内镜下松解治疗腕管综合征的临床研究

Endoscopic release in treatment of carpal tunnel syndrome

目的探讨内镜下松解和改良开放手术松解治疗腕管综合征(CTS)的临床疗效。方法选取2014年6月-2017年6月收治的CTS患者52例,随机分为两组,采用内镜下松解26例,改良开放手术松解26例。对两组患者术中、术后情况进行观察比较。结果所有患者获得随访,平均随访(12.70±2.50)个月。内镜组在手术时间、平均住院日、拆线时间、恢复工作时间和切口视觉模拟评分(VAS)上与改良开放组比较[(15.12±6.34)vs(13.35±5.12)min,(3.45±0.78)vs(3.61±1.41)d,(6.25±1.21)vs(7.12±1.25)d,(21.40±3.10)vs(23.20±2.20)d,(2.20±0.80)vs(2.30±0.60)分],差异均无统计学意义(t=1.83、0.87、1.45、1.95和0.45,均P>0.05),两组Kelly功能评价优良率比较,差异无统计学意义(93.55%vs90.63%,χ^2=0.00,P>0.05)。结论内镜下松解治疗CTS能取得良好的临床疗效,虽然内镜手术技术要求较高、学习曲线较长,但具有手术创伤小、术后恢复快和并发症少等优点,值得临床推广。

Objective To discuss the clinical effect of endoscopic release and modified open surgical release in treatment of carpal tunnel syndrome(CTS).Methods From June 2014 to June 2017,52 patients with CTS were enrolled in the study,and they were randomly divided into two groups.26 cases were treated with endoscopic release,and 26 cases were treated with modified open surgical release.The intraoperative and postoperative situations of the two groups were observed and compared.Results All the 52 patients were followed up with an average of(12.70±2.50)months.The operative time,average hospitalization time,stitches removal time,recovery time and VAS score of incision of the endoscopic release group was similar with the modified open surgical release group[(15.12±6.34)vs(13.35±5.12)min,(3.45±0.78)vs(3.61±1.41)d,(6.25±1.21)vs(7.12±1.25)d,(21.40±3.10)vs(23.20±2.20)d,(2.20±0.80)vs(2.30±0.60)score],there were no statistically significant difference(t=1.83,0.87,1.45,1.95,0.45,P﹥0.05).Functional evaluation was conducted according to Kelly functional assessment standard.There was no statistically significant difference of the excellent rate between the two groups(93.55%vs 90.63%,χ^2=0.00,P﹥0.05).Conclusion Endoscopic release can achieve good clinical effectiveness in treatment of CTS.Although endoscopic surgery requires high technology and long learning curve,it has the advantages of less surgical trauma,faster postoperative recovery and fewer complications,which was worthy of clinical promotion.