正中神经外膜显微松解术在腕管综合征中的应用

The clinical application of microsurgical release of median nerve epineurium in carpal tunnel syndrome

目的探讨正中神经外膜显微松解术在伴有正中神经病变的腕管综合征中的临床应用及效果。方法2014年3月-2017年12月,采用正中神经外膜显微松解联合腕横韧带松解术治疗伴有正中神经病变的腕管综合征16例。术后定期随访,随访内容包括:麻痛、感觉异常、肌萎缩(大鱼际肌)、对掌功能、握力和瘢痕痛六个方面。结果术后16例切口均甲级愈合,无感染发生。随访3~15个月,平均8个月,采用顾玉东腕管综合征功能评定标准判断治疗效果,优2例(12.5%),良11例(68.75%),可2例(12.5%),差1例(6.25%),优良率为81.25%。结论正中神经外膜显微松解术是治疗伴有正中神经病变腕管综合征的一种有效方法,可获得较好的临床效果。

Objective To explore the clinical application and effect of the microsurgical release of median nerve epineurium in carpal tunnel syndrome with median neuropathy.Methods From March 2014 to December 2017,16 cases of unilateral carpal tunnel syndrome were diagnosed and treated in our hospital.According to Pangtin classification,there were 15 cases of type II,1 case of type III and no case of type I.All patients were followed up regularly.The follow-up included six aspects:pain and paresthesia,sensory abnormality,muscle atrophy(thenar muscle),opposition function,grip strength and scar pain.Results There were 16 cases in this study.All cases were not infected and the incision accepted primary healing.The patients were followed up for 3 to 15 months,with an average of 8 months.According to Gu Yudong’s criteria of carpal tunnel syndrome,there were excellent in 2 cases(12.5%),good in 11 cases(68.75%),fair in 2 cases(12.5%),poor in 1 case(6.25%).The excellent rate was 81.25%.Conclusion Microsurgical release of median nerve epineurium is an effective method to treat carpal tunnel syndrome with median nerve degeneration,which can obtain better clinical effect.