节点文献
改良腕关节镜及小切口治疗腕管综合征的临床研究
The Study of Improved Wrist Arthroscopy and Minimally Invasive Mathod in Treatment of Carpal Tunnel Syndrome(CTS)
【作者】 陈博；
【导师】 林向进；
【作者基本信息】 浙江大学 ， 外科学， 2015， 硕士
【摘要】 背景：腕管综合征(carpal tunnel syndrome, CTS)指的是腕管内正中神经受到卡压而引起的一组临床症状和体征,是上肢最常见的周围神经卡压征。腕管松解减压术即切断屈肌支持带、解除正中神经卡压的手术,是外科治疗腕管综合征的经典方法,分切开松解减压(open carpal tunnel release, OCTR)和内窥镜松解减压(endoscopic carpal tunnel release, ECTR)两种形式。开放术式手掌部的皮肤切开易损伤正中神经的掌皮支,虽然切口从长度、形状不断发生多种多样的变更,但最终难免在手掌部残留手术瘢痕和形成掌皮支神经瘤所产生的疼痛性瘢痕。目的：使用改良的ECTR (Improved ECTR)法治疗CTS。并与其他三种常用方法进行治疗效果比较。方法：按手术方法分为四组：(1)传统直视下腕部切开松解正中神经术组(OCTR);(2)传统内窥镜下松解正中神经术(ECTR)；(3)小切口行腕部松解正中神经术(minimal incision carpal tunnel relese,MICTR)；(4)改良内窥镜下松解正中神经术(IECTR),采用的手术方法在正中神经鱼际支体表投影处,采取近侧掌纹处小切口切开直接松解鱼际支神经,并在使用钩刀时予以直接保护,避免损伤。其余松解减压术与Okutsu内窥镜方法相同。术后进行了6-24月的门诊随诊,随访术后一般情况及术后并发症、客观指标的测评和主观指标的评分,并进行统计学分析。结果：术后6个月OCTR组和MICTR组疤痕较其他两组压痛明显(P<0.05), IECTR组恢复正常生活时间早于其他各组(P<0.05)。两点辨别觉、Tinel征、Phalen试验阳性率、电生理检测及Levine腕管问卷调查评分各组间均无统计学差异(P>0.05)。结论：采用腕关节镜在近腕横纹处及近侧掌横纹近端皮肤小切口利用勾刀、推刀切开腕横韧带减压松解正中神经术治疗腕管综合征具有松解彻底、切口愈合快、无常规切口疼痛性疤痕及松解和保护正中神经鱼际支不损伤等优点,为改良的内窥镜下治疗腕管综合征的方法。
【Abstract】 Background:carpal tunnel syndrome (CTS) is a neurological disorder characterized by paresthesias, pain and numbness in the hands due to lesions (compression) and/or dysfunction of the nervus medianus. Surgery is performed to release the compressive pressure on the median nerve. The method is composed of open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR). Endoscopic decompression aimed to avoid potential scar morbidities and also allow faster rehabilitation and return to normal activities.Object:We evaluated the method of improved endoscopic carpal tunnel release (IECTR). The result was compared with OCTR, MICTR (minimal incision carpal tunnel release), ECTR group. Method:6months postoperatively, OCTR group and MICTR group had more scar pain than other two groups (P<0.05). IECTR group recovered earlier to normal life time than the other groups (P<0.05). The two-point discrimination, Tinel syndrome, the positive rate of Phalen test, electrophysiological and Levine carpal tunnel questionnaire score in each group showed no significant difference (P>0.05).Conclusion:The improved endoscopic carpal tunnel release having less incision pain, better appearance and less recovery time. The result of operation effect is similar with other methods. Thus, this is a feasible method for carpal tunnel release without reconstruction of opponens function.