腕横纹小切口治疗轻中度腕管综合征的临床疗效评价

Evaluation on clinical therapeutic effect of small incision releasing of transverse carpal ligament in treatment of mild and moderate carpal tunnel syndrome

目的:探讨腕横纹小切口腕横韧带切开术治疗轻中度腕管综合征(CTS)的疗效和优点,阐明腕横纹小切口腕横韧带切开术的独特临床疗效。方法:切口长约2cm,位于中间腕横纹水平,掌长肌作为手术标记位于切口中点。切开皮肤、皮下,辨清掌长肌腱显露正中神经,显露腕横韧带近侧部分,于掌腱膜与腕横韧带之间向切口远端钝性分离;提起掌长肌腱和皮肤,将腕关节背伸约15°,用钝头组织剪直视下沿正中神经尺侧环指中轴延长线纵向将腕横韧带完全剪开。结果:术后随访,2周后27例患者症状明显缓解,示、中指正中神经的感觉神经动作电位(SNAP)潜伏期缩短;3个月后患者症状完全消失,示指指腹平均两点辨别觉恢复至(5.0±0.5)mm、拇短展肌肌力部分恢复,复合肌肉动作电位(CAMP)的远端潜伏期(DML)明显缩短、波幅有所增加;术后1年,所有患者均无临床症状,拇对掌功能正常,各项神经电生理指标恢复正常。未发现切口瘢痕痛和其他并发症。结论:腕横纹小切口腕横韧带切开术是一种治疗轻中度CTS的有效方法。

Objective To explore the therapeutic effect and advantages of small incision releasing of transverse carpal ligament in the treatment of mild and moderate carpal tunnel syndrome（CTS）,and to clarify its special clinical curative effect.Methods An incision 2.0cm in length was made at the level of the middle wrist crease and the palmaris longus tendon was on the midpoint of the incision,as an anatomical landmark.After the skin and subcutaneous tissue were cut,the palmaris longus tendon and the median nerve were exposured,and the transverse carpal ligament proximal part was revealed. A mosquito haemostat was advanced forward between palmar aponeurosis and flexor retinaculum and the proximal portion of transverse carpal ligament was visualized.The palmar aponeurosis and skin were lift up and the wrist joints was extend about 15°.The wrist transverse ligament was completely cut in the direct vision along the line of the ulnar side of the median nerve ring axial extension cord by the blunt organization scissor.Results The follow-up results showed that all the clinical symptoms of all the patients were released obviously,and the latent periods of sensory nerver action potential（SNAP）of the median nerve at the wrist were shortened when the index and middle fingers were stimulated 2weeks after the operation;3months after the operation,the symptoms of numbess and pain disappeared in all cases and the two-point discrimation of the index finger pulp had a recovery to the level of（5.0±0.5）mm,and the muscle strength of the abductor pollicis brevis muscles was partly recovered,and the latent periods and amplitudes of the abductor pollicis brevis compound muscle action potential（CMAP）became shortned and increased,respectively.One year after the operation,all the patients had no clinical symptoms of numbess and pain.The function of thumb on the plam got normal.All the electrophysiologic parameters turned to the normal levels and no scar discomfort and other apalmar arch were seen.Conclusion Release of the transverse carpal ligament under the direct vision by a small incison is an effective surgical procedure for CTS.