改良腕关节镜及小切口治疗腕管综合征的临床研究
发布时间：2018-12-25 15:36
【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(P0.05), IECTR组恢复正常生活时间早于其他各组(P0.05)。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(P0.05)。 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 (carpal tunnel syndrome, CTS) refers to a group of clinical symptoms and signs caused by the compression of the median nerve in the carpal tunnel, which is the most common peripheral nerve compression sign in the upper limb. Carpal tunnel decompression is the classic surgical treatment of carpal tunnel syndrome, which is to cut off flexor spurs and relieve median nerve compression. It is divided into open decompression (open carpal tunnel release, OCTR) and endoscope decompression (endoscopic carpal tunnel release,. ECTR) in two forms. Open incision of the palm can easily damage the metacarpal cutaneous branch of the median nerve, although the incision changes in length and shape in a variety of ways. But it is inevitable that surgical scar and painful scar caused by palmar cutaneous neuroma will remain in the palm. Objective: to use the modified ECTR (Improved ECTR) method to treat CTS. The therapeutic effect was compared with other three common methods. Methods: according to the method of operation, the patients were divided into four groups: (1) (OCTR); (2) under traditional direct looking wrist incision and decompression of median nerve (ECTR);) (3) the median neurorrhaphy of the wrist was performed with a small incision (minimal incision carpal tunnel relese,MICTR). (4) the modified endoscopic neurolysis of median nerve (IECTR),) was performed at the projection of the hypothenar branch of the median nerve. A small incision at the proximal palmprint was used to release the hypothenar nerve directly and to protect the nerve directly when the hook was used. Avoid damage. Other decompression procedures were the same as Okutsu endoscopy. The patients were followed up for 6 to 24 months. The general situation, postoperative complications, objective index and subjective index were evaluated and analyzed statistically. Results: six months after operation, the scar in OCTR group and MICTR group was significantly higher than that in the other two groups (P0.05). The recovery time of normal life in), IECTR group was earlier than that in other groups (P0.05). There were no statistical differences among the two points discrimination, Tinel sign, positive rate of Phalen test, electrophysiological test and Levine carpal tunnel questionnaire (P0.05). Conclusion: the treatment of carpal tunnel syndrome by wrist arthroscopy in the proximal transverse carpal stripe and proximal metacarpal striated skin small incision with hook knife and push knife incision for decompression and release of median nerve of transverse carpal ligament has the advantages of complete release and quick wound healing. The treatment of carpal tunnel syndrome by endoscope is an improved method without the advantages of pain scar and release and protection of median nerve hypothenar branch without conventional incision.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R688
本文编号：2391308
[Abstract]:Background: carpal tunnel syndrome (carpal tunnel syndrome, CTS) refers to a group of clinical symptoms and signs caused by the compression of the median nerve in the carpal tunnel, which is the most common peripheral nerve compression sign in the upper limb. Carpal tunnel decompression is the classic surgical treatment of carpal tunnel syndrome, which is to cut off flexor spurs and relieve median nerve compression. It is divided into open decompression (open carpal tunnel release, OCTR) and endoscope decompression (endoscopic carpal tunnel release,. ECTR) in two forms. Open incision of the palm can easily damage the metacarpal cutaneous branch of the median nerve, although the incision changes in length and shape in a variety of ways. But it is inevitable that surgical scar and painful scar caused by palmar cutaneous neuroma will remain in the palm. Objective: to use the modified ECTR (Improved ECTR) method to treat CTS. The therapeutic effect was compared with other three common methods. Methods: according to the method of operation, the patients were divided into four groups: (1) (OCTR); (2) under traditional direct looking wrist incision and decompression of median nerve (ECTR);) (3) the median neurorrhaphy of the wrist was performed with a small incision (minimal incision carpal tunnel relese,MICTR). (4) the modified endoscopic neurolysis of median nerve (IECTR),) was performed at the projection of the hypothenar branch of the median nerve. A small incision at the proximal palmprint was used to release the hypothenar nerve directly and to protect the nerve directly when the hook was used. Avoid damage. Other decompression procedures were the same as Okutsu endoscopy. The patients were followed up for 6 to 24 months. The general situation, postoperative complications, objective index and subjective index were evaluated and analyzed statistically. Results: six months after operation, the scar in OCTR group and MICTR group was significantly higher than that in the other two groups (P0.05). The recovery time of normal life in), IECTR group was earlier than that in other groups (P0.05). There were no statistical differences among the two points discrimination, Tinel sign, positive rate of Phalen test, electrophysiological test and Levine carpal tunnel questionnaire (P0.05). Conclusion: the treatment of carpal tunnel syndrome by wrist arthroscopy in the proximal transverse carpal stripe and proximal metacarpal striated skin small incision with hook knife and push knife incision for decompression and release of median nerve of transverse carpal ligament has the advantages of complete release and quick wound healing. The treatment of carpal tunnel syndrome by endoscope is an improved method without the advantages of pain scar and release and protection of median nerve hypothenar branch without conventional incision.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R688
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相关期刊论文 前2条
1 史其林,薛峰,王金武,顾玉东;腕管综合征在内窥镜视下手术与常规手术的疗效比较[J];中华手外科杂志;2000年03期
2 王启华,刘庆麟,钟伟雄;腕管的应用解剖学[J];临床解剖学杂志;1987年03期
，本文编号：2391308
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