结核性腱鞘滑膜炎所致腕管综合征的手术治疗

Surgical treatment of carpal tunnel syndrome secondary to tuberculous tenosynovitis

目的总结腱鞘结核所致的腕管综合征的临床表现,观察手术治疗的效果。方法对11例术前不能明确病因的腕管综合征患者行手术治疗,广泛切除腱鞘滑膜上病灶组织,经病检确诊为结核性腱鞘滑膜炎,术后行抗痨治疗。通过随访观察症状的改善、神经肌电图的变化来评估手术疗效。结果11例随访6～18个月,9例术后1周神经症状缓解,1个月后麻木症状消失。术后6个月临床症状和神经传导较术前明显改善,结核未复发,手指功能恢复良好,未产生并发症。结论结核性腱鞘滑膜炎好发于腕部屈肌腱,是引起腕管综合征病因之一。手术切除病灶,加上抗痨治疗和早期功能锻炼,疗效满意。

Objective To summarize the clinic features of carpal tunnel syndrome caused by tuberculous tenosynovitis, and to study its etiology and to observe the surgical treatment effect. Methods A retrospective study was undertaken to 11 cases of carpal tunnel syndrome, which a definite diagnosis could not be made preoperatively. Extensive surgical debridement of involved synovium was done. With histopathology suggestive of tuberculous tenosynovitis. Anti tuberculous therapy was applied. Symptoms and electromyography were recorded to evaluate the treatment effect. Results 11 cases were followed up for 6 ~ 18 months. The symptoms of nerve relieved 1 week after operation in 9 cases ,and the numbness disappeared in all cases 1 month later. 6 months postoperatively, the clinlic symptoms and nerve conduction improved, function of all the hands were excellent. No complications or tuberculosis recurrence were found. Conclusions Tuberculous tenosynovitis mostly involves the tendons of digital flexors and cause carpal tunnel syndrome. Wide surgical excision of involved synovium, early postoperative mobilization and anti-tuberculous therapy is necessary to treat carpal tunnel syndromes secondary to tuberculosis tenosynovitis.