单切口和无特殊辅助器械改良内镜松解术治疗腕管综合征的疗效观察*

Efficacy of modified endoscopic release in treatment of carpal tunnel syndrome*

摘要:

目的 探索一种单切口和无需特殊器械即可完成的关节镜下治疗腕管综合征（CTS）的新技 术体系，包括手术入路、手术标准操作流程、并发症预防及处理措施等技术环节。方法 选取2012 年4 月 -2015 年3 月由同一医师收治的46 例特发性CTS 患者，随机分为两组，传统开放手术组24 例，改良内镜组 22 例。术后评价两组患者各医疗指标的差异，包括手术时间、平均住院时间、恢复工作/ 生活时间、术中副 损伤率、术后切口感染率、临床症状缓解（Kelly 评分）、术区疼痛评估、术后两点辨别觉恢复情况和交感神 经营养不良发生率。结果 两组在切口感染率、术中副损伤率、术后两点辨别觉恢复情况、交感神经营养不 良发生率和临床症状缓解等方面比较差异无统计学意义，而改良关节镜下腕管松解组的术区疼痛评分、手术 时间、住院时间以及恢复工作时间均明显低于传统开放手术组，差异有统计学意义（P <0.01）。结论 单切 口无特殊器械辅助内镜下松解术治疗CTS 临床效果显著，是特发性CTS 的有效治疗方法，值得推广。

Abstract:

Objective To explore a new technology system with single-portal and without special equipment to complete the arthroscopic treatment of carpal tunnel syndrome. Methods All the patients with CTS were randomly divided into two groups, modified endoscopic carpal tunnel release (MECTR) group (22 cases) and open carpal tunnel release (OCTR) group (24 cases). Nine parameters were evaluated, which including operation time, intraoperative complications, two-point discrimination 3 months after the operation, hospitalization time, scar pain score, incision infection rate, each patient’s symptom amelioration (Kelly grading), the time needed to resume normal lifestyle and activity, symptoms of sympathetic dystrophy. Results No significant difference was observed between the MECTR group and OCTR group in regard to incision infection rate, intraoperative complications, two-point discrimination,symptoms of sympathetic dystrophy and clinical symptoms amelioration. In comparison to OCTS, MECTR significantly decreased operation time, hospitalization time, scar pain score and the time needed to resume normal lifestyle and activity. Conclusion MECTR for treatment of carpal tunnel syndrome has higher patient satisfaction, shorter operation time and hospitalization time, earlier return to work or normal lifestyle, less postoperative scar pain, so it is an effective method for the treatment of idiopathic carpal tunnel syndrome.