局麻下掌部小切口治疗腕管综合征的临床效果观察

Clinical effect observation of palm small incision under local anesthesia in the treatment of carpal tunnel syndrome

目的 探讨局麻下掌部小切口治疗腕管综合征的手术方法 和效果。方法 选取2010年12月-2012年8月本院收治的35例（39侧）腕管综合征患者，采用局部麻醉下掌部小切口，切断腕横韧带、屈肌支持带远侧纤维束、前臂远端深筋膜，行腕管减压，局部注射激素，部分重度患者应用显微外科技术行正中神经外膜间断切开松解减压。结果 术中无神经、血管、肌腱损伤，术后无感染，无血肿形成，切口全部一期愈合，术后2周拆线。随访6～18个月．平均11个月，术后均未出现柱状痛，无屈肌腱弓弦样畸形发生，无手部握力下降。至随访结束：麻痛症状完全消失37侧．明显缓解1侧，仍有部分麻痛症状1侧。优33侧，良5侧，可1侧，差0侧，优良率为97．4％。结论 局麻下掌部小切口治疗腕管综合征的方法 安全，疗效满意。

Objective To discuss the operation methods and curative effects of palm small incision under local anesthesia in the treatment of carpal tunnel syndrome. Methods 35 cases （39 sides） of patients with carpal tunnel syndrome in our hospital from December 2010 to August 2012 were selected.Small incision of metacarpus with local anesthesia,including cut off ligamenta carpi transversum,DHFFR,deep fascia of forearm was used to reduce the pressure of carpal tunnel and injected hormone regionally.For some serious cases,microsurgery was used to cut off outer membrane of nervi medianus to reduce pressure. Results All cuts were primarily healed and there was no neurovascular injure,no tendon injure,no wound infection,no hematoma.Post-operation follow-up was six to eighteen months and the average was eleven months,there was no pillar pain,no flexor tendon bow deformity,no reduced grip streagth.The paresthesias and pain of the hand disappeared in 37 wrists,relieveed in 1 wrists,the residual part of hemp pain symptoms in a wrists. 33 sides were A,5 sides were B,1 side was C,O side was D,good rate was 97.4%. Conclusion The operation method of palm small incision under local anesthesia in the treatment of carpal tunnel syndrome is safe and the effect is satisfactory.