正中神经双卡综合征的围手术期康复治疗

The perioperative rehabilitation therapy of Median nerve dual - card syndrome

目的介绍三级序贯式康复治疗在正中神经双卡综合征围手术期的应用。方法自2005年2月到2009年2月，应用以理疗、手法治疗，注射及小针刀微创治疗，开放手术为阶梯的三级序贯式康复治疗方案，对42例正中神经双卡综合征患者进行围手术期康复治疗。结果42例正中神经双卡综合征的患者中，10例经颈部理疗、手法椎孔外颈神经松解完全治愈。有18例经颈部理疗、手法治疗未完全好转，再行腕管糖皮质激素注射，10例治愈，其余8例行腕管小针刀微创切开治愈。8例先行腕管糖皮质激素注射未完全治愈，再经颈部非手术松解3周治愈。6例腕管综合征，手术切开减压，术后12周手麻未完全缓解，改颈部康复治疗后4周痊愈。结论正中神经双卡综合征首选非手术治疗，当非手术治疗失败或症状比较严重时应及时手术治疗。过于积极的手术减压不一定能达到预期的疗效，应用围手术期三级序贯式康复治疗方案，可以使早期患者免于手术，晚期患者免于两次手术，减少医疗风险。

Objective Introducing the programs of setting up perioperative three - stage rehabilitation therapy of Median nerve dual card syndrome. Methods From February 2007 to February 2009, setting up three - stage rehabilitation treatment programs including physical therapy, manipulation therapy,injections and minimally invasive. Treating 42 cases of Median nerve dual card syndrome patients with three - stage perioperative rehabilitation therapy. Results Among 42 cases of Median nerve dual- card syndrome patients,10 patients fully recovered with neck physiotherapy,manipulation foramen external carotid nerve release, 18 patients have not been completely improved after treating with physical therapy and manipulation therapy, 10 patients were cured after further carpal tunnel cortieosteroid injections and the remaining 8 were cured by minimally invasive small needle - knife incision of carpal tunnel. 8 cases have not been completely cured with carpal tunnel corticosteroid injections hut through non - surgical neck releasing all cured in three weeks. 6 cases had surgical incision to decompress due to carpal tunnel syndrome, there is no complete remission of hand numb after 12 weeks, whereas after changing to neck rehabilita- tion treatment all were cured 4 weeks later. Conclusion Median nerve dual - card syndrome preferred non - surgical treatment,when the non - surgical treatment fails or having serious symptoms timely surgery is required. Too positive surgical decompression may not be able to achieve the desired effect,setting up perioperative three -stage rehabilitation therapy which can prevent early - stage patients from surgery and terminal patients from twice surgeries, reducing medical risks.