手腕部结核性腱鞘滑膜炎致腕管综合征诊治经验

目的探讨因结核性腱鞘滑膜炎所致腕管综合征的临床表现及综合治疗效果。方法 2014年4月-2018年3月,对3例术前不能明确病因的腕管综合征患者行手术治疗,广泛切除腱鞘滑膜病变组织,经病检确诊为滑膜结核,术后行抗结核治疗,通过随访观察来评估疗效及总结经验。结果 3例患者术后1周内症状均有所改善,1个月后麻木症状消失。其中1例术后5个月可疑为结核性腱鞘滑膜炎复发,虽未出现患手感觉异常,但对掌功能较前受限。结论结核性腱鞘滑膜炎可导致腕管综合征,手术治疗效果明显,并且术后应进行规范的抗结核治疗,否则容易复发。     

慢性滑膜炎所致腕管综合征的手术治疗

目的探讨手术治疗慢性滑膜炎所致腕管综合征的临床疗效。方法我院自2022年2月至10月手术治疗7例慢性滑膜炎所致腕管综合征, 术中广泛切除滑膜病灶组织, 彻底松解腕横韧带, 切除标本送病理、细菌培养及分子生物学检测, 术后予消肿、止痛、营养神经等对症治疗, 依据术后症状改善、滑膜炎是否复发、疼痛改善情况评估临床疗效。结果病理结果均示滑膜组织增生、炎性细胞浸润, 术后1例证实结核性滑膜炎予抗结核治疗, 术后随访6～14个月, 正中神经卡压症状明显改善, 滑膜炎无复发, 局部无疼痛, 手指屈伸活动可。结论手术治疗慢性滑膜炎所致腕管综合征疗效满意, 术中广泛切除滑膜病灶组织, 松解正中神经是预防复发和确保临床疗效的关键。     

病灶清除植骨内固定术治疗腰椎结核48例临床观察

目的 探讨前路一期病灶清除、植骨、前路或后路内固定手术治疗腰椎结核的临床疗效.方法 自2001年8月-2006年12月对48例腰椎结核患者进行一期病灶清除植骨内同定,在X线片上测量术前术后后凸角度(Cobb角),观察植骨融合情况,应用Frankel分级评分评估恢复情况.结果 随访12-48个月,术后6-12个月所有患者均显示骨性融合,14例有神经症状的患者,术后神经功能均不同程度恢复,后凸畸形未见加重,无结核复发及切口感染.结论 一期病灶清除植骨内固定手术结合规范抗痨治疗腰椎结核,可以促进植骨融合,改善神经症状,防止后凸畸形,临床疗效显著、可靠.     

48例结核性肛瘘治疗体会

探讨结核性肛瘘的治疗方法。方法　采用 2HRZE/4HR抗痨方案 ,手术彻底切除肛门局部结核病灶 ,术后每日用 1/5 0 0 0高锰酸钾溶液坐浴 ,用自行配制的利福平、异烟肼混合液换药。结果　 48例结核性肛瘘均 1次手术治愈。疗程 15～ 30d ,随访 1～ 3年 ,均无复发。结论　结核性肛瘘应全程抗痨治疗与手术彻底切除病灶相结合 ,术后伤口用抗痨药物换药 ,防止结核病灶复发。     

痛风致腕管综合征10例疗效

目的探讨痛风致腕管综合征的手术疗效及临床经验。方法 2016年12月-2018年12月,对10例13侧痛风致腕管综合征进行手术治疗,腕管切开减压正中神经松解及痛风石切除,术前及术后应用抗痛风药物。结果所有病例术后2周拆除缝合线,切口均Ⅰ期愈合,全组随访时间1个月,手术部位切口愈合良好,手指感觉恢复,疼痛消失,功能恢复满意。结论痛风致腕管综合征要考虑痛风石压迫神经的可能,切开手术是唯一有效方法,术中要彻底探查腕管,尽量切除病变组织。     

负压封闭引流技术应用于胸壁结核治疗（附38例报道）

目的 通过更换引流方式,探讨胸壁结核术后应用负压封闭引流（VSD）的疗效。方法 回顾分析38例胸壁结核并窦道形成患者,术前常规三联抗痨一个月后,行手术彻底切除结核病灶,术后使用负压封闭引流,病愈出院后继续三联抗结核6个月。结果 38例患者一次性治愈率100%,随访1~2年无复发。结论 胸壁结核术前需正规的抗结核治疗,彻底行病灶清除,术后使用负压封闭引流方式,并继续抗结核治疗,可有效减少或避免术后病灶复发。     

显微外科技术治疗老年人腕管综合征28例

目的 探讨应用显微外科技术治疗老年人腕管综合征的临床疗效. 方法 自2005年10月至2011年7月,对收治的28例老年腕管综合征患者,采用掌部纵形小切口,切断腕横韧带,应用显微外科技术行正中神经松解、减压,术后辅以神经营养药物等治疗. 结果 术后所有患者切口均一期愈合,无并发症发生.术后随访6～24个月,平均18个月.症状完全消失24例,占全部随访病例的85.7％;仍有部分症状残留2例,占全部随访病例的7.1％;症状无明显缓解2例,占全部随访病例的7.1％;原13例大鱼际肌肉萎缩患者均有不同程度恢复,拇指对掌功能恢复正常,捏、握力较术前明显改善.根据顾玉东推荐的腕管综合征的功能评定标准评定治疗效果:优18例,良6例,可2例,差2例,优良率为85.7％. 结论 应用显微外科技术治疗老年人腕管综合征简便易行,在手术显微镜直视下操作可彻底有效的松解受压神经,避免神经的副损伤,临床疗效满意.     

手术加抗痨治疗结核性肛瘘52例临床疗效分析

目的探讨手术加抗痨治疗结核性肛瘘的临床疗效。方法对采用2HRZE／4HR抗痨方案,手术切除瘘管及肛周结核病灶,术后每日用中药坐浴、熏洗伤1：3及利福平、异烟肼混合液换药治疗的52例结核性肛瘘患者临床资料进行回顾性分析。结果52例结核性肛瘘均一次手术治愈,疗程15-30d,随访1～3年,均无复发。结论结核性肛瘘应全程抗痨治疗与手术切除结核病灶相结合,术后伤口用中药坐浴、熏洗,抗痨药物换药,能有效促进伤口愈合,防止结核病灶复发。     

食管结核的诊断和外科治疗

目的 探讨食管结核的临床病理特征、诊断及外科治疗方法,减少误诊发生.方法 回顾性分析11例患者的相关临床资料.结果 术前诊断为食管结核2例;误诊9例,分别诊断为食管癌7例、食管平滑肌瘤2例.药物治疗2例,手术治疗9例,手术方式包括病灶段食管切除+胃食管吻合术5例、淋巴结切除术2例、胃造瘘术1例,1例术中冰冻切片检查证实结核而未切除食管,术后无严重并发症发生.11例患者均经病理证实为食管结核,全部治愈,随访1～27年,症状均消失,结核无复发.结论 食管结核属罕见良性疾病,临床无特异征象,与食管癌和食管良性肿瘤鉴别困难.术前明确诊断后采用药物保守治疗有效,如出现并发症则需外科干预,术后需抗结核治疗12～18个月,预后较好.     

内窥镜治疗腕管综合征的疗效观察

目的：观察内窥镜治疗腕管综合征的临床疗效。方法2009年至今,利用内窥镜单切口入路,通过切开腕管、松解正中神经,治疗腕管综合征18例（30侧）。术前及术后3个月进行神经电生理测试,测定正中神经掌腕段感觉及运动传导速度。结果本组患者术后随访6个月,术后3个月正中神经感觉、运动神经传导速度明显较术前加快（P〈0.05）,患者肢体感觉基本恢复正常,未见复发。结论内窥镜治疗腕管综合征疗效确切,术后正中神经功能恢复明显。     

轻中度腕管综合征药物治疗长短期疗效

目的探讨轻中度腕管综合征药物治疗的长短期疗效。方法门诊随访24例(35腕)口服四联药(弥可保、地巴唑、维生素B1、维生素B6)的轻中度腕管综合征病人。病人在入组时、治疗4个月、6个月后及停药1年后来我院门诊随访,向医生汇报其近期临床症状表现,自评其患手功能并填写Boston腕管问卷调查表(BCTQ)。病人在入组时及治疗6个月后,需接受患肢桡侧3指感觉神经传导速度(SNCV)检测。结果药物治疗后病人临床症状明显好转,短期(4个月、6个月)临床有效率可高达94.3%,长期(停药后1年)临床有效率可高达91.4%。BCTQ功能总评分及桡侧3指SNCV也较治疗前有明显恢复。结论弥可保联合地巴唑、维生素B1及维生素B6治疗轻中度腕管综合征有很好的长短期疗效。     

腕管综合征与嗜酸性筋膜炎

目的 了解嗜酸性筋膜炎与腕管综合征的关系。方法 总结6例(男5例，女1例，平均年龄35．5岁)嗜酸筋膜炎合并腕管综合征的病例，就其发病机理，治疗及预后进行讨论。结果 4例行腕管切开，正中神经松解术，2例用药物治疗。治疗后患者的神经卡压症状缓解，全身症状消失。治疗后2例失访，4例随访14～38个月。患者全身症状及神经卡压症状均未复发。结论 由嗜酸性筋膜炎所致的腕管综合征与一般常见原因引起的腕管综合征不同，单纯手术减压效果不理想，需配合药物治疗方可缓解症状。     

An analysis of the flexor synovium in idiopathic carpal tunnel syndrome: report of 625 cases.

This study was undertaken to determine the presence or absence of tenosynovitis in persons with idiopathic carpal tunnel syndrome. Eight hundred thirty-five consecutive operations for carpal tunnel syndrome were retrospectively reviewed, and 625 cases of idiopathic carpal tunnel syndrome were identified. Of these 96% (601) had a synovial tissue histologic diagnosis of benign fibrous tissue without inflammation, 4% (23) showed chronic inflammation, and 0.2% (1) revealed evidence of acute inflammation. We believe that tenosynovitis is not a part of the pathophysiologic process in chronic idiopathic carpal tunnel syndrome. Further histologic analysis of the flexor synovium for pathologic changes other than inflammation is needed.     

Tenosynovitis: tendon and nerve entrapment

The pathophysiology associated with tendon and nerve entrapment due to idiopathic tenosynovitis of the hand and wrist is discussed. The basis of clinical symptoms, nonoperative and operative treatment, complications, and prognosis relating to stenosing tenosynovitis and carpal tunnel syndrome are reviewed. A systematic approach to developing a philosophy for operative treatment is based upon severity of symptoms and findings at surgery. Deformities of the median nerve are classified into grades that correlate with symptoms and influence selection of the surgical procedure.     

Mycobacterium tuberculosis-induced carpal tunnel syndrome: management and follow-up evaluation

PURPOSE: To determine the clinical characteristics of 12 patients with Mycobacterium tuberculosis-induced carpal tunnel syndrome. This article also presents our intraoperative findings and surgical treatment results. METHODS: Twelve patients with tuberculosis-induced carpal tunnel syndrome who had surgery during a 10-year period that began in March 1991 were reviewed. The entrance criterion was a positive histologic report of tuberculosis for surgical specimens. The preoperative evaluation leading to diagnosis was reviewed for all patients. Transection of the transverse carpal ligament and complete synovectomy were performed for all patients. After surgery the patients were given an antituberculosis regimen for 1 year and were followed up for an average of 6 years. RESULTS: Twelve cases from a total of 1,180 patients with carpal tunnel syndrome were traced to M tuberculosis involvement of synovial tissue of the flexor tendons. Ten patients had large rice bodies in thick synovial membranes, and in the other 2 patients thick synovial tissue with yellow exudates were observed during surgery. In contrast to tendon involvement with rupture, no direct median nerve involvement was noted. Histopathologic study results of surgical specimens were positive for tuberculosis in all patients. Eight of 10 initial smears showed acid-fast bacillus and all 10 cultures of the specimens were positive for tubercle bacilli. Surgery and antituberculosis therapy were associated with a desirable outcome and sensory disturbance in the median nerve distribution resolved in all patients. Anterior wrist swelling disappeared and there has been no clinical or laboratory evidence of recurrence in all treated patients. CONCLUSIONS: Early diagnosis and surgical treatment combined with antituberculosis medical treatment are important in treating this condition. All patients treated were relieved of symptoms of synovial proliferation at the wrist, with no recurrence of the condition during the follow-up period. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

腕管综合征复发7例分析

目的 总结7例小切口手术治疗腕管综合征复发病例的诊治过程,为临床提供治疗经验.方法 2012年1月至2019年12月,对已在外院经临床和电生理确诊为腕管综合征且行小切口手术治疗后复发的7例病人进行二次常规手术切口治疗.术中探查发现7例腕管内均有白色粉末状物沉积,给予腕管内病灶清除及彻底松解正中神经.根据顾玉东推荐的腕管...     

Gouty tenosynovitis and compression neuropathy of the median nerve

Two cases of gouty tenosynovitis were associated with carpal tunnel syndrome. Both patients had carpal tunnel release with good relief of symptoms. In one patient, gout was not suspected before operation; this patient developed wound dehiscence with tophaceous urate crystal drainage that eventually disappeared. Proper preoperative antigout therapy may have prevented this complication. Carpal tunnel syndrome associated with gout is rare. Preoperative investigations for gout may be indicated in patients with carpal tunnel syndrome.     

Combined ulnar and median nerve compression due to atypical mycobacterial tenosynovitis: case report

A 39-year-old woman with signs, symptoms and laboratory findings of carpal tunnel syndrome and ulnar compression is presented. Radical surgical debridement, excision of the affected synovium and early postoperative mobilization were performed. Mycobacterium marinum was identified from the culture of the excised flexor tenosynovium. Neither pulmonary nor extrapulmonary tuberculosis was diagnosed by X-ray and the other laboratory examinations. There has not been any previously reported case of mycobacterial tenosynovitis causing ulnar and median nerve compression together.     

Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout

The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis.     

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.