侧),男2例,女13例;年龄34～69岁,平均48岁;单侧12例,双侧3例;病程8～26个月,平均18个月。主要临床表现为:桡侧3个半指麻木或疼痛,腕部疼痛,并向前臂放射,夜间麻醒史,大鱼际肌肉萎缩,Tinel征阳性,Phalen征阳性。电生理检查均有正中神经感觉神经传导速度(SCV)减慢、感觉神经动作电位(SNAP)波幅下降或缺失,严重者拇短展肌可有自发电位。术后随访时采用GSS评分(Global symptom score),分别从疼痛、麻木感、感觉异常、肌力减退和夜醒等5个方面进行评价。结果:术后所有患者伤口均甲级愈合,无并发症发生。15例患者均获随访,时间20～28个月,平均24个月。除1例患者未完全缓解外,其余患者症状消失,拇短展肌肌力增强,GSS评分较术前有明显改善(P<0.05)。结论:小切口减压治疗腕管综合征具有安全性高、手术时间短、创伤小、瘢痕小等优点,直视下切断腕横韧带,可彻底松解正中神经,是安全、有效的手术入路。     

掌部小切口手术治疗中重度腕管综合征58例体会

目的总结掌部小切口手术治疗中重度腕管综合征(CTS)的体会。方法收集2016-01—2018-01间在郑州市骨科医院接受掌部小切口手术的58例中重度CTS患者的临床资料,进行回顾性分析。结果 58例患者的切口均甲级愈合。术后均获12～24个月随访。夜间麻木感均完全缓解。末次随访10例患者仍有指端麻木感。大鱼际肌萎缩恢复较慢,均于12～18个月内逐渐恢复。根据腕管综合征运动、感觉评定标准判定疗效:本组优20例,良32例,可6例。优良率为79.4%。结论掌部小切口手术治疗中重度CTS,具有创伤小、恢复快及效果可靠等优点,对符合手术适应证的患者是一个理想的手术方法。     

改良小针刀腕部微创减压治疗腕管综合征

目的介绍改良小针刀腕部微创松解减压治疗腕管综合征的方法,并评价其疗效及安全性。方法自2005年1月至2012年1月,采用微创技术通过改良小针刀腕部切断腕横韧带并松解掌腱膜治疗腕管综合征60例72个腕管,其中男12例,女48例;年龄35～70岁,平均48．5岁。主要表现为：桡侧3指半疼痛或麻木,腕部疼痛并向前臂放射,多有夜间麻醒史,大鱼际肌肉萎缩,Tinel和Phalen征阳性。电生理检查均有正中神经感觉神经传导速度减慢、感觉神经动作电位波幅下降或缺失。术后随访时采用GSS评分,分别从疼痛、麻木、感觉异常、肌力减退和夜醒等5个方面进行评价。结果所有患者针孔均甲级愈合,无并发症。60例患者全部获得随访,时间3～48个月,平均14个月。有5个手腕症状未完全缓解,1例患者3个月时再次出现手指麻木,经注射得保松后缓解,其余患者症状完全消失,拇短展肌肌力增强,GSS评分较术前明显改善（P〈O．05）,差异有统计学意义。结论改良小针刀腕部微创减压治疗腕管综合征具有手术时间短、创伤小、无瘢痕、局麻下完成、效果好、安全可靠等优点。     

腕管综合征病因学的研究进展

<正>腕管综合征（Carpal tunnel syndrome,CTS）是由各种急性或慢性原因引起的腕管内压力升高,而使腕管内正中神经受到压迫而产生的症状或体征,典型症状是由正中神经支配区疼痛、麻痹及感觉异常,同时伴或不伴肌力减退,严重者会发生大鱼际肌肉萎缩的一种综合征,是手外科中最常见的周围神经卡压综合征。     

小切口治疗腕管综合征14例报告

Objective　To introduce the technique of carpal tunnel release by small incision,and evaluate its outcome in the treatment of carpal tunnel syndrome.Methods　This method was applied in the operations of 14 cases of carpal tunnel syndrome.An incision 1.5 cm in length was made at the level of the proximal transverse wrist crease ulnar to the palmaris longus tendon.The proximal margin of the transverse carpal ligament was visualized and the ligament was cut subcutaneously under direct vision.The flexor digitorum tendons were retracted and the edematous synovium excised.Results　Follow - up of the patients 2 weeks postoperatively showed that the symptoms of numbess and pain disappeared in all 14 cases.Normal 2 - PD in the pulp of the thumb,index finger and long finger was ＜ 4 mm.One year after the operation,muscle atrophy in 5 patients who sustained preoperative thenar muscle atrophy was greatly improved with recovery of normal opponens function of the thumb.No pillar pain and injury of the ulnar nerve and superficial palmar arch was found.Conclusion　Carpal tunnel release under direct vision through a small incision is a new and effective surgical procedure.     

腕掌侧远端横纹小切口松解治疗腕管综合征的体会

目的 观察腕掌侧远端横纹小切口松解治疗腕管综合征的疗效,总结临床治疗体会。方法 回顾性分析自2020-01—2022-10采用腕掌侧远端横纹小切口切开松解治疗的33例(41侧)腕管综合征,切口位于腕掌侧远端横纹处,于掌长肌腱尺侧作一长约1.5 cm横形切口。如果出现难以直视、操作困难情况则可采用L形延长切口,位于第3指蹼与掌长肌腱尺侧缘连线上,在横形切口桡侧端向上延伸一长约1 cm的纵形切口。结果 33例手术均顺利完成,其中3侧需采用L形切口,术后未出现感染、血肿。33例均获得随访,随访时间为8～20个月,平均15个月。术后第1天所有患者手掌部麻木、感觉异常症状均有不同程度缓解。术后第14天34侧手掌部麻木感完全消失,7侧手掌部仍有麻木感。末次随访时5侧手掌部偶有轻微麻木感,2侧手掌部遗留麻木但较术前减轻。末次随访时大鱼际肌肉萎缩的13侧完全恢复,对掌功能、捏力、握力恢复正常;大鱼际肌肉萎缩的3侧部分恢复,对掌功能恢复正常,捏力、握力较术前明显改善。所有患者术后均未出现瘢痕痛、掌浅弓损伤,未出现正中神经掌皮支、返支损伤。末次随访时采用腕管综合征功能评定标准：优31侧,良8侧,可2侧。结...     

正确掌握与评估内镜松解治疗腕管综合征

1986年Okutsu首次在临床利用USE(universal subcutaneous endoscope)系统通过近腕部的小切口，切断腕横韧带，松解腕部正中神经卡压，取得满意效果。由于组织创伤轻，避免了手掌部痛性疤痕，能早日恢复日常生活与工作，此术式已在欧美不断普及与改良。     

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。     

A case of complex regional pain syndrome type II after transradial coronary intervention

The transradial approach for coronary catheterization is now a routine technique without serious complications at the puncture site. We report a case of complex regional pain syndrome type II (CRPS type II) in the hand after the transradial coronary intervention, which may alert medical personnel that the technique may cause serious regional pain with disability. A 61-year-old woman underwent coronary intervention via the right radial artery for the treatment of unstable angina. After the operation she complained of severe pain in the right hand, consistently felt along the median nerve distribution. The nerve conduction study suggested carpal tunnel syndrome. We made a diagnosis of CRPS type II, and the patient received stellate ganglion blockade, cervical epidural blockade, and administration of amitriptyline and loxoprofen. The symptoms gradually improved and her activities of daily living markedly improved. The median nerve appeared to be damaged by local compression and potential ischemia. Careful attention should be paid to avoid CRPS type II, associated with excess compression.     

108例腕管综合征正中神经传导测定结果分析

分析１０８例腕管综合征正中神经传导测定结果，以求最敏感的电诊断指标。比较１０８例正中神经复合肌肉动作电位，肘至腕的运动传导速度测定及指至腕部的感觉神经动作电位三项。指标异常检测率，表明拇指至腕段的感觉传导速度减慢是最敏感的电诊断参量。１０８例中伴有前臂段运动传导速度减慢的占１０．５％。同组病例无症状上肢出现电生理异常者为２０％，指示有亚临床的腕管部神经卡压存在的可能。     

Carpal tunnel pressure alters median nerve function in a dose-dependent manner: a rabbit model for carpal tunnel syndrome.

BACKGROUND: An in vivo animal model for carpal tunnel syndrome (CTS) is presented which allows for graded application of pressure to the median nerve within the carpal canal. We hypothesized that such pressure would cause electrophysiologic changes in the median nerve in a dose-related manner, with NCS/EMG changes consistent with CTS in humans. METHODS: In 40 New Zealand white rabbits, ranging from 2 to 2.5 kg, angioplasty catheters were placed in the carpal tunnel in the forepaws and pressures ranging from 50 to 80 mmHg applied to one side while the contralateral side served as the control and remained uninflated. Pressure was applied until a 15% increase in distal motor latency was obtained for 2 consecutive weeks by nerve conduction studies. RESULTS: All the experimental limbs exhibited a 15% increase in distal motor latency. None of the control limbs showed a significant increase in distal motor latency. In the experimental animals the 15% delay was achieved in approximately 4-5 weeks in the 50-70 mmHg groups and in approximately 1 week in the 80 mmHg group. CONCLUSION: This new animal model for CTS demonstrates a direct cause and effect relationship between carpal tunnel pressure and median nerve dysfunction. We anticipate that this in vivo model with clinically relevant outcomes will facilitate identification of injury mechanisms, and will serve as a basis for future development of novel interventions and treatments.     

Carpal tunnel syndrome surgery: identification of a neurophysiological high-risk category

Surgical decompression of the median nerve is a standardized treatment for carpal tunnel syndrome. After surgery a clinical and neurophysiological improvement is observed also on severe cases. We report 4 cases of carpal tunnel syndrome (CTS) in the hands of 3 patients with prolonged median wrist-thenar distal motor latency (longer than 10 ms, normal values < 4.0 ms) and absence of digit-wrist sensory responses. In these patients surgery caused complete loss of median nerve function. Such a marked increase of median distal motor latency (DML) is rare (0.6% in 500 CTS hands consecutively examined in our laboratory) and suggests the presence of a chronic condition with severe disruption of the myelin. On the basis of these anecdotal observations, we suggest that patients with median DML of 10 ms or more be considered at high risk for CTS surgery failure. Received: 5 July 2000; Accepted: 6 October 2000     

腕管综合征的误诊原因分析

目的：进一步提高腕管综合征的诊断水平,减少误诊,避免出现误诊可能造成的正中神经严重损害的后果。方法：收集了１６ 例（１９ 个腕）误诊的腕管综合征病例,对引起误诊的原因进行详细分析。结果：引起误诊的原因可归纳为三个方面：１、对腕管综合征重视不够,容易将其误诊为更为常见的颈椎病;急性腕管综合征容易误诊为外伤时较常见的正中神经挫伤。２、询问病史、体格检查不够详细是造成部分病例误诊的关键。３、对可疑病例未进行必要的肌电图检查。结论：加强对腕管综合征这一临床常见的周围神经受压综合征的认识,准确收集临床资料,必要时结合肌电图检查是提高鉴别诊断能力,是减少误诊的关键。     

Carpal tunnel syndrome

Carpal tunnel syndrome is the commonest entrapment neuropathy and is due to combined compression and traction on the median nerve at the wrist. It is often idiopathic. Although spontaneous resolution is possible, the usual natural evolution is slow progression. Diagnosis is mainly clinical depending on symptoms and provocative tests. An electromyogram is recommended preoperatively and in cases of work-related disease. Medical treatment is indicated early on or in cases with no deficit and consists of steroid injection in the canal or a night splint in neutral wrist position. Surgical treatment is by section of the flexor retinaculum and is indicated in resistance to medical treatment, in deficit or acute cases. Mini-invasive techniques such as endoscopic and mini-open approaches to carpal tunnel release with higher learning curves are justified by the shorter functional recovery time compared to classical surgery, but with identical long-term results. The choice depends on the surgeon's preference, patient information, stage of severity, etiology and availability of material. Results are satisfactory in 90% of cases. Nerve recovery depends on the stage of severity as well as general patient factors. Recovery of force takes about 2–3 months after the disappearance of ‘pillar pain’. This operation has a benign reputation with a 0.2–0.5% reported neurovascular complication rate.