内镜在腕管综合征治疗中的应用选择

Application of Endoscopy to Treatment of Carpal Tunnel Syndrome

目的探讨内镜治疗腕管综合征(carpal tunnel syndrome,CTS)的病例选择。方法2004年7月～2007年9月,用内镜技术治疗21例(24腕)CTS。手术在局麻下进行,距腕横纹近侧3cm处掌长肌腱尺侧横切口1cm,前臂筋膜深层分离将专用外套管置入腕管,在内镜监视下用专用钩刀切断腕横韧带。术后1、2、3、5个月随访。结果术后5个月时按Kelly法疗效评级:优11例;良6例;一般2例(3腕);差2例。其中疗效差1例于内镜术后7个月行传统开放手术神经干束间松解而缓解,1例存在明显的手指皮肤痛觉过敏并皮肤干燥等交感神经症状而继续保守治疗。结论按如下原则选择内镜处理或开放手术治疗CTS:①特发性病例内镜处理;继发性病例开放手术,如类风湿关节炎所致的滑膜增生肿胀,腕内骨折后畸形,腕管内肿瘤、囊肿、炎症、痛风,神经干自身病变等。②拇指对掌功能有障碍及晚期CTS选择开放手术。③老年患者(>60岁)优先考虑开放手术;年轻、有较高职业和外观要求的患者可以优先考虑内镜治疗。

Objective To study the indications of endoscopic treatment for carpal tunnel syndrome（CTS）.Methods From July 2004 to September 2007,21 patients（24 wrists） with CTS received endoscopic treatment in our hospital.Under local anesthesia,an 1-cm incision was made at the level of the proximal transverse wrist crease ulnar to the palmaris longus tendon.A special cannula was inserted into the carpal tunnel,and then the transverse carpal ligment was cut and the median nerve was decompressed.All the patients were re-examined in 1,2,3,and 5 months postoperation.Results According to the criteria of Kelly,11 cases achieved excellent outcomes in 5 months,meanwhile 6 were good,2（3 wrists） were fair,and 2 were poor.One of the 2 poor cases received a second operation by traditional procedures（nerve release） 7 months after the first surgery,another case were treated by conservative therapy because of sympathetic symptoms.Conclusions ① Endoscopy is the first choice for idiopathic cases,while open surgery should be performed on secondary cases（rheumatic synovitis,fracture deformity,tumar,inflammation,gout,neurodegenerative desease etc.）.② The carpal tunnel release should be used for patients with abnormal opponens function of the thumb,as well as advanced cases.③ Routine operation are the first choice for eldly patients but not for the younger ones.