内镜下松解治疗腕管综合征的临床研究

目的探讨内镜下松解和改良开放手术松解治疗腕管综合征(CTS)的临床疗效。方法选取2014年6月-2017年6月收治的CTS患者52例,随机分为两组,采用内镜下松解26例,改良开放手术松解26例。对两组患者术中、术后情况进行观察比较。结果所有患者获得随访,平均随访(12.70±2.50)个月。内镜组在手术时间、平均住院日、拆线时间、恢复工作时间和切口视觉模拟评分(VAS)上与改良开放组比较[(15.12±6.34) vs (13.35±5.12)min,(3.45±0.78) vs (3.61±1.41)d,(6.25±1.21) vs (7.12±1.25)d,(21.40±3.10) vs (23.20±2.20)d,(2.20±0.80) vs (2.30±0.60)分],差异均无统计学意义(t=1.83、0.87、1.45、1.95和0.45,均P0.05),两组Kelly功能评价优良率比较,差异无统计学意义(93.55%vs 90.63%,χ2=0.00,P0.05)。结论内镜下松解治疗CTS能取得良好的临床疗效,虽然内镜手术技术要求较高、学习曲线较长,但具有手术创伤小、术后恢复快和并发症少等优点,值得临床推广。     

腕管综合征的显微外科治疗

目的探讨利用显微外科技术治疗腕管综合征的疗效。方法对20例25侧腕管综合征患者正中神经主干及正中神经返支去除外部受压因素及显微镜下探查松解。结果全部病例术后随访3月-1．5年,功能优20例,良3例,可2例,无差病例。结论腕管综合征患者尤其是中、重度患者在行正中神经主干松解同时应行正中神经返支探查松解才能取得更好疗效。     

腕管综合征46例临床与神经电生理分析

目的：探讨腕管综合征的临床特点和神经电生理检测的诊断价值。方法：回顾性分析46例腕管综合征的临床特征和神经电生理检测结果。结果：46例腕管综合征中76．1％为女性，共有病变71侧，单侧病变21例，双侧病变25例。以桡侧3个半手指为主29侧，5个手指均有症状42侧。临床表现为手指麻木、疼痛，可向肘部和肩部放射。电生理检查正中感觉神经传导速度异常占95．8％，正中运动神经潜伏期延长占67．6％，运动传导速度异常53．5％，拇展短肌呈神经源性损害占31％。结论：腕管综合征以中年女性多见，临床上以手指麻木、疼痛为主要特点，活动和甩手可使症状减轻。神经电生理检测对腕管综合征的诊断与鉴别诊断具有重要价值。     

曲安奈德腕管内注射治疗轻度腕管综合征的临床研究

目的 观察曲安奈德腕管内注射治疗轻度腕管综合征的临床疗效.方法 选取74例轻度腕管综合征患者随机分为观察组和对照组,观察组37例使用曲安奈德药物腕管内注射治疗;对照组37例使用超短波治疗仪患处局部疗法加用丹参和维生素B1、B6、B12等药物治疗.结果 观察组疗效与对照组的差别有显著性意义(P＜0.05)、观察组复发率与对照组的差别也有显著性意义(P＜0.05).结论 曲安奈德腕管内注射治疗轻度腕管综合征的临床疗效明显,优于其他保守疗法,且见效快,复发率低,临床评价疗效满意.     

内镜下手术治疗腕管综合征的应用分析

目的探讨内镜下手术治疗伴有滑膜增生腕管综合征(CTS)的临床疗效。方法回顾性分析在该院手术治疗的37例(41腕)伴有腱周滑膜组织增生的CTS患者,术中均在内镜下切断腕横韧带,同时经内镜入口切除指浅屈肌腱周围增生的滑膜。比较患者手术前后临床症状、体征改变,统计术后优良率。结果按Kelly分级,术后整体优良率为95.12%。夜间麻醒症状均消失,Tinel征、Phalen征阳性率降低至2.44%(P0.05),两点辨别觉平均值低至(3.5±0.9)mm(P0.05),无严重并发症。结论对于伴有腕管内滑膜轻度增生的特发性CTS患者,内镜下腕横韧带切开联合滑膜组织切除,是一种新的、可行的、近期疗效显著的治疗方式,值得临床推广。     

53例腕管综合征神经电生理诊断分析

目的:分析腕管综合征(CTS)的神经电生理特点。方法:对CTS患者53例进行神经电生理检测,分析其特点。结果:正中神经远端运动潜伏期延长44例,正中神经运动传导未引出电位7例,正中神经传导正常2例;正中神经SCV测定消失17例,正中神经感觉潜伏期延长、波幅降低26例,SCV减慢10例。拇短展肌可见正峰及纤颤自发电位18例。结论:神经电生理检查在CTS的诊断中有重要意义。     

腕管综合征478例治疗效果评价

目的:评价应用不同方法治疗腕管综合征(CTS)的治疗效果,为提高CTS的诊治提供依据.方法:选择南方医院2000年5月至2009年9月收治的478例CTS患者,根据临床表现和神经电生理指标分为轻度、重度、完全CTS,采用保守治疗、内窥镜下腕管松解治疗、手术单纯腕管松解治疗、手术腕管松解+掌腱膜完全松解四种方法进行相应的治疗,比较治疗前后患者的临床表现、神经电生理检测、Chen W-S腕部正中神经损害疗效评分等指标.结果:治疗前后四种治疗方法的评分值差异有统计学意义(F=8.272,P=0.000).轻度CTS:手术治疗相较采用保守治疗效果无明显优势,保守治疗有效率可达到93.9%;重度CTS:手术腕管松解+掌腱膜完全松解治疗效果最佳,约72%效果良好,内窥镜下腕管松解治疗与手术单纯腕管松解效果相当,均优于保守治疗;正中神经完全损伤型CTS:保守治疗和手术彻底松解均效果不佳.结论:早期发现早期治疗并去除发病诱因是促进CTS患者恢复的有效措施.针对CTS的不同损伤程度,可采用不同的治疗方法促进手部功能恢复.     

腕管综合征的诊断进展

腕管综合征(CTS)是常见的周围神经病,是正中神经损伤后出现的一组临床症状。目前诊断CTS的金标准为电生理检查。高频超声和磁共振等影像学技术为CTS的诊断提供了新方法,能有效提高CTS诊断的敏感性和特异性。     

内窥镜辅助下微创治疗腕管综合征的临床应用

目的 分析内窥镜辅助下微创治疗腕管综合征的临床应用效果。方法 选择2021年1月至2022年1月该院收治的80例腕管综合征患者为研究对象,按随机数字表法分为常规组(40例,以常规手掌部开放腕管切开减压术治疗)和观察组(40例,以内窥镜辅助下微创治疗),比较两组手术效果。结果 常规组患者的手术总有效率为85.00%,低于观察组的97.50%,差异有统计学意义(P<0.05);常规组的手术切口长度、手术时长及术后并发症总发生率均明显高于观察组(P<0.05),且治疗后的常规组患者BCTQ各项目评分均显著低于观察组(P<0.05)。结论 在腕管综合征患者的临床治疗中,选择内窥镜辅助下微创术式可有效改善患者手术指标,降低患者术后并发症发生率,促进患者握力快速恢复,疗效显著,值得临床推广应用。     

Sonographic monitoring of endoscopic carpal tunnel release

We evaluated the effectiveness of sonographic monitoring of endoscopic carpal tunnel release for the prevention of median nerve or arterial injury and incomplete release of the flexor retinaculum (FR). When the outer tube (OT) was inserted, we used sonography to confirm the relationship of the OT, median nerve, ulnar artery, and superficial palmar arch. Under real‐time US monitoring, the OT was lifted up before and after FR release, the so‐called lift‐up test, to evaluate its mobility under sonography and confirm complete FR release. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44 :597–599, 2016     

Carpal tunnel pressure measurement during two-portal endoscopic carpal tunnel release

Background

Although there remain concerns of median nerve damage during endoscopic carpal tunnel release for carpal tunnel syndrome, carpal tunnel pressure variations during Chow's two-portal techinique have not been well investigated.

Methods

We performed a modified two-portal endoscopic carpal tunnel release on 30 patients by inserting a catheter pressure transducer into the carpal tunnel for continuous pressure measurement during the procedure. Grip and pinch strengths, Semmes–Weinstein monofilament test, and nerve conduction studies were examined preoperatively and at postoperative 1, 3, and 6 months. Numbness and the Disabilities of the Arm, Shoulder and Hand score were also evaluated pre and postoperatively.

Findings

Subjective symptoms and nerve conduction study findings improved uneventfully. The pressure was always observed to be maximum pressure immediately before the cannula was withdrawn from the exit portal, and carpal tunnel pressure > 300 mm Hg was recorded in most of the patients.

Interpretation

A transient increase in the carpal tunnel pressure occurred in all the patients; however, it did not correlate with their clinical outcome or with increased risk of peri-operative complications. Since time–pressure threshold of the median nerve during endoscopic carpal tunnel release is still unknown, our results did not guarantee its safety.     

Median and ulnar nerve block for endoscopic carpal tunnel release

A median and ulnar nerve block was administered for endoscopic carpal tunnel release. Three (14.2%) of 21 patients required further anesthesia with local anesthetic agents and sedation. No solution ran back to the surgical site. This technique is rapid and reliable, and it seems to be suitable for outpatient surgery.     

Evaluation of results of single portal endoscopic carpal tunnel release

Background. Results of operative treatment of carpal tunnel syndrome (CTS) depend on many factors including age and stage of disease. The aim of the study was to research influences of age and stage of carpal tunnel syndrome on single portal endoscopic carpal tunnel release outcomes. Material and methods. The examined material comprises 45 patients operated with single portal endoscopic method in the years 2001-2004. In order to analyze the results of treatment, patients were sorted out by age and stage of disease. To evaluate outcomes of treatment a four-point subjective scale as well as Carpal Tunnel Syndrome Severity Status Scale (CTS SSS) and Carpal Tunnel Syndrome Functional Status Scale (CTS FSS) results were used. Additionally, CTS SSS - difference and CTS FSS - difference results (difference between pre, and postoperative survey outcomes) were analyzed. Results. Statistical analysis has shown significantly better CTS FSS (p = 0,03) and CTS SSS (p = 0,002) survey outcomes for a group of patients with diagnosed I stage of disease as well as significant statistical correlation between CTS SSS - difference (p = 0,08), CTS FSS - difference (p = 0,01) and patients age. Conclusions. As shown in the study, significant statistical correlations between CTS SSS - difference, CTS FSS - difference and patients age as well as statistical significantly better postoperative CTS SSS and CTS FSS survey outcomes for the group of patients with diagnosed I stage of disease constitute an encouragement for early operative treatment of carpal tunnel release.     

有限小切口松解与常规切开松解修复腕管综合征的Meta分析

背景：自1991年以来,许多医师在使用腕横纹开放式小切口技术试图结合传统腕管切开松解的简单性和安全性减少组织损伤和术后复发率。但哪一种技术更具优势一直存在争议。目的：对非内窥镜的有限小切口松解和传统腕管切开松解治疗腕管综合征的疗效进行系统评价。方法：按照Cochrane系统评价的方法,计算机检索MEDLINE（1966年1月至2010年3月）、EMBASE（1966年1月至2014年5月）、Cochrane图书馆（2014年5月）及中国生物医学文献数据库（1979年1月至2013年12月）,并手工检索相关的中英文骨科杂志。收集所有相关的随机对照试验,并评价纳入研究的方法学质量,采用Cochrane协作网提供的软件Revman5.2进行Meta分析,以获得有限小切口松解与传统腕管切开松解治疗腕管综合征的疗效及其安全性是否有差异的相关证据。结果与结论：共纳入7个随机对照试验进行评价。Meta分析显示,有限小切口松解组与传统腕管切开松解组的瘢痕痛、柱状痛,主观满意率、治疗后恢复日常工作时间差异无显著性意义（P〉0.05）;有限小切口松解组后并发症发生率和手术时间显著低于传统腕管切开松解组（P〈0.05）。结果表明,与传统腕管切开松解相比,有限小切口松解可降低腕管综合征治疗后并发症,缩短手术时间;两种术式治疗后瘢痕痛率、柱状痛率、主观满意度、恢复日常工作时间差异无显著性。因研究质量及样本的局限性,此两种治疗方法与治疗后恢复时间、治疗后疼痛和手功能等指标的比较上有待进一步研究。     

Biomechanical and anatomical consequences of carpal tunnel release

Carpal tunnel syndrome is an exceedingly common orthopaedic problem in the United States. When conservative management is unsuccessful, most surgeons proceed to surgical treatment. Though the carpal tunnel release procedure is usually curative, many patients experience postoperative complications, such as scar sensitivity, pillar pain, recurrent symptoms, and grip weakness, regardless of whether the release was done through an open, mini-open, or endoscopic approach. The exact causes of these and other complications of carpal tunnel release remain unclear. Release of the carpal tunnel has an effect on carpal anatomy and biomechanics, including an increase in carpal arch width, carpal tunnel volume, and changes in muscle and tendon mechanics. We set out to review the morphological and biomechanical changes caused by carpal tunnel release with the goal of better understanding the root causes of postoperative complications. This article first reviews normal carpal tunnel anatomy and anatomic variations, then available surgical techniques for carpal tunnel release, and finally the literature on morphologic, physiologic and biomechanical alterations in the wrist after carpal tunnel release.     

Neurologic disorders masquerading as carpal tunnel syndrome: 12 cases of failed carpal tunnel release

We describe 12 patients with a diagnosis of carpal tunnel syndrome in whom carpal tunnel release was unsuccessful and another neurologic disorder was diagnosed subsequently. Final diagnoses included polyneuropathy, radiculopathy, motor neuron disease, spondylotic myelopathy, syringomyelia, and multiple sclerosis. Sources of error by the electromyographer and treating physician were identified. Care must be taken to avoid an inappropriate carpal tunnel operation when clinical or electrodiagnostic features are atypical.