微创手术联合高压氧辅助治疗中重度腕管综合征42例疗效观察

Observation on clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in 42 cases of moderate to severe carpal tunnel syndrome

目的探讨微创手术联合高压氧辅助治疗中重度腕管综合征的临床疗效。方法回顾性分析2016年3月至2019年12月上海交通大学医学院附属新华医院成人骨科及新华医院崇明分院骨科收治的86例中重度腕管综合征患者的临床资料。按照治疗方法分为观察组(n=42)和对照组(n=44),对照组采用内窥镜下改良Okutsu法治疗,观察组在对照组治疗的基础上予以高压氧治疗。根据腕管综合征功能评定标准评价术后3个月2组患者的临床疗效,并比较其优良率;采用肌电图仪于术前及术后14、30、90 d测定2组患者正中神经感觉传导速度(SCV)、运动神经传导速度(MCV)、感觉神经动作电位波幅(SNAP)及运动神经末端运动潜伏期(DML);使用上肢功能(DASH)量表评价2组患者术前、术后14、30、90 d的上肢功能;采用Jamar手指捏力测试仪和Jamar握力测试仪检测2组患者术前及术后14、30、90 d的捏力和握力。结果随访3个月,观察组患者治疗后优良率(85.71%)明显高于对照组(70.45%),差异有统计学意义(P<0.05)。观察组患者术后14、30、90 d DASH量表评分明显低于对照组,SCV和MCV明显快于对照组,DML明显短于对照组,SNAP明显大于对照组,握力和捏力明显高于对照组,差异均有统计学意义(P<0.05)。结论采用内窥镜下改良Okutsu法治疗腕管综合征,术后予以高压氧辅助治疗,提高了治疗优良率,改善了正中神经电生理功能,提高了患者日常生活能力,可为治疗腕管综合征等周围神经卡压疾病造成的慢性损伤提供参考。

Objective To investigate the clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in the treatment for moderate to severe carpal tunnel syndrome.Methods The clinical data of 86 patients with moderate to severe carpal tunnel syndrome admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of the Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2016 to December 2019 were retrospectively analyzed.According to the treatment method,they were divided into observation group(n=42)and control group(n=44).The control group was treated with modified Okutsu method of endoscopic carpal tunnel release(ECTR),and the observation group was given hyperbaric oxygen on the basis of the treatment in the control group.The clinical efficacy of the two groups three months after operation was assessed by using carpal tunnel syndrome evaluation criteria,and their excellent and good recovery rates were compared.The median nerve sensory conduction velocity(SCV),motor nerve conduction velocity(MCV),sensory nerve action potential(SNAP)amplitude,and motor nerve distal motor latency(DML)of the two groups were measured by electromyography before operation,and 14 d,30 d,and 90 d after operation.The disabilities of arm,shoulder,and hand(DASH)questionnaire was used to evaluate the upper-extremity function of the two groups before operation,and 14 d,30 d,and 90 d after operation,and the pinch strength and grip strength of the two groups before operation,and 14 d,30 d and 90 d after operation were measured by Jamar Pinch Gauge and Jamar Hand Dynamometer.Results After three months of follow-up,the excellent and good recovery rate of the observation group(85.71%)was significantly higher than that of the control group(70.45%),with a significant statistical difference(P<0.05).The DASH scores of the observation group were significantly lower than those of the control group at 14 d,30 d,and 90 d after operation(P<0.05).The SCV and MCV of the observation group were significantly faster than those of the control group at 14 d,30 d,and 90 d after operation(P<0.05).The DMLs of the observation group were significantly shorter than those of the control group at 14 d,30 d,and 90 d after operation,while the SNAPs were significantly bigger than those of the control group(P<0.05).The grip strength and pinch strength of the observation group were significantly stronger than those of the control group at 14 d,30 d,and 90 d after operation(P<0.05).Conclusion Modified Okutsu method of ECTR combined with postoperative hyperbaric oxygen treatment can improve the clinical excellent and good recovery rate of carpal tunnel syndrome,which can enhance the electrophysiological function of their median nerves,and their daily functioning,to provide reference for treating chronic injuries caused by carpal tunnel syndrome and other peripheral nerve entrapment syndromes.