腕管综合征的治疗方法选择与疗效评价

Selection of therapeutic methods for carpal tunnel syndrome

目的 评价不同方法治疗腕管综合征（CTS）的疗效,为提高CTS的诊治水平提供依据.方法 回顾性分析2005年5月至2009年9月收治的162例CTS患者,其中轻度CTS 96例,重度CTS 54例,正中神经完全损伤型CTS 12例.针对不同类型患者分别采用保守治疗、单纯腕管松解手术治疗、腕管＋掌腱膜完全松解手术治疗.比较治疗前后患者的临床表现、神经电生理检测、Chen W-S腕部正中神经损害疗效评分等指标.结果 162例患者治疗后获6～36个月（平均15个月）随访.轻度CTS：3种治疗方法均有效,临床症状改善明显,经治疗后Chen W-S评分由（73.1±6.5）分提高到（94.9±8.7）分,手术治疗较保守治疗效果无明显优势.重度CTS：3种治疗方法均有效,保守治疗患者治疗后Chen W-S评分提高了（9.9±1.4）分,单纯腕管松解手术后Chen W-S评分提高了（24.6±8.2）分,腕管＋掌腱膜完全松解手术后Chen W-S评分提高了（33.9±7.5）分,腕管＋掌腱膜完全松解手术的疗效优于单纯腕管松解手术,而二者均优于保守治疗.正中神经完全损伤型CTS：治疗后临床症状改善不明显.结论 早期发现、及时治疗并去除发病诱因是促进CTS患者恢复的有效措施.针对CTS的不同损伤程度,采用不同的治疗方法可促进手部功能恢复.

Objective To evaluate 3 therapeutic methods for carpal tunnel syndrome （CTS）.Methods From May 2005 to September 2009, 162 CTS patients were treated in our hospital. Of them, 96 were mild, 54 were severe, and 12 had complete damage to the median nerve. Conservative therapy, simple carpal tunnel release （CTR） and complete carpal tunnel ＆ palmar aponeurosis release （CTPAR） were selected for different types of CTS. Clinical presentations, electroneurophysiological results and Chen W-S evaluation scores of the patients were compared before and after therapy. Results For slight CTS cases, all the 3 methods improved obviously the clinical presentations. The Chen WS scores were increased from 73.1 ± 6. 5before therapy to 94. 9 ± 8.7 after therapy. There was no significant difference between surgery and conservative therapy. For Severe CTS, all the 3 methods were effective. CTR increased the Chen W-S score by 24.6 ± 8.2 points while CTPAR by 33.9 ± 7.5 points. Of the 3 methods, surgery was superior to conservative therapy and CTPAR was superior to CTR. For complete damage to the median nerve, none of the 3 methods was effective. Conclusions Early diagnosis and treatment is crucial for a fine functional recovery for CTS patients. Different therapeutic methods should be applied for CTS patients according to the severity of their injury.