开放和关节镜下松解治疗腕管综合征的临床对照研究

Open surgical versus arthroscopic release in the treatment of carpal tunnel syndrome:a clinical parallel-group trial

目的比较开放手术松解和关节镜下松解术治疗腕管综合征的手术方法和临床疗效。方法 2005年2月至2010年7月收治腕管综合征患者43例,男性19例,女性24例,平均年龄44.7岁(35～63岁)。患者均有典型的腕管综合征表现,包括正中神经分布区的感觉减退和麻木,Phalen试验和Tinel征阳性,15例患者伴有大鱼际肌肉萎缩肌电图检查显示感觉神经传导速度减慢,运动传导末端潜伏期延长。采用开放手术松解20例(左侧7例,右侧13例),关节镜下松解23例(左侧9例,右侧14例)术前术后分别评估患者症状、功能等,功能评价采用臂-肩-手功能障碍(DASH)评分,记录有无并发症发生。结果所有患者术后感觉减退症状均有明显缓解,握力及捏力改善;关节镜下腕管松解术平均总手术时间为25.4min,开放手术为50.3min,差异有统计学意义(P<0.05);术后平均住院日关节镜下手术组为3.1d,开放手术组为8.6d,差异有统计学意义(P<0.05)。开放手术组术后DASH评分从术前的37.7±6.96分(27～55分)减少至19.5±3.05分(12～31分),差异有统计学意义(t=10.711,P=0.0000);关节镜手术组术后DASH评分从术前的36.1±5.83分(30～47分)减少至18.1±2.85分(13～26分),差异有统计学意义(t=12.405,P=0.0000);两组患者术后DASH评分之间差异无统计学意义(t=0.4167.P=0.1276)。术后肌电图检查显示两组患者正中神经感觉传导速度均比术前增快。所有患者均无神经、血管损伤等围手术期并发症。结论开放手术松解和关节镜下腕管松解术对腕管综合征均有较好的疗效,关节镜下松解术手术时间短,术后恢复较快。

Objective To compare the surgical methods and curative effects of arthroscopic release of carpal tunnel with that of open surgical release in patients with carpal tunnel syndrome （CTS）. Methods From February 2005 to July 2010, 43 patients with CTS were diagnosed and treated. There were 19 males and 24 females with an average age of 44.7 years old （range; 35-63 years）. All patients had suffered typical symptoms of CTS, which comprised of hypesthesia, numbness, positive Phalen test and positive Tinel test. 15 patients had atrophy of the thenar muscles. Electromyogram showed prolonged distal motor latency and reduced distal sensory nerve conduction velocity in all patients. Open surgical release was performed in 20 patients with CTS （7 cases on the left side and 13 cases on the right side） and arthroscopic release was performed in 23 patients with CTS （9 left and 14 right）. The assessments of the patients＇ symptoms, functions and so on were made preoperatively and postoperatively. Disabilities of the Arm, Shoulder, and Hand （DASH） score was used in functional evaluation and any complication from the procedure was recorded. Results After surgery, all patients＇ hypesthesia, grip and pinch strength were significantly improved. The operating time was 25.4 min in arthroscopic release group, and 50.3 min in open surgical release group. There were statistically significant differences between them （P〈0.05）. The hospital stay after surgery was 3.1 days in arthroscopic release group, and 8.6 days in open surgical release group. There were also statistically significant differences （P〈0.05）. Comparing with that before surgery, DASH scores of arthroscopic release group were significantly decreased from 36.1±5.83 points （27-55 points） to 18.1±2.85 points （13-26 points）, and significantly decreased from 37.7±6.96 points （27-55 points） to 19.5±3.05 points （12-31 points） in open surgery release group. The differences among DASH scores of both the 2 groups postoperatively were not statistically significant （P〉0.05）. Postoperative electromyogram showed that sensory nerve conduction velocity was increased. There was no neurovascular structure injury. Conclusions Both open surgical and arthroscopic release of carpal tunnel in the treatment of CTS have good curative effects, and patients in the arthroscopic release group recover faster postoperatively.