远侧腕横纹处小切口与传统纵切口治疗腕管综合征的临床对比分析

发布时间：2018-04-05 16:28

本文选题：腕管综合征　切入点：小切口　出处：《扬州大学》2017年硕士论文

【摘要】：目的分别采用腕横纹处小切口和传统纵切口手术治疗需要手术的腕管综合征患者,根据患者术前及术后手功能评分变化评价腕横纹处小切口是否具有更优的疗效。方法自2008年9月至2012年9月,在我院分别采用传统纵形切口和远侧腕横纹处横形小切口治疗84名需要手术的腕管综合征患者,共106例患手。其中12名男性患者(14%),72名女性患者(86%);年龄27～81岁,平均年龄53岁。对于既往手腕部外伤史以及腕管内有占位性病变等疾病的患者排除在外。依据患者手术方式的不同,将84名患者分为两个组。传统纵形切口组(open carpal tunnel release,OCTR):4名男性患者、6例患手;34名女性患者、40例患手。远侧腕横纹横形小切口组(small incision carpal tunnel release,SICTR):6名男性患者、10例患手;40女性患者、50例患手。在患者住院期间客观记录手术时间、术中失血量、住院时间等;在随访期间观察并记录患者术后并发症的发生情况及恢复情况,如握力和捏力的恢复情况、柱状痛的发生率、感觉恢复情况等。术后随访数据采用SSPS16.0统计软件进行统计学分析,运用完全随机设计两样本比较的秩和检验对患者术前、术后的手功能评分结果进行对比分析。结果在随访期内(13～24个月),平均11.6个月,其中18名患者失访,未前往我院门诊随访(传统切口组:6名,小切口组:12名)。两组患者患手术后均未出现切口感染的情况。传统切口组术后7例柱状痛、8例复发、2例疤痕过度增生;小切口组术后均无明显神经损伤情况,但3例柱状痛、1例复发、3例感觉异常改善不明显。腕管综合征手功能评分传统切口组:术前2.97±0.87,术后6.83±1.15;小切口组:术前3.41±0.95,术后10.11±0.99。两组术前评分秩和检验P0.05(α =0.05),差异无统计学意义;两组术后评分秩和检验P0.05(α=0.05),差异有统计学意义。结论传统纵形切口的术后并发症相对于腕横纹处横形小切口较多。腕横纹处横形小切口手术具有安全性相对较高、手术时间相对短、创伤较小、美容外观、术后瘢痕过度增生发生率低、住院时间短及费用低等优点。
[Abstract]:Objective to evaluate the efficacy of small incision of carpal striation and traditional longitudinal incision in the treatment of carpal tunnel syndrome patients before and after operation.Methods from September 2008 to September 2012, 84 patients with carpal tunnel syndrome were treated with traditional longitudinal incision and small transverse incision of distal carpal stria, including 106 patients with carpal tunnel syndrome.Twelve male patients and 72 female patients aged 2781 years with an average age of 53 years.Patients with previous wrist trauma and carpal tunnel lesions were excluded.Eighty-four patients were divided into two groups according to the different operation methods.In the traditional longitudinal incision group, open carpal tunnel release OCTR: 4 male patients had 6 cases of hand and 34 cases of female patients with 40 cases of hand.Small incision carpal tunnel release: six male patients with distal transverse stripe of wrist were divided into 10 cases and 40 cases of female patients, and 50 cases of them were involved in the group of small transverse carpal stripe and small incision group, and 50 cases were involved in the group of small incision carpal tunnel release.The time of operation, the amount of blood lost during the operation, the duration of hospitalization were recorded objectively during the period of hospitalization, and the occurrence and recovery of postoperative complications, such as the recovery of grip strength and pinch strength, the incidence of columnar pain, were observed and recorded during the follow-up period.Feel a recovery, etc.The postoperative follow-up data were statistically analyzed by SSPS16.0 software, and the results of hand function score before and after operation were analyzed by rank sum test, which were compared by completely random design of two samples.Results during the follow-up period, there were 13 ~ 24 months (mean 11.6 months), in which 18 patients lost their visits and did not go to our outpatient clinic to follow up (traditional incision group: 6 cases, small incision group: 12 cases).There was no incision infection in both groups.In the traditional incision group, there were 7 cases of columnar pain and 8 cases of recurrence and 2 cases of hyperplastic scar after operation, while in the small incision group, there was no obvious nerve injury after operation, but in 3 cases of columnar pain, 1 case of recurrence and 3 cases of abnormal sensory improvement were not obvious.Traditional incision group: 2.97 卤0.87 before operation, 6.83 卤1.15 after operation, small incision group: 3.41 卤0.95 before operation, 10.11 卤0.99 after operation.There was no significant difference between the two groups in the preoperative score rank sum test (伪 -0.05) and the postoperative score rank sum test (P0.05), the difference was statistically significant.Conclusion the postoperative complications of the traditional longitudinal incision are more than those of the transverse incision of wrist.The transversal small incision at transverse striation of wrist has the advantages of relatively high safety, relatively short operation time, less trauma, less cosmetic appearance, low incidence of hypertrophic scar, short hospital stay and low cost.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R688

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