经典针刀术式治疗腕管综合征的临床解剖学研究

Clinical anatomical study on the treatment of carpal tunnel syndrome with classic Acupotomy

目的:探讨经典针刀术式治疗腕管综合征的安全性,为临床治疗提供解剖学依据。方法:选取10%甲醛固定的成人标本26例(男15例,女11例),年龄60~95(82.54±6.94)岁,共52侧(其中有2侧无法试验),研究时间为2017年11月至2018年5月,标本来源于北京大学基础医学院遗体捐献中心。进行人体标本上模拟经典针刀术式松解腕横韧带的操作,并测量4个进针点到周围解剖结构的距离,计算其对神经血管的直接损伤率,并定义针刀离神经血管的最短距离≥2 mm为安全。结果:试验术式中针刀对神经、血管的直接损伤率分别为14%、12%。4个进针点对神经直接损伤率的差异有统计学意义(P<0.05)。4个进针点对血管直接损伤率的差异无统计学意义(P>0.05)。在这4个进针点中,对神经的安全性的差异有统计学意义(P<0.05),并且桡侧进针点1和进针点3比尺侧进针点2和进针点4的安全性高(P<0.05)。4个进针点对血管的安全性差异有统计学意义(P<0.05),并且桡侧进针点1比尺侧进针点2和进针点4的安全性高(P<0.05)。结论:经典针刀术式治疗腕管综合征安全性与其进针点位置有关,桡侧近心端进针处安全性最高。

Objective:To explore the safety of classic Acupotomy in the treatment of carpal tunnel syndrome.Methods:Twenty six adult specimens(15 males and 11 females),aged 60 to 95(82.54±6.94)years old,were selected from 10%formalin antiseptic fixation.There were 52 sides(two of them could not be tested).The study period was from November 2017 to May 2018.The specimens were collected from the body donation center of the school of basic medicine,Peking University.The operation of releasing the transverse carpal ligament on the human body specimen was simulated by the classic acupotomy,and the distance from the four points to the surrounding anatomical structure was measured to calculate the direct injury rate to the nerve and blood vessels,and the shortest distance between the acupotomy and the nerve and blood vessels was defined as≥2 mm as safety.Results:In the experimental operation,the direct injury rate of nerve and blood vessel was 14%and 12%respectively.There was significant difference in the rate of direct nerve injury between the four injection points(P<0.05).There was no significant difference in the rate of direct vascular injury between the four injection points(P>0.05).Among the four points,there was a statistically significant difference in the safety of nerves(P<0.05),and the safety of point 1 and point 3 of radial injection was higher than that of point 2 and point 4 of ulnar injection(P<0.05).There was significant difference in the safety of blood vessels between the four points(P<0.05),and the safety of radial point 1 was higher than that of ulnar point 2 and point4(P<0.05).Conclusion:The safety of the classic Acupotomy for carpal tunnel syndrome is related to the location of the needle entry point,and the safety of the radial proximal end of the needle is the highest.