腕关节镜下Chow法行腕横韧带松解术治疗腕管综合征的临床研究

目的探讨内镜下采用双入口Chow法施行腕横韧带松解术治疗腕管综合征的疗效。材料和方法2007年3月至2010年9月,卫生部北京医院骨科住院治疗的36例(38个腕,男14例,女22例)腕管综合征患者,全部采用双入口Chow术式施行腕关节镜下腕横韧带松解术。术中、术后进行评估。结果本组患者33-61岁(平均47.3岁)右侧腕22例,左腕12例,双腕2例。患病5个月至6年不等(平均14.3个月),据滨田分类法分级:Ⅰ级的有15个腕,Ⅱ级的21腕,Ⅲ级的2腕。所有患者术前均经保守治疗无效,才行手术并全部经术后2周、4周和12周的随访(平均13.7周)。镜下手术时间15～45min(平均23.4min);术中出血量5～30mL(平均16.7mL)。疼痛VAS评分:术前(6.4±2.1),术后(1.8±2.5)(P<0.05)。术后有4例患者捏、握力减退、拇对掌障碍没有完全改善且复查ECG阳性。按Kelly分级进行术后疗效评估:优16侧,良18侧,一般2侧,差2侧,总体优良率88.9%(32/36)。结论腕关节内镜下双入口Chow法治疗腕管综合征,虽然有学习曲线长、医疗费用高的缺点,但作为微创技术具有保护正常的解剖结构、手术损伤小、恢复快、并发症少的优点,会被更多的外科医师所充分认识,值得开展推广。

The Clinical Outcome for Endoscopic Treatment of Carpal Tunnel Syndrome with Chow's Technique

Objective The goal of this paper is to present and evaluate a outcome of the endoscopic procedures currently with Chow's technique in use for the treatment of CTS.Endoscopic techniques and outcomes are discussed.Methods?From March 2008 to September 2010,36 cases(38 wrists,14 males and 22 females,33-61 years old,mean age 47.3) with CTS were treated in author's department.ECTR(Chow's technique) itself is an operation where double-tunnel small incision is made in the wrist and in the palm and an endoscope is used to visualize the carpal ligament which is cut with small blades under direct visualization.At the latest follow-up evaluation,Symptom of motion wtih hand and wrist,patients' evaluation and Visual Analog Scale(VAS) were used to provide a final evaluation of hand and wrist function for 2 weeks,4 weeks and 12 weeks.Hamada's Classification and Kelly's criteria will be used in preoperation and postoperation of ECTR.Results?They suffered from the CTS for about 14.3 months in average(5-72 months).Hamada's classification show that we have the 15 wrists in Grade Ⅰ,Grade Ⅱ of 21 wrists,Grade Ⅲ 2 wrists.Endoscopic surgery time were 15-45 minutes(mean 23.4 minutes);blood loss was 5-30 ml(mean 16.7 ml).All of 36 patients(38 wrists) with CTS were followed up for more than 12 weeks after ECTR,13.7 weeks on average.Mean VAS pain score of(1.8±2.5) were in postoperation and(6.4±2.1) in preoperation(P<0.05).The operation was satisfactory for 32 cases.According to Kelly's criteria,the results were excellent in 16 wrists,good in 18 wrists,fair in 2 wrists,poor in 2 wrists,and the excellent and good rate was 89.5%.Conclusions?By using an endoscopic technique——double-entry Chow technique for treatment of CTS,although there is a long learning curve,the shortcomings of the high medical costs,as a minimally invasive technique,this technique has the protection of the normal anatomy,quick recovery,significantly less pain,returned to work and activities of daily living earlier,fewer complications advantages.It will be more fully aware of surgeons and worth to carry out promotion.