基于不同症状腕管综合征分类手术治疗的效果分析

Analysis of clinical efficacy of surgical treatment for carpal tunnel syndrome based on different symptoms classification

目的评估根据不同症状腕管综合征分类手术治疗的效果及并发症的预防。方法自2018年1月至2021年6月我们共诊治90例腕管综合征患者,根据不同症状采用腕管近端松解9例、全腕管松解25例、腕管远端松解15例、微创腕管松解41例。于术后1、3、6个月比较4组患者的视觉模拟评分(visual analogue scale,VAS)、Kelly评分、BCTQ评分、两点分辨觉、神经电生理参数和并发症发生情况。结果术后1、3、6个月4组患者VAS、Kelly评分、BCTQ评分评价的临床疗效有效率和优良率相比差异无统计学意义(P>0.05);两点分辨觉和各项神经电生理参数相比差异无统计学意义(P>0.05);微创腕管松解组患者的切口长度、术后瘢痕和并发症发生率明显低于其余三组,差异有统计学意义(P<0.05);全腕管松解组的切口长度、恢复工作时间、术后瘢痕和并发症发生率明显高于其余三组,差异有统计学意义(P<0.05)。4组患者的住院费用、手术时间和住院时间相比差异均无统计学意义(P>0.05)。结论根据不同症状腕管综合征分类治疗能够安全、有效地松解不同部位正中神经,减少术后并发症,加速患手功能恢复。

Objective To evaluate the clinical efficacy of surgical treatment based on different symptoms of carpal tunnel syndrome and prevention of complications.Methods From January 2018 to June 2021,90 patients with carpal tunnel syndrome were treated with proximal carpal tunnel release in 9 cases,total carpal tunnel release in 25 cases,distal carpal tunnel release in 15 cases,and minimally invasive carpal tunnel release in 41 cases according to different symptoms.The visual analogue scale(VAS),Kelly score,BCTQ score,two-point discrimination,neuroelectrophysiological parameters and the incidence of complications were compared among the four groups at 1,3 and 6 months after surgery.Results There was no statistically significant difference in the clinical efficacy and excellent and good rates evaluated by VAS,Kelly score,and BCTQ score among the four groups of patients at 1,3,and 6 months after surgery(P>0.05).There was no statistically significant difference in two-point discrimination and various neurophysiological parameters(P>0.05).The incision length,postoperative scar formation,and incidence of complications in the minimally invasive carpal tunnel release group were significantly lower than those in the other three groups,with statistical significance(P<0.05).The incision length,recovery time,postoperative scar formation,and incidence of complications in the total carpal tunnel release group were significantly higher than those in the other three groups,with statistical significance(P<0.05).There was no statistically significant difference in hospital expenses,surgical time,and hospital stay among the four groups of patients(P>0.05).Conclusion The classification and treatment of carpal tunnel syndrome based on different symptoms can safely and effectively release the median nerve in different parts,reduce postoperative complications,and accelerate the recovery of hand function.