小切口正中神经松解术治疗腕管综合征25例

25 cases of carpal syndrome treated with median neurolysis with small incision

目的探讨小切口正中神经松解术治疗腕管综合征的临床疗效。方法 2011年11月~2015年8月收治25例(33侧)腕管综合征患者,其中男性4例,女性21例,按照顾玉东腕管综合征分型,Ⅱ型21例29腕,Ⅲ型4例4腕。取腕部小切口,长约1.5 cm^2.0 cm切口,切断腕横韧带,松解正中神经,比较手术前和末次随访时波斯顿腕管问卷(症状/功能)评分,示指末节两点辨别觉和腕部正中神经肌电图潜伏期的变化,手术时间及并发症的发生情况。结果患者术后切口均Ⅰ期愈合,手术平均时间(10±1.97)分钟。随访时间16~60个月,平均35个月,其中完全缓解23例(31腕),有2例(2腕)患者仍残留部分手指麻木症状,没有切口瘢痕痛的发生。末次随访时,测量患者波斯顿问卷(症状/功能)评分,两点辨别觉和正中神经肌电图的潜伏期,均较术前显著改善,差异有统计学意义(P<0.05)。结论小切口正中神经松解术治疗腕管综合征安全,创伤小、临床疗效满意。

Objective To explore the mini-open incision decompression of median nerve in the treatment of carpal tunnel syndrome(CTS)and evaluate its efficacy.Methods From Nov2011to Aug2015,twenty-five patients(33sides)with carpal tunnel syndrome were treated with mini-open incision release.There were4males and21females,with an average age of55years(ranged39to75years).Twenty-one patients(29sides)was rated as type II,4patients(4sides)as type1H according to Gu classification and therapeutic regimens for carpal tunnel syndrome.The operation was performed under axillary blockade with a pneumatic tourniquet to control bleeding.We started a1.5to2.0cm longitudinal incision,beginning distally at the intersection ofthe Kaplan,s line and a line located5mm on the ulnar side from thenar crease,cutting the transverse carpal ligament and releasing the median nerve.Each patient was assessed with the Boston Carpal Tunnel Questionnaire(BCTQ),2-Point discrimination of distal index finger,and the latency of a mediannerve distal motor from the wrist to abductor pollicis brevis.Operative time and complications were recorded.Results Postoperative wound smoothly healed in all patients and no complications occurred.The mean operative time was10minutes(range8to15minutes).All patients were followed up from16to60months(mean35months).Symptoms of2patients had not incomplete relief,other patient's symptoms disappeared and muscle force of abductor pollicis brevis reinforced.The incision scar at the palm was small.The score on BCTQ(symptom severity)from(3.38士0.63)points preoperative to(1.3士0.28)points atthe last time follow-up.Similarly,The score on BCTQ(function status),2-Pointdiscrimination of distal index finger and the latency of a median nerve distal motor from the wrist to abductor pollicis brevis obviously improved than that preoperative(P<0.05).Conclusion Treatment of carpal tunnel syndrome with mini-open incision decompression have the advantages of minimal invasive incision,small skin scar,and short operative time and recovery time.Thoroughly decompressing median nerve under direct sight,it is a safe and effective operative approach.