高频超声和电生理检查对中期腕管综合征患者疗效判定

High-frequency ultrasound and electrophysiological examination to determine the efficacy of different treatments of carpal tunnel syndrome

目的对口服药物、局部封闭或手术治疗的中期腕管综合征(CTS)患者进行高频超声和电生理检查,以判定治疗效果,指导预后。方法将CTS患者按照完全自愿原则分成3组:口服药物治疗组56例85侧,局部封闭治疗组75例108侧,手术治疗组68例96侧。中期腕管综合征患者在口服药物、局部封闭或手术治疗前后行高频超声及电生理检查,观察高频超声及电生理变化特点。结果手术治疗组有效率显著高于局部封闭组及口服药物组;疗效差的患者,豌豆骨、钩骨钩水平正中神经的横截面积及钩骨钩水平正中神经横径与前后径之比与治疗效果好的患者有统计学差异;手术治疗效果差的患者电生理仍有明显改善。结论手术治疗效率最高;豌豆骨、钩骨钩水平正中神经的横截面积越大,钩骨钩水平正中神经横径与前后径之比越大,预后越差;手术治疗无效的患者治疗后仍有显著的电生理改变。

Objective To observe the efficacy of patients with intermediate carpal tunnel syndrome（ CTS） treated with oral medicine,local sealing and surgery. Methods CTS patients were divided into 3 groups according to the principle of complete voluntary： oral drug treatment group（ 56 cases,85 sides）,locally closed treatment group（ 75 cases,108sides）,surgical treatment group（ 68 cases,96 sides）. After CTS patients were treated with oral medicine,local sealing or operation,the characteristics of high-frequency ultrasound and electrophysiological changes were observed.Results The effective rate of surgery was higher than that of local sealing and oral medicine. There were significant differences in the cross-sectional area of the median nerve in pisiform bone and hamate hook,and the ratio of transverse diameter and anteroposterior diameter of the hamate hook between patients with poor and good therapeutic efficacy.Even patients with poor efficacy had improved electrophysiological changes. Conclusion Surgical treatment is the most effective treatment for CTS. Larger cross-sectional area of the median nerve in pisiform bone and hamate hook,and larger ratio of the transverse diameter and anteroposterior diameter of the hamate hook mean poorer prognosis. Patients with ineffective surgical treatment still showsignificant electrophysiological changes after treatment.