腕管内外松解治疗腕部正中神经双卡征疗效观察

发布时间：2019-05-08 03:02

【摘要】：目的探讨腕管内、外松解治疗腕部正中神经双卡征的疗效。方法 2011年4月—2014年5月,收治31例腕部正中神经双卡征患者。男8例,女23例;年龄33~69岁,平均56.4岁。手掌桡侧3个半指皮肤两点辨别觉7~14 mm,平均9.5 mm;其中4~10 mm 24例,10 mm 7例。腕管正中神经Tinel征(+),正中神经返支手掌体表投影点处按压大鱼际肌有乏力、酸胀不适感。神经电生理检查:正中神经末梢运动潜伏期4.5~10 ms 22例,10 ms 9例;出现纤颤电位和正相电位6例;所有患者正中神经感觉传导速度减慢,运动传导速度减慢;运动神经波幅5~10 mV 19例,5 mV 12例。病程3~8个月,平均5.5个月。行腕管内正中神经及腕管外正中神经返支手术探查,尤其对正中神经返支存在的多种易卡压因素如拇短屈肌起点增厚腱弓、拇短屈肌浅头尺侧缘腱纤维束、掌腱膜深层纤维膜及变异的拇短屈肌浅头起点等给予彻底松解,解除卡压因素。结果术后患者伤口均Ⅰ期愈合,未出现伤口瘢痕痛。31例患者均获随访,随访时间24~59个月,平均33个月。所有患者夜间麻痛症状消失,正中神经返支穿入大鱼际处酸胀感消失。28例手掌桡侧3个半指皮肤感觉恢复至S4,3例示、中指指尖感觉恢复至S_(3+);正中神经支配区皮肤两点辨别觉4~6 mm,平均4.8 mm。拇指对掌功能恢复正常29例,轻度受限2例;31例握力均恢复,其中1例有明显增加。术前大鱼际肌萎缩者,术后肌力恢复至S_5 4例,S_4 2例。术后2年根据顾玉东推荐的腕管综合征功能评定标准评价,优29例,良2例,优良率100%。结论腕管内、外松解治疗腕部正中神经双卡征时,正中神经返支存在较多易卡因素,应彻底松解,可提高临床疗效。
[Abstract]:Objective to investigate the effect of internal and external release of carpal canal in the treatment of double card sign of median nerve of wrist. Methods from April 2011 to May 2014, 31 patients with double card sign of median nerve of wrist were treated. There were 8 males and 23 females with an average age of 56.4 years (33 / 69). The average 9. 5 mm; of 2-point discrimination of 3 hemi-finger skin was 9. 5 mm; (4 / 10 mm in 24 cases and 10 mm in 7 cases). The Tinel sign of median nerve of carpal tunnel showed that pressing the projection point of the back branch of (), median nerve had fatigue and acid distension at the projection point of the palmar body surface of the median nerve of carpal tunnel. Neuroelectrophysiological examination: motor latency of median nerve endings was 4.5 脳 10 ms in 22 cases and 10 ms in 9 cases, fibrillation potential and normal phase potential appeared in 6 cases, sensory conduction velocity and motor conduction velocity of median nerve slowed down in all patients. Motor nerve amplitudes were 5-10 mV in 19 cases and 5 mV in 12 cases. The course of disease was 3 months and 8 months (mean 5.5 months). Surgical exploration of the median nerve and the reentrant branch of the median nerve outside the carpal canal was performed, especially in the presence of the recurrent branch of the median nerve, such as the thickening of the tendon arch at the beginning of flexor pollicis brevis and the fibrous bundle of the ulnar edge of the flexor pollicis brevis muscle. The deep fiber membrane of palpal aponeurosis and the starting point of the superficial head of variant flexor pollicis brevis were completely loosened and the clamping factors were relieved. Results all the patients healed in stage 鈪，

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