腕管综合征患者与正常人腕横韧带厚度的超声影像学研究

[目的]探讨超声测量腕横韧带厚度在腕管综合征(CTS)临床诊断中的应用价值.[方法]52侧(40例)腕管综合征(CTS)患者的手腕为CTS组,均经手术证实,术前均行超声检查,32侧(20例)正常人手腕为正常对照组,由同一人进行超声检查,测量豌豆骨水平和钩骨钩水平腕横韧带的厚度.[结果]CTS组钩骨钩水平腕横韧带厚度(0.41±0.10) cm,豌豆骨水平(0.35±0.11) cm,正常人组钩骨钩水平腕横韧带厚度(0.28±0.11) cm,豌豆骨水平(0.20±0.08) cm.CTS组与正常人组腕横韧带厚度在豌豆骨水平和钩骨钩水平均差异显著(P≤0.01).[结论]超声测量腕横韧带厚度是诊断CTS的一种新的有价值的方法,对治疗方式的选择有重要意义.     

改良Paine腕横韧带刀在腕管综合征手术中的临床研究

目的 比较改良Paine刀行微创小切口手术与传统手术治疗腕管综合征(carpal tunnel syndrome,CTS)的疗效,为临床确定理想的微创小切口腕管松解术提供理论及数据支持。 方法 收集我院自2018年12月至2023年12月CTS患者100例,术中患者均用游标卡尺测量腕横韧带厚度,根据厚度值对Paine腕横韧带刀改良。其中50例为实验组行改良Paine刀微创手术,50例为对照组行传统手术。术后随访两组患者,使用顾玉东腕管综合征功能评定标准、Levine腕管综合征问卷调查表、术后Kelly评分评价疗效,并比较两点分辨觉、切口长度、腕关节功能恢复时间、手术时间、平均住院日、术后恢复工作时间及并发症发生率等。 结果 对照组患者腕横韧带厚度为(3.98±0.75) mm,实验组(4.02±0.81) mm,两组患者差异无统计学意义( P>0.05)。实验组患者术后顾玉东腕管综合征功能评定标准、Levine腕管综合征问卷调查表、术后Kelly评分、两点分辨觉、切口长度、腕关节功能恢复时间、手术时间、平均住院日、术后恢复工作时间及术后并发症发生率较对照组更优,差异有统计学意义( P<0.05)。 结论 使用改良Paine腕横韧带刀行腕管松解术,刀头开口与腕横韧带更贴合,术后疗效优于传统手术,术中使用与之相匹配的改良Paine腕横韧带刀对治疗CTS有更明显优势。     

关节镜镜视下行腕横韧带切开术

目的 介绍在关节镜镜视下行腕横韧带切开术治疗腕管综合的方法。方法 1999年3月以来，对15例（18侧）腕管综合征采用Chow两点法在关节镜镜视下行腕横韧带切开术。腕管入口位于腕横纹近端2－3cm，掌长肌腱尺侧缘。腕关节背伸位时，将带槽套管自腕管入口处对准第3指蹼方向插入，从腕管远端穿出。在关节镜监控下用钩刀切开腕横韧带。结果 术后随访2－16上月，平均7个月。术后桡侧3指半的感觉已恢复正常。3例有拇指对掌功能和大鱼际肌萎缩者，术后3－6个月均恢复正常。无血管神经损伤和感染等并发症发生。结论 关节镜镜视下切开腕横韧带治疗腕管综合征是安全有效的微创手术。     

腕关节镜监视下腕横韧带松解术治疗腕管综合征的疗效及切口美观度分析

目的：观察腕关节镜监视下腕横韧带松解术治疗腕管综合征的疗效、并发症及切口美观度情况。方法：纳入2019年9月-2020年9月笔者医院收治的90例腕管综合征患者作为研究对象,采用非随机同期对照及患者自愿原则进行分组,观察组52例实施腕关节镜监视下腕横韧带松解术治疗,对照组38例实施开放腕横韧带松解术治疗,术后随访6个月以上。比较两组围术期参数（手术时间及术中出血量）,临床疗效,术后并发症发生情况,术前及术后末次随访关节活动度（屈伸活动度、尺桡活动度）和Michigan手功能评分（Michiganhandoutcomesquestionnaire,MHQ）情况。结果：所有患者均顺利完成手术及随访,观察组平均随访时间（8.72±1.63）个月,对照组平均随访时间（8.90±1.47）个月,组间比较差异无统计学意义（P>0.05）。观察组手术时间短于对照组,术中出血量小于对照组差异有统计学意义（P<0.05）。两组总体疗效优良率比较差异无统计学意义（P>0.05）。观察组疼痛性瘢痕及并发症总发生率均低于对照组,差异有统计学意义（P<0.05）。两组术后末次随访屈伸活动度...     

腕横韧带切除预防桡骨下端骨折迟发性腕管综合征的病例对照研究

目的：探讨桡骨下端骨折采用掌侧切口切开复位＂T＂形钢板内固定并Ⅰ期行腕横韧带切除对术后发生迟发性腕管综合征的预防作用。方法：自2000年3月至2007年3月,桡骨下端骨折患者采用两种方法治疗。采用切开复位＂T＂形钢板内固定并Ⅰ期行腕横韧带切除治疗32例,男8例,女24例;年龄46～66岁;B3型骨折21例,C1型骨折6例,C2型骨折4例,C3型骨折1例。采用单纯骨折切开复位＂T＂形钢板内固定治疗30例,男7例,女23例;年龄45～65岁;B3型骨折13例,C1型骨折9例,C2型骨折6例,C3型骨折2例。对两组术后迟发性腕管综合征发生率进行比较。结果：骨折切开复位＂T＂形钢板内固定并Ⅰ期行腕横韧带切除组32例,其中3例发生迟发性腕管综合征,而单纯骨折切开复位＂T＂形钢板内固定组30例,其中10例发生迟发性腕管综合征,两组差异有统计学意义（P〈0.05）。结论：Ⅰ期行腕横韧带切除能较好地预防桡骨下端骨折掌侧切口术后迟发性腕管综合征。     

屈腕神经压迫试验诊断腕管综合征

腕管综合征 (ＣＴＳ)是神经受压综合征中最常见的一种 ,应根据病史、体征、肌电图作出临床诊断。其中神经激惹试验是非常重要的临床指标。但是由于目前的激惹试验 (Ｐｈａｌｅｎ ｓ试验、Ｔｉｎｅｌ ｓ试验和腕管加压试验 )的敏感性和特异性有一定的局限性 ,且肌电图有一定的假阴性率和假阳性率 ,因此自 1997～ 2 0 0 0年我院采用一种新的激惹试验—屈腕神经压迫试验诊断腕管综合征 ,并与其他激惹试验作比较 ,证明了屈腕神经压迫试验是一种快速、准确的临床诊断指标。试验资料和结果报告如下。1　资料与方法1.1　一般资料病人分为研究组和对…     

超声检查在腕管综合征分期诊断中的应用及临床意义

目的 探讨彩色多普勒超声检查在腕管综合征(carpal tunnel syndrome,CTS)早、中、晚三期中的诊断作用及临床意义.方法 对50例(81侧)临床诊断为CTS的患者,按电生理分期诊断标准分为三期,其中早期25侧,中期36侧,晚期20侧.应用超声检测观察三期患者腕部正中神经受压的情况,测量并记录正中神经外膜厚度、豌豆骨平面正中神经截面积,并与电生理结果 和30例(50侧)健康志愿者腕部超声结果 进行相关性的对比研究.结果 超声检测在早期CTS患者中正中神经显示为外膜厚度增加,与对照组比较两组差异有统计学意义,豌豆骨平面正中神经截面积未见增加;在中、晚期CTS中显示正中神经的外膜厚度、豌豆骨平面正中神经截面积均增大,与对照组比较两组差异有统计学意义.56侧中、晚期CTS患者的腕管中,有49侧正中神经有受压表现,卡压点局限于屈肌支持带下方,即钩骨钩平面及桡腕关节、豌豆骨、钩骨以远平面.14侧CTS晚期患者正中神经出现神经瘤样改变.结论 对腕管综合征中、晚期的患者,超声检测可显示腕管内正中神经受压部位及程度.     

超声检查在腕管综合征诊断中的应用

目的　探讨B型超声检查在诊断和治疗腕管综合征中的临床意义。方法　对5 0例临床及电生理检测确诊为腕管综合征的患者,应用B超对腕管进行检测,并与电生理结果和3 0例正常腕管B超结果进行相关性的对比研究。结果　B超检查CTS组屈肌支持带平均厚度为0 .3 9cm(正常为0 .3 3cm) ,钩骨钩平面正中神经平均扁平度为4.5 6(正常为3 .12 ) ,桡腕关节、豌豆骨、钩骨钩、钩骨远端四个平面正中神经横截面面积均大于对照组,两组差异有统计学意义。B超显示腕管内正中神经受压的程度,与电生理诊断结果相符。结论　B超检查对明确腕部疾病的诊断、正中神经受压程度均有参考价值,为临床提供了一种简单、可靠、无创的检测方法。     

腕管综合征高频超声诊断指标的选择

目的 探讨正中神经截面积差值作为超声诊断腕管综合征(CTS)指标的准确性。方法 2018年1月-2021年3月,临床诊断CTS 31例40侧为观察组,非CTS 18例36侧为对照组,分别测量正中神经豌豆骨水平截面积CSA₁和钩骨钩水平截面积CSA₂,计算△CSA=CSA₁-CSA₂。分别比较两组CSA₁和△CSA的差异。编制CSA₁和△CSA的受试者工作特征曲线,采取预先设定临界值,确定临界值下的诊断敏感度和特异度,利用曲线下面积比较两者的诊断效率。结果 CSA₁在观察组为(15.57±2.28)mm²,在对照组(8.06±1.36)mm²,两组比较差异有统计学意义(P<0.01);△CSA在观察组(3.65±1.31)mm²,对照组(0.26±0.15)mm²,两组比较差异有统计学意义(P<0.01)。预设临界值法表明,CSA     

腕管综合征治疗研究进展

目的对腕管综合征(carpal tunnel syndrome,CTS)的治疗研究现状作一综述。方法查阅近年来国内外CTS治疗的相关文献,进行分析总结。结果腕夹板、类固醇适用于轻、中度CTS患者,近期效果显著;治疗后复发的CTS患者需采取手术治疗。主要术式为腕管松解术,包括腕管切开松解减压术(传统型和小切口型)、内镜下腕管松解减压术等。结论 CTS的最佳治疗方法尚无定论,部分学者推荐首选手术治疗。     

The usefulness of ultrasonography in the diagnosis of carpal tunnel syndrome

This study assessed the use of ultrasound in the diagnosis of carpal tunnel syndrome and to determine the best ultrasound criterion for diagnosis. Forty wrists of 27 patients with surgically proven moderate and severe carpal tunnel syndrome and 30 wrists of 15 controls were examined. Measurements of the cross-sectional area and the anteroposterior diameter of the median nerve at the inlet and outlet of the carpal tunnel were obtained. Patients also underwent electrophysiological evaluation. Median nerve ultrasonographic measurements were significantly higher in patients. The cross-sectional area of the median nerve at the tunnel inlet was found to be the most useful diagnostic criterion. The optimal cut-off value was 6.5 mm2 (sensitivity 89.5%, specificity 93%). Ultrasound parameters failed to correlate with the electrophysiological findings. The usefulness of ultrasonography in the diagnosis of carpal tunnel syndrome is discussed.     

Treatment of carpal tunnel syndrome : from ultrasonography to ultrasound guided carpal tunnel release

Carpal tunnel syndrome is the most common nerve entrapment syndrome. The majority of cases are due to compression or irritation of the median nerve in the carpal canal. It is diagnosed clinically, often being confirmed by an electromyogram, while ultrasonography criteria have become increasingly useful for the diagnosis. Ultrasonography is better tolerated, less expensive, yet just as effective as other diagnostic methods. It provides a good indication of the severity of the condition and it allows anatomical variants to be discerned. In light of this, for a number of medical professionals it is the first-line examination. In terms of therapeutic use, ultrasound can be used to guide infiltrations. In case medical treatment is unsuccessful, release by transection of the flexor retinaculum is generally done surgically as an open procedure or by endoscopy. A new minimally invasive percutaneous treatment to release the nerve based on ultrasonography guided or ultrasound surgery appears to be a promising alternative, however, to conventional open surgery or endoscopic treatments.     

腕管综合征与肘管综合征诊治中的有关问题

腕管与肘管综合征是手外科临床中最常见的二类周围神经卡压征,如何规范它们的诊治标准是进一步开展临床研究的必要条件,为此笔者将近期有关资料进行综合,并提出相关的诊治标准,供全国同道讨论、修改与参考.     

Postoperative morphologic analysis of carpal tunnel syndrome using high-resolution ultrasonography

The authors evaluated the morphologic changes that follow division of the transverse carpal ligament in patients with carpal tunnel syndrome (CTS) using high-resolution ultrasonography. Ten patients, for a total of 20 hands, underwent high-resolution ultrasonographic studies before the operation and 8 months after the operation. They were all diagnosed with bilateral idiopathic CTS. The authors evaluated the configuration of the median nerve and carpal tunnel at 3 different levels of the wrist: the distal radiocarpal joint level, the pisiform level, and the hook of hamate level. The median nerve gained in thickness to a remarkable extent at 2 distal levels after the operation. The change in morphology of the carpal tunnel at these 2 distal levels was obvious, but the cross-sectional area of the carpal tunnel was increased significantly only at the hook of hamate level. The transverse diameters of the carpal tunnel were not significantly changed. As mentioned, the authors found that the median nerve gained significantly in volume at the distal part of the carpal tunnel postoperatively, and the volumetric increase in the carpal tunnel appears to have resulted from an anterior displacement of newly formed transverse carpal ligament, rather than from a widening of the bony carpal arch.     

Is mere surgical division of the transverse carpal ligament in treatment of carpal tunnel syndrome adequate?

In the period between 1985-1986 137 patients underwent simple nerve decompression by division of the carpal ligament as therapy for carpal tunnel syndrome. In a long-term follow-up it was possible to control the results of 61 cases. Beside two patients all showed an absolutely satisfying result, subjectively as well as electroneurophysiologically. Therefore we can recommend simple ligament division as a safe and quick method for the therapy of carpal tunnel syndrome.     

A clinical questionnaire for the diagnosis of carpal tunnel syndrome

This prospective study compared the sensitivities of a scored questionnaire and electrophysiological examination in the diagnosis of carpal tunnel syndrome. Patients were assessed by a hand surgeon using a scored questionnaire, and then underwent an electrophysiological assessment by an experienced neurophysiologist (blinded to the questionnaire results). Patients diagnosed as having carpal tunnel syndrome by either the questionnaire, the electrophysiological examination or both underwent decompression. Symptom relief was taken as the "gold standard" for true carpal tunnel syndrome. The results showed a sensitivity of 85% for the scored questionnaire and 92% for nerve conduction studies with a positive predictive value of 90% for the scored questionnaire and 92% for nerve conduction studies. The authors recommend that a scored questionnaire can replace nerve conduction studies in the initial assessment of whether patients presenting with dysaesthesiae in the fingers should undergo surgery. This will give major time, personnel and cost benefits.     

The value of the history in the diagnosis of carpal tunnel syndrome

Details of the clinical history were elicited by questionnaire from 8,223 patients with suspected carpal tunnel syndrome and compared with the neurophysiological findings. Distribution of symptoms to the radial part of the hand and nocturnal exacerbation of symptoms showed the strongest individual correlations with positive nerve conduction studies. The regression model derived from the complete questionnaire achieved an overall sensitivity of 79% and specificity of 55% for the diagnosis of carpal tunnel syndrome when compared with the nerve conduction study results as a gold standard. A simple regression model for evaluating the history compares favourably with widely used clinical signs in its ability to predict the findings of nerve conduction studies.