环线切割手术治疗腕管综合征的初步临床观察  

The preliminary outcomes of percutaneously looped thread transection in the surgical treatment of carpal tunnel syndrome

作　　者：王易彬 汤宇[2] 徐子涵[2] 吉毅峥[3] 孙天胜[2] 

机构地区：[1]安徽医科大学北京军区总医院临床学院,合肥230032 [2]北京军区总医院骨科,100700 [3]北京军区总医院超声科,100700

出　　处：《中华骨科杂志》2016年第3期129-135,共7页Chinese Journal of Orthopaedics

基　　金：首都市民健康项目培育（Z131100006813035） 【致谢】感谢美国的郭丹竹医生、郭丹青医生和郭学则博士提供手术使用的切割线.

摘　　要：目的探讨环线切割手术治疗腕管综合征的初步临床疗效。方法2012年1月至2014年12月共收治腕管综合征患者72例（103侧），男27例，女45例；年龄22-94岁，平均51．3岁。采用切开减压手术21例（30侧）、环线切割手术51例（73侧）。切开手术于掌心鱼际纹尺侧做切口，显露腕横韧带并切断，达到腕管减压的目的。环线切割手术在超声引导下进行，分别从腕横韧带的深层及浅层穿线，形成环套切断腕横韧带，使腕管减压。于术前、术后3个月行超声检查，观察正中神经长宽比（钩骨层面正中神经横断面的长和宽的比值）和肿胀比（豌豆骨层面与桡骨远端层面正中神经横断面积的比值）；术前、术后3个月采用波士顿腕管综合征评分量表（Boston carpal tunnel questionnaire, BCTQ）评估腕管综合征症状以及腕关节功能。结果11例失随访，61例随访3-27个月，平均11．6个月。切开减压组与环线切割组术前BCTQ评分分别为（28．5±4．6）分、（29．4±5.3）分，两组差异无统计学意义（t=1．34，P=0.528）。术后3个月BCTQ评分分别为（16．3±5．7）分、（15．7±4．9）分，两组差异无统计学意义（t=1．12，P=0.674）。术后3个月两组BCTQ评分均较术前下降，差异均有统计学意义（P均〈0．05）。切开减压组术前、术后3个月超声检查示正中神经长宽比分别为3．8±0．7、2．6±0．4，肿胀比分别为2．3±0．4、1．2±0．3，手术前后比较差异均有统计学意义（P均〈0．05）。环线切割组术前、术后3个月正中神经长宽比分别为3．9±0．6、2．7±0．5，肿胀比分别为2．1±0．3、1．4±0．4，手术前后的差异均有统计学意义（P均〈0.05）。两组正中神经长宽比、肿胀比的差异均无统计学意义（P均〉0．05）。切开减压组和环线切割组术后均无感染、愈合不良及血管、神经损伤等并发症发生。结论超声引�Objective To study the preliminary effects of percutaneously looped thread transection on the surgical treatment of carpal tunnel syndrome （CTS）. Methods A total of 72 cases （103 sides） were treated from January 2012 to December 2014 （27 males and 45 females, aged 22-94 years, with an average of 51.3 years）. Among all the cases, 21 cases （30 sides） were treated with open decompression and 51 cases （73 sides） were treated with percutaneously looped thread transection. We did the incision in the ulnaris hypothenar pattern, revealed and cut off the transverse carpal ligament to decompress the carpal tunnel in the open surgery. Percutaneously looped thread transection was under the guidance of ultrasound, threading from the deep and shallow transverse carpal ligament, respectively, forming loops to cut off and decompressed the carpal tunnel. We observed the median nerve aspect ratio （the ratio of length to width of the uncinatum median nerve on transverse section） and swelling ratio （the ratio of area of median nerve on transverse section of pisiform and distal radius） under ultrasound before, during and 3 months after operation. Telephone follow-up was conducted in postoperative 3 months according to the Boston Carpal Tunnel Questionnaire （BCTQ） to evaluate the symptoms of carpal tunnel syndrome and wrist joint function. Results There were 11 cases lost in the follow-up, and 61 cases were followed up for 3 to 27 months, with an average of 11.6 months. The preoperative BCTQ scores of open decompression group and looped thread transection group were 28.5±4.6 and 29.4±5.3, respectively. There was no statistically significant difference between two groups （t=1.34, P=0.528）. The postoperative 3 months BCTQ scores were 16.3±5.7 and 15.7±4.9. There was no statistically significant difference between two groups （t=1.12, P=0.674）. The median nerve aspect ratios measured under ultrasound of open decompression group before and 3 months after operation were 3.8±0.7 and 2.6±0.4, resp

关 键 词：腕管综合征 外科手术 微创性 超声检查 减压术 外科 

分 类 号：R688[医药卫生—骨科学]