神经监护下关节镜微创治疗老年腕管综合征  

Arthroscopic carpal tunnel release in elder with carpal tunnel syndrome under eletroneurophilogy monitoring

作　　者：杨睿[1] 陈仲[1] 赵敏[1] 宋斌[1] 欧阳毅[1] 谭伟权[1] 李卫平[1] 

机构地区：[1]中山大学孙逸仙纪念医院运动医学科,广东中山510120

出　　处：《中国老年学杂志》2016年第20期5082-5084,共3页Chinese Journal of Gerontology

基　　金：国家自然科学基金面上项目(No.81472102);广东省自然科学基金(No.2015A030313085)

摘　　要：目的探讨术中应用神经电生理监测评价关节镜下钩刀联合射频消融治疗腕管综合征的安全性和疗效。方法通过年龄筛选60岁以上腕管综合征老年患者15例,气管内全麻下联合应用体感诱发电位(SSEP)及运动诱发电位(MEP)对上肢正中神经进行实时诱发电位监测。应用开口套管保护正中神经,于2.7 mm小关节镜监视下,应用关节镜钩刀联合射频消低温汽化切断腕横韧带、狭窄屈肌支持带和鱼际肌腱膜,进行腕管彻底减压。对比术前、术后术后2 d、1 w、2 w、6个月及1年月对指力、症状的严重程度评分、上肢残疾问卷评分,评价其安全性和疗效。结果15例患者术中监测稳定,腕管中置入关节镜、钩刀和射频等操作过程对神经监护影响微弱。15例患者均得到随访,平均随访时间14个月,所有患者对指力、症状的严重程度评分、上肢残疾问卷均较术前明显改善。2例患者腕部Tinel征阳性,其中1例患者同时Phalen征阳性。结论关节镜监视开口套管保护下应用钩刀联合射频消融治疗腕管综合征创伤小、恢复快,安全有效。Objective To assess the safety and effectiveness of elder carpal tunnel syndrome at the wrist that treated by arthroscopic bush-hook and radio-frequency that monitored by eletroneurophilogy in operation. Methods Fifteen hands of 60 years older patients with carpal tunnel syndrome was enrolled and somatosensory evoked potential（SSEP） and motor evoked potential（MEP） were examined for monitoring evoked potential of median nerve. 2.7 mm -arthroscope was used for observing the procedure of bush-hook and hypothermal radio frequency cut off transverse carpal ligament ,flexor retinaculum and thenar fascia for releasing carpal tunnel with medial nerve prevention by cannula. The safety and effectiveness of operation were assessed, the finger to finger, symptom ssevere scale （SSS）and disability of arm shoulder and hand（DASH） were compared between pre-operation and post-operation. Results The nervous react of the 15 patients with carpal tunnel syndrome were slightly influenced by the procedure of arthroscope, bush-hook and radio-frequency was introduced through carpal tunnel. After 14 months follow-up, the assessments of finger to finger, SSS and DASH were significantly improved in ＇all cases. Tinel sign＇ positive was found in 2 cases that 1 case had Phalen sign positive simultaneously. Conclusions Arthroscopic using bush-hook and radio-frequency for carpal tunnel releasing with prevention by cannula appears to be a safe, trauma less and effective procedure. Also, the symptom restored is more faster ＇after carpal tunnel release.

关 键 词：关节镜 腕管综合征 微创神经监测 

分 类 号：R658.2[医药卫生—外科学]