【作者】 孙浩然；

【导师】 路来金；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的:探讨在开放性切口下行腕横韧带切开、正中神经松解术治疗腕管综合征的疗效分析和临床体会。方法:回顾性分析2013年7月至2016年9月间我院收治的腕管综合征137例患者的临床资料:男37例,女100例;年龄22~85岁,平均年龄55.4岁。患手189侧,其中左77侧,右112侧,双侧患者52例。依顾玉东分型均为中重度,其中中度患者31例,重度患者106例。所有患者均行开放性腕管切开松解减压术,其中行S型切口47例,直切口90例;73例行类固醇激素外膜下注射;56例同时行正中神经外膜松解术;29例行正中神经返支松解;2例同时行一期对掌功能重建术。结果:82例患者得到随访,随访时间6-30月。依据中华医学会手外科学会上肢周围神经功能评定试用标准,82例(中度19例,重度63例)获得随访的患者中优25例(中度18例,重度7例);良39例,(中度1例,重度38例);可15例(中度0例,重度15例);差3例(中度0例,重度3例);总优良率达78.0%。将获得随访的病例根据是否行肌电图检查、手术中切口的选择、正中神经外膜是否松解、是否外膜下注射类固醇激素、重度腕管综合征的正中神经返支松解与否进行二分类,应用SPSS 21.0软件统计进行分析得出:对于重度腕管综合征行神经松解组与未行神经松解组优良率比较,p=0.036<0.05,具有统计学意义。其他二分类形式p值均大于0.05,无统计学意义。结论:腕管切开松解减压术是治疗腕管综合征确切有效的重要手术方法之一,手术效果与切口的形状、松解神经外膜、神经外膜下注射类固醇激素无统计学相关性;术前正确的临床分型对于腕管综合征的手术治疗具有一定指导价值;对于重度腕管综合征的患者,同时行正中神经返支松解术具有临床意义;对于合并大鱼际肌萎缩的患者,我们不建议一期行对掌功能重建手术。更多还原

【Abstract】 objectve To discuss the efficacy and clinical experience in open carpal tunnel release for treatment of the carpal tunnel syndrome.Methods We retrospectfully analyse the data of the 137 patients who are diagnosed with the carpal tunnel syndrome from July 2013 to September 2016 in our hospital.There are 37 males and 100 females among the data.The age level ranges from 22 to 85 years old and the average age is 55.4 years old.There are 191 hands totally,including 77 left hands,113 right hand and bilateral 53.According to the Gu Classification,all patiants are moderate to severe level,which contains 31 moderate level patiants and 106 severe level patients.All of them underwent the carpal tunnel release.47 patients use "S" incision and 90 patients use straight incision.There are 73 patients conducting the corticosteroid injection beneath the epineurium,56 patients operating the release of the median nerve epineurium,29 patients doing the recurrent branch of median nerve releasing and 2 patients with the palmar function reconstruction in the first operation.Results 82 patients(moderate level 19 cases,severe level 63 cases)were followed-up for 6-30 months.According to the function evaluation trial standards of the upper extremity peripheral nerve from the Hand Surgery Organization of Chinese Medical Association,Excellent results were covered in 25 cases(moderate level 18 cases,severe level 7 cases),good in 39 cases(moderate level 1cases,severe level 38 cases),fair in 15 cases(no moderate level case,severe level 15 cases),and the poor in 3case(no moderate level case,severe level 3 cases).The total rate of excellent and good is about 78 percent.According to whether they were doing the electromyography examination before the surgery,the choice of the surgical incision,whether there were releasing the median nerve epineurium,whether they were injecting corticosteroid under the median nerve,whether they were operating the recurrent branch of the median nerve release,we divided all of them into two groups.We can conclude via the software SPSS 21.0 that the comparision of exellent and good rate between release of the recurrent branch of the median nerve group and no release of the recurrent branch of the median nerve,p=0.036<0.05,it has statistical significance.For other forms of binary classification,the p is greater than 0.05,there are no statistical significance.Conclusion Open carpal tunnel release is an effective surgical method,statistical association has not been found between the effect of the surgery and shape of the incision,median nerve epineurium release,corticosteroid injection beneath the median nerve epineurium.It is meaningful for preoperative clinical classification to guide the surgical treatment.For the patiens with severe carpal tunnel syndrome,it is significative to release the recurrent branch of the median nerve.We don’t consider operating the palmar function reconstruction surgery to the patients with an atrophy of the thenar muscle in their first operation.更多还原