关节镜监视下双通道腕横韧带松解术的长期疗效观察

LONG-TERM EFFECTIVENESS OF TRANSVERSE CARPAL LIGAMENT RELEASE WITH ARTHROSCOPIC “TWO-PORTAL” TECHNIQUE

目的探讨关节镜下双通道腕横韧带松解术治疗腕管综合征的长期临床疗效。方法2002年11月-2008年8月，对3l例腕管综合征患者采用关节镜监视下双通道腕横韧带松解术治疗。其中男4例，女27例；年龄24-71岁，平均52岁。病程1个月～14年，平均42个月。滨田法分级为Ⅰ级20侧，Ⅱ级16侧，Ⅲ级5侧。桡侧3个半指感觉S2＋7例，S3 19例，S，5例；拇短展肌、拇对掌肌肌力2级5例，3级14例，4级7例。手术前后采用Michigan手功能评分（MHQ）评定手部功能。结果术后切口均Ⅰ期愈合，无血管、神经损伤、粘连及感染等并发症发生。3l例患者均获随访，随访时间6—11．8年，平均9．6年。术后手指麻木及感觉异常均恢复正常（S4）；8例肌力恢复至4级，23例至5级。术后6个月根据MHQ评分标准，功能、日常生活、工作、疼痛、外观、满意度评分均较术前显著改善，差异有统计学意义（P〈0．05）。术后无复发患者。结论局麻关节镜监视下双通道腕横韧带松解术能够有效解除腕管对正中神经的压迫，有助于神经功能恢复，长期疗效肯定。

Objective To study the effectiveness of transverse carpal ligament release for carpal tunnel synctrome （CTS） with arthroscopic ＂two-portal＂ technique under local anesthesia. Methods Transverse carpal ligament was released with arthroscopic ＂two-portal＂ technique in 31 patients with CTS between November 2002 and August 2008. There were 4 males and 27 females, aged 24-71 years （mean, 52 years）. The disease duration was 1 month to 14 years （mean, 42 months）. According to the guidelines of Bin Tian, 20 sides were rated as grade Ⅰ, 16 sides as grade Ⅱ, and 5 sides as grade Ⅲ before operation. The sensation was S2＋ in 7 cases, S3 in 19 cases, and S4＋ in 5 cases. The muscle strength of the abductor pollicis brevis and opponens pollicis muscles was grade 2 in 5 cases, grade 3 in 14 cases, and grade 4 in 7 cases. Michigan hand function scoring system （MHQ） was used to evaluate the function of the hand before and after operation. Results All incisions healed primarily, and no complications of median nerve injury and adhesion occurred. All of the 31 patients were followed up 6-11.8 years （mean, 9.6 years）. After operation, numbness and paresthesia of fingers were relieved （S4）; the muscle power returned to grade 4 in 8 cases, and to grade 5 in 23 cases. The MHQ scores of function, daily life, work, pain, appearance, and satisfaction were improved significantly at 6 months postoperatively when compared with preoperative ones （P〈0.05）. There was no relapse. Conclusion Arthroscopic ＂two-portal＂ technique is an effective surgical procedure for relieving the compression symptoms on the median nerve from carpal canal, so it is helpful to functional recovery of the median nerve. The long-term effectiveness is definite.