改良小切口治疗腕管综合征

Small incision treatment of carpal tunnel syndrome

目的探讨改良小切口腕管综合征减压、正中神经松解的临床疗效。方法 96位患者,112例腕管综合征均采用平行鱼际纹至腕横纹,沿腕横纹远侧向尺侧横行1～1.5cm的类"L"形切口。术中切开鱼际间筋膜及腕横韧带,注意保护正中神经掌支及返之。正中神经一般不做外膜切开松解,如有明显狭窄及外膜纤维条索化,显微镜下单纯局部、阶段性外膜切开、切除,不做束膜松解,不缝合腕横韧带及鱼际间筋膜。采用无创伤可吸收线缝合皮肤。结果 105例患肢明显改善,麻木、无力、夜间疼痛感消失,手部推捏力正常。4例患肢夜间疼痛症状改善,手部对掌功能、握捏力恢复可,但仍有麻木无力。3例患肢显微镜下行神经外膜切开,松解后,麻木有改善,但疼痛感对掌功能及手部推捏力恢复欠佳。112例患肢随访3～18个月,均无术后墩柱部疼痛或复发加重,优良率为93.7%。结论改良小切口治疗腕管综合征,临床上完全能达到减压,松解得要求,能解决临床上腕管综合征常见的发病原因。如果存在正中神经狭窄或外膜纤维条索化,可显微镜下松解切除。如发现占位,腕骨结构异常,滑膜增生等造成的狭窄卡压,可适当延长切口解决致病原因。112例患肢经改良小切口腕管综合征,术后随访3～18个月均无墩柱部疼痛及复发再卡压形成,优良率为93.7%。因此,改良小切口治疗腕管综合征疗效可靠,外形美观,创伤小,无术后墩柱部疼痛,减少了术后复发及二次压迫的发生率,是值得推荐的治疗腕管综合征的有效手术方法。

Objective To investigate the clinical efficacy of small incision carpal tunnel syndrome decompression,the release of the median nerve. Methods 96 patients with 112 cases of carpal tunnel syndrome were used in parallel the thenar lines to the wrist crease,far lateral ulnar rampant 1-1.5 cm classes of ＂L＂ -shaped incision along the wrist crease. Thenar fascia and transverse carpal ligament,pay attention to the protection of the median nerve palm branch and back to the surgery incision. The median nerve generally do not the outer membrane cut loose,if any significant stenosis and outer membrane fiber strips cable,under the microscope than partial,phased outer membrane incision,excision,not beam film release,non-closure of carpal transverse ligament and thenar fascia. The use of non- invasive skin absorbable suture. Results 105 patients with limb significantly improved,numbness,weakness,the night pain disappeared,hand push pinch strength. The improved four cases of limb pain at night,hand on the palm features gripping force to restore,but there is still numbness. 3 cases of limb microscope downlink the epineurium cut,release,numbness improved,but the pain push on the the palm functions and hand pinch strength poor recovery. 112 patients with limb were followed up for 3-18 months,there was no postoperative the pier columns pain or recurrent increase,the excellent and good rate was 93.7%. Conclusion The modified small incision in the treatment of carpal tunnel syndrome,the clinical completely to achieve decompression,release requirements,to solve clinical carpal tunnel syndrome common causes. If there is a narrow median nerve or outer membrane fiber cord,can be under the microscope release resection. Such as mass,abnormal carpal structure,synovial hyperplasia caused by narrow entrapment,may be appropriate to extend the incision to address the cause of the disease. 112 cases of limb through the small incision carpal tunnel syndrome,patients were followed up for 3-18 months had no the pier columns pain and recurrence entrapment form,good rate of 93.7%. Therefore,improved the small incision treatment of carpal tunnel syndrome,reliable,beautiful appearance,trauma,no postoperative pain pier column,to reduce the incidence of recurrence and secondary oppression,is the recommended treatment of carpal tunnel syndrome effective surgical methods.