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。

Treatment of carpal tunnel syndrome with mini-incision decompression

Objective: To introduce the method of the transverse carpal ligament (TCL) transection through palmar mini-incision for carpal tunnel syndrome (CTS) and evaluate its efficacy and safety. Methods: From January 2006 to September 2007,15 patients (18 hands) with CTS were treated with palmar longitudinal mini-incision decompression. There were 2 males and 13 females,with an average age of 48 years (ranged 34 to 69) and an average course of 18 months (ranged 8 to 26). The main clinical symptom including the radial numbness or pain of the 3 and a half fingers,wrist pain and radiation to the forearm,the night awake history of numbness,thenar muscle atrophy,positive Tinel sign and Phalen sign. Median nerve electrophysiology showed that sensory nerve conduction velocity (SCV) slowed down and sensory nerve action potential (SNAP) decreased or missed,short abductor muscle of thumb had spontaneous potential in severe cases. Clinical effect were evaluated according to the Global symptom score(GSS) scoring in aspect of pain,numbness,paraesthesia,weakness and nocturnal awakening. Results: Postoperative wound smoothly healed in all patients and no complications occurred. All patients were followed up from 20 to 28 months with an average of 24 months. Symptoms of 1 patient had not incomplete relief,other patient's symptoms disappeared and muscle force of abductor pollicis brevis reinforced. Postoperative GSS scoring obviously improved than preoperative(P<0.05). Conclusion: Treatment of carpal tunnel syndrome through palmar mini-incision decompression has advantages such as higher safe,shorter operative time,less invasive,smaller scar,which can cut off carpi transversum ligament and thoroughly decompress median nerve under direct sight,it is a safe and effective operative approach.