改良腕關(guān)節(jié)鏡及小切口治療腕管綜合征的臨床研究
發(fā)布時(shí)間：2018-12-25 15:36
【摘要】：背景： 腕管綜合征(carpal tunnel syndrome, CTS)指的是腕管內(nèi)正中神經(jīng)受到卡壓而引起的一組臨床癥狀和體征,是上肢最常見的周圍神經(jīng)卡壓征。腕管松解減壓術(shù)即切斷屈肌支持帶、解除正中神經(jīng)卡壓的手術(shù),是外科治療腕管綜合征的經(jīng)典方法,分切開松解減壓(open carpal tunnel release, OCTR)和內(nèi)窺鏡松解減壓(endoscopic carpal tunnel release, ECTR)兩種形式。開放術(shù)式手掌部的皮膚切開易損傷正中神經(jīng)的掌皮支,雖然切口從長度、形狀不斷發(fā)生多種多樣的變更,但最終難免在手掌部殘留手術(shù)瘢痕和形成掌皮支神經(jīng)瘤所產(chǎn)生的疼痛性瘢痕。 目的： 使用改良的ECTR (Improved ECTR)法治療CTS。并與其他三種常用方法進(jìn)行治療效果比較。 方法： 按手術(shù)方法分為四組：(1)傳統(tǒng)直視下腕部切開松解正中神經(jīng)術(shù)組(OCTR);(2)傳統(tǒng)內(nèi)窺鏡下松解正中神經(jīng)術(shù)(ECTR)；(3)小切口行腕部松解正中神經(jīng)術(shù)(minimal incision carpal tunnel relese,MICTR)；(4)改良內(nèi)窺鏡下松解正中神經(jīng)術(shù)(IECTR),采用的手術(shù)方法在正中神經(jīng)魚際支體表投影處,采取近側(cè)掌紋處小切口切開直接松解魚際支神經(jīng),并在使用鉤刀時(shí)予以直接保護(hù),避免損傷。其余松解減壓術(shù)與Okutsu內(nèi)窺鏡方法相同。術(shù)后進(jìn)行了6-24月的門診隨診,隨訪術(shù)后一般情況及術(shù)后并發(fā)癥、客觀指標(biāo)的測評和主觀指標(biāo)的評分,并進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 術(shù)后6個(gè)月OCTR組和MICTR組疤痕較其他兩組壓痛明顯(P0.05), IECTR組恢復(fù)正常生活時(shí)間早于其他各組(P0.05)。兩點(diǎn)辨別覺、Tinel征、Phalen試驗(yàn)陽性率、電生理檢測及Levine腕管問卷調(diào)查評分各組間均無統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論： 采用腕關(guān)節(jié)鏡在近腕橫紋處及近側(cè)掌橫紋近端皮膚小切口利用勾刀、推刀切開腕橫韌帶減壓松解正中神經(jīng)術(shù)治療腕管綜合征具有松解徹底、切口愈合快、無常規(guī)切口疼痛性疤痕及松解和保護(hù)正中神經(jīng)魚際支不損傷等優(yōu)點(diǎn),為改良的內(nèi)窺鏡下治療腕管綜合征的方法。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R688
本文編號：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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R688
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相關(guān)期刊論文 前2條
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2 王啟華,劉慶麟,鐘偉雄;腕管的應(yīng)用解剖學(xué)[J];臨床解剖學(xué)雜志;1987年03期
，本文編號：2391308
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