摘要
目的探讨内镜下手术治疗伴有滑膜增生的腕管综合征(CTS)的临床疗效.方法2000年5月至2015年9月,采用手术治疗CTS共79腕,对照组(腕管内无病理性滑膜增生,共38腕)在内镜下切开腕横韧带,试验组(腕管内有病理性滑膜增生,共41腕)在内镜下切开腕横韧带后,经腕部切口切除屈肌腱周围增生的滑膜组织.统计术后两组患者正中神经感觉传导速度增加值、远端运动电位潜伏期降低值、两点辨别觉、握力、捏力及Tinel征、Phalen征阳性率之间的差异,并按Kelly分级计算优良率.P<0.05为差异有统计学意义.结果在对照组和试验组:①按Kelly分级,术后优良率分别为94.7%和95.1%,两组间差异无统计学意义(P>0.05).②两组Tinel征、Phalen征阳性率较术前分别显著降低至2.6%和2.4%(P<0.05),但两组间差异无统计学意义(P>0.05).③术后两组的两点辨别觉平均值分别为(3.7±1.1)mm、(3.5±0.9)mm,两组间差异无统计学意义(P>0.05).④手术前后,两组的感觉神经传导速度增加值分别为(14.3±5)m/s和(16.1±6)m/s,远端运动电位潜伏期降低值分别为(0.8±0.3)ms和(0.7±0.4)ms,两组之间上述两个指标间的差异均无统计学意义(P>0.05).结论内镜下切开腕横韧带并切除增生滑膜组织,用于治疗伴有滑膜增生的特发性CTS,可获得与不伴有滑膜增生的特发性CTS相仿的预后,近期随访效果满意,值得推广;此类CTS开放式手术可能不是必须的.
Objective To explore the clinical effect of endoscopic treatment of carpal tunnel syndrome(CTS) with subsynovial hyperplasia.Methods Thirty-eight wrists of idiopathic CTS (control group) without subsynovial connective tissue (SSCT) hyperplasia and 41 wrists of idiopathic CTS with SSCT hyperplasia (experimental group) were surgically treated under endoscope from May,2000 to September,2015,and they were retrospectively studied at clin ic.The endoscopic release of the transverse ligament of wrist was done in the control group.While in the experimental group,the SSCT around the flexor tendons in the carpal tunnel was removed additionally after transverse ligament re lease through the same incision.The varieties of sensory nerve conduction velocity (SNCV),distal motor lantacy(DML),two points of discrimination (TP).Tinel sign,Phalen sign,grip and pinch force before and after operation in both groups were statistically calculated and compared,then the excellent and good rate according to Kelly classification was calculated.The difference was considered as statistically signifcant when P<0.05.Results For the control group and experimental group:①According to Kelly classification,the overall excellent and good rate were 94.7% and 95.1% respectively.There was no statistical difference between 2 groups (P>0.05).②The positive rate of Tinel sign and Phalen sign were significantly reduced to 2.6% and 2.4% respectively (P<0.05).But there was no statistical difference between 2 groups (P>0.05).③The average TP were (3.7±1.1) mm and (3.5±0.9) mm respectively.There was no statistical difference between 2 groups (P>0.05).④The SNCV of the 2 groups were (14.3±5) m/s and (16.1±6) m/s,and the DML of the 2 groups were (0.8±0.3) ms and(0.7±0.4) ms respectively,while there was no statistic differences regarding SNCV and DML before and after operation between the 2 groups (P>0.05).Conclusion Similar and satisfactory recent clinical effect can be harvested with cutting transverse ligament under endoscope and removing SSCT aroun
作者
李俊杰
祝斌
杨科跃
王科杰
张健
蔡晓明
竺枫
王欣
Li Junjie;Zhu Bin;Yang Keyue;Wang Kejie;Zhang Jian;Cai Xiaoming;Zhu Feng;Wang Xin(Department of Hand Surgey,Ningbo No.6 Hospital,Ningbo,Zhejiang Province 315000,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2019年第3期237-240,共4页
Chinese Journal of Microsurgery
关键词
腕管综合征
内镜
滑膜下结缔组织
正中神经
Carpal tunnel syndrome
Endoscope
Subsynovial connective tissue
Median nerve
