复发的腕管综合征的显微外科治疗

Microsurgery for recurrent carpal tunnel syndrome

目的探讨复发的腕管综合征（CTS）的显微外科治疗效果。方法2001年6月至2009年12门采川显微神经松解联合带血管蒂小鱼际皮下脂肪瓣（HTFPF）治疗2l例复发的CTS患抒，男5例，女16例；年龄35～78岁，平均52．2岁。17例采HJ腕管切开松解减瓜术后复发，4例采用内镜下腕管松解术后复发。术后复发时间5～35个月，平均19．6个月。按照CTS分型：LfI度8例，重度13例。所有患者桡侧3～4个手指麻木、疼痛，有麻刺感；Tinel征均阳性；食指指腹两点分辨觉5～14mm，平均9．3mm握力6～18kg，平均11．7kg。所有患行复发后采取保守治疗3用均无效．结果21例患者术肝获18～48个月（平均24．4个月）随访。正中神经卡压症状明显改善时间2～14d，平均7．2d；两点辨别觉提高举2～8mm，平均4．0mm；握力18～37kg，平均23．5kg。所行患者手指活动、感觉正常，麻木、针刺感淌失，无明显的腕部疼痛，拊指对掌功能正常，肌电图检查均阴性，Tinel征、Phalen，征、ReversePhalen征均阴性。术后i8个月，按CTS功能评定标准：优16例，良4例，可l例，优良率为95．2％，腕部主观疼痛减轻率达100％．所有患者均恢复正常工作和生活。全部忠学术后未出现支柱疼痛、小鱼际疼痛、反射性交感神经营养不良、正中神经及其返支、掌浅弓损伤等并发癖。结论屁微外科治疗足治疗复发的CTS的有效方法，显微神经松解联合HTFPFnr以恢复正中神经的滑动，并提供良好的软组织营养綦床，显苫改簿复发的cTS患行的症状。

Objective To investigate tile clinical outcomes of microsurgery fi）r the recurrent carpal tunnel syndrome （RCTS） . Methods This study included 21 llCTS patients who had been treated with mieroneurolysis plus grafting of a hypothenar fat pad flap （ftTFPF） in our hospital between June 2001 and l）ecember 2009. Patients with incomplete release of the transverse carpal ligament at the original operation were excluded. They were 5 men and 16 women with an average age of 52.2 years （range, 35 to 78 years）. RCTS occurred after original open carpal tunnel release in 17 eases and after endoscopic carpal tnnnel release in 4 eases. The mean recurrent time was 19.6 months （range, 5 to 35 months） . By Gu Yudong＇s Classification, 8 eases were moderate and 13 severe. All the patients experienced ntunbness, pain and tingling at the radialis 3 to 4 fingers. Their Tinel tests were positiye. Their two-point discriminations averaged 9.3 mm （range. 5 to 4 ram） and their grip strengths averaged 11. 7 kg （range, 6 to 18 kg）. Conservatism treatment for 3 weeks failed to improve their syndrome. Results All the 21 patients were followed up for a mean time of 24. 4 months （range, 18 to 48 mnnths） . The mean time of evident inlprovement of ROTS was 7.2 （lays （rmlge, 2 to 14 days）. The average twn-point discrimination improved to 4.0 mm （range, 2 to 8 ram）. The average grip strength improved to 23.5 kg （range, 18 to 37 kg）. All the patients obtained normal finger ac- livitv and sensation, normal opposition of thumb and no sensation of numlmess, tingling or pain. Their Tinel tests. Phalen tests, Reverse Phalen tests and electromyogram examinations were all negative. According to Gu Yudong＇s criteria, 16 cases were rated as excellent, 4 cases as good and one case as fair, with a good to excellent rate of 95.2%. Patients reported 100% of subjeclive pain imprnve,nent. All returned to their normal work and life. No patient reported pain of scar or hypothenan reflecting sympathetic dystrophy, or complications like injury to the median nerve, its reeurrent branch, or arcns pahnaris superfieialis after reoperation. Conclusion Comlbination of mieronenrolysis and HTFPF grafting is a sat） and efficient surgical procedure for RCTS, because it can restore median nerve gliding, prnvide soft-tissue coverage and improve symptoms.