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.     

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。     

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。     

腕管综合征

腕管综合征是正中神经在腕管内被卡压引起的一组症状与体征。解剖特点腕管由骨和韧带形成的隧道,其底及两侧由腕骨组成,腕横韧带横跨其上;尺侧附于豌豆骨和钩骨钩,桡侧为舟骨结节和大多角骨嵴。腕横韧带致密坚固缺乏弹性,近侧1/3平均厚2.5mm,中、远1/3约厚3.6mm。管内有拇长屈肌腱、8根屈指浅、深肌腱和正中神经。10％的人尚有一根较大的正中动脉通过腕管。正中神经位置最浅,在肌腱和腕横韧带之间。腕管内肌腱由尺侧和桡侧滑囊包绕。在腕中立位时腕管容积最大,掌屈则变小。由于这些解剖特点,一旦腕管缩小或内容物增大、增多,正中神经即易被卡压。大鱼际肌运动支在腕横韧带远     

显微技术在治疗腕管综合征中的应用

目的探讨显微技术在治疗腕管综合征中的应用价值。方法随机将62例腕管综合征患者分为A、B两组，A组在腕横韧带切开的基础上，应用手术显微镜行正中神经内松解术；B组单纯行腕横韧带切开减压术。比较两组术前、术后在症状、体征、肌电图方面的改变。结果随访8～18个月，平均12个月。按自拟疗效评估标准判定，A组优良率92．5％，B组优良率70．97％。结论在腕横韧带切开的基础上，采用显微技术行正中神经内减压治疗腕管综合征可显著提高手术效果。     

滑膜水肿增厚致腕管综合征30例手术治疗经验

目的探讨滑膜切除及腕横韧带重建术在滑膜水肿增厚所致腕管综合征的疗效及对腕横韧带功能保留的作用。方法 2010年3月-2016年5月,对30例(32侧)滑膜水肿增厚导致腕管综合征采用滑膜切除及腕横韧带重建术。结果经3～12个月随访,平均8个月。术后拇示中指感觉、示指末节两点辨别觉恢复良好。术后6个月3例拇指对掌功能障碍功能恢复。据腕管综合征评定标准:优22侧,良7侧,可3侧。结论滑膜切除及腕横韧带重建术是治疗滑膜水肿增厚导致腕管综合征及保留腕横韧带功能有效的治疗方法。     

内窥镜下治疗腕管综合征89例报告

目的 :探讨应用内窥镜技术治疗腕管综合征 (ECTR) ,从腕管内切断腕管横韧带 ,解除其对正中神经压迫的手术方法及技巧。并对其术后疗效进行分析 ,介绍内窥镜下治疗腕管综合征的经验与疗效。方法 :局部麻醉 ,皮肤 1cm切口 ,在内窥镜下切断腕管横韧带。松解受压的正中神经。据Kelly疗效评定标准 ,对其术后疗效进行分析评价。结果 :临床应用 165例 192腕 ,手术时间平均 10min ,出血少 ,术后随访 89例 98腕 ,优 73腕 ;良 2 0腕 ;一般 3例 ;差 2例 ,其中 2例发生术后正中神经粘连 ,行 2次手术。结论 :内窥镜技术治疗腕管综合征 (ECTR)皮肤切口小 ,组织创伤轻 ,手术时间短 ,术后不需石膏外固定 ,不残留手术瘢痕。注意手术适应证 ,是一种安全有效的微创手术方法。     

微型钩刀治疗腕管综合征12例报告

目的 观察微型钩刀治疗腕管综合征的疗效。方法 在掌长肌腱尺侧，距腕横纹近侧1cm作1cm长的横切口，分离到深筋膜并切开，插入槽型扩张导管，在槽的导引下插入微型钩刀，从远至近把腕横韧带完全钩割开。结果 术后4周随访，12例中10例症状完全消失，2例症状改善；术后随访1年，3例术前大鱼际肌肉明显萎缩，都有明显好转。结论 微型钩刀治疗腕管综合征是一种简单、安全有效的治疗方法。     

痛风石致腕管综合征的病例分析

目的 探讨痛风石导致的腕管综合征的临床特点,以期指导其诊断和治疗.方法 回顾性分析2008年1月至2010年10月收治的6例腕管综合征患者,病程1～6个月,平均(3.0±0.6)个月.6例均为单发,除腕部外的身体其他部位均未发现痛风石.在行腕管切开减压时,发现腕管内有痛风石生长,痛风石侵犯指屈肌腱和正中神经.术中刮除痛风石,切开腕横韧带,解除周围组织对正中神经的压迫,行正中神经外膜或束膜松解术.结果 6例患者伤口均Ⅰ期愈合,手指麻木症状减轻.术后发现5例患者血尿酸升高,1例患者血尿酸正常.随访10～ 25个月,平均(17.0±5.3)个月,腕管综合征症状消失4例,缓解2例,未见新的痛风石出现.结论 痛风石导致的腕管综合征好发于男性,多伴有血尿酸升高,腕部B超、CT或MRI检查对其有诊断意义;腕横韧带切开,痛风石清除和正中神经外膜松解术是治疗痛风石导致的腕管综合征的有效方法.     

小双切口治疗腕管综合征15例体会

目的 介绍应用小双切口作腕管切开治疗腕管综合征的方法及临床效果。方法 在掌长肌腱尺侧，平行远侧腕横纹作1．5cm长的横切口，腕横纹以远2．5cm为中心沿鱼际肌纹作1cm长的纵切口，分别显露腕横韧带远近缘及指屈肌腱及正中神经，直视下将腕横韧带完全切开，正中神经外膜松解3例，鱼际肌支松解1例。结果 术后2周，15例症状完全消失，拇、示、中3指指腹两点辨别觉恢复正常。术后1年随访，术前大鱼际肌萎缩5例，肌萎缩明显改善，拇指对掌功能恢复正常。全部病例无1例产生腕掌部瘢痕疼痛及尺神经、掌浅弓损伤等并发症。结论 小双切口行腕管松解术，可操作窄间大，并发症少，术后美观。是治疗腕管综合征的有效方法。     

Relationship of carpal canal contents volume to carpal canal pressure in carpal tunnel syndrome patients

Forty patients long-term haemodialysis with a second recurrence of carpal tunnel syndrome and concomitant loss of flexor tendon function due to flexor adhesions were treated by excision of the flexor digitorum superficialis tendons. During the procedure the carpal canal pressure was measured using a continuous infusion technique. The preoperative mean carpal canal pressure was 81 (SD, 53)mmHg. After removal of all the flexor digitorum superficialis tendons, the carpal canal pressure decreased to 10 (SD, 8)mmHg. The clinical symptoms of carpal tunnel syndrome were relieved and hand strength and finger motion were improved in all patients.     

Human carpal ligament recruitment and three-dimensional carpal motion

In five fresh human cadaver wrist joints six carpal ligaments and seven carpal bones were marked with small, radio-opaque pellets. Using a roentgenstereophotogrammetric measuring system, the ligamentous length changes and the kinematics of carpal bones were determined in different flexion and deviation positions of the hand. The data generated by this method differ significantly from lengthening data predicted by current concepts on carpal ligament functioning. The motions of carpal bones and the lengthening of the carpal ligaments were related to each other. It appeared that most carpal ligaments lengthen only during one half of a full movement cycle. Hence, ligaments seem to constrain either a dorsal- or a palmar-directed motion of the hand, or an ulnar- or a radial-directed motion of the hand. When the hand is in maximal radial deviation or maximal palmar flexion, none of the ligaments has a greater length than in the neutral situation. The tested parts of the lunatotriquetrum palmar ligament do not lengthen during any movement of the hand. Significant lengthening relative to the neutral situation was found for the radiocapitate palmar ligament (6.5% in maximal ulnar deviation and 11.7% in maximal dorsal flexion of the hand), and for the distal string of the radiolunate palmar ligament (6.4% in maximal ulnar deviation). It was confirmed that the carpals, apart from moving in the plane in which the hand motion takes place, also execute considerable out-of-plane motions during hand motions. The combination of these experimentally and simultaneously determined data on length change and on the movements of carpal bones are found to be necessary in order to give suitable explanations for the observed separate kinematical phenomena.     

Segmental carpal canal pressure in patients with carpal tunnel syndrome

PURPOSE: To clarify which part of the median nerve is the most compressed and to compare carpal canal pressure with the latency of the sensory nerve potential and the duration of symptoms. METHODS: Fifteen patients with idiopathic carpal tunnel syndrome were studied using a pressure guidewire system to record canal pressure. The wire was introduced from the distal end of the carpal canal to 2 cm proximal to the distal wrist crease (DWC) and then retracted in 5-mm increments using an image intensifier to guide the progress. A nerve conduction study was performed, and all patients were asked how long the symptoms lasted. RESULTS: Carpal canal pressure was significantly higher 5 to 15 mm distal to the DWC. The most compressed point was 10 mm distal to the DWC, with a pressure of 44.9 +/- 26.4 mm Hg. The correlation coefficient between the highest canal pressure and the latency was 0.393 and between highest canal pressure and duration of symptoms was 0.402. CONCLUSIONS: Our study showed that the most compressed part of the median nerve in the carpal canal is 10 mm distal to the DWC. The carpal canal pressure was related to the latency and to the duration of symptoms.     

Symptomatic carpal coalition

The carpus is initially a cartilaginous structure that subsequently demarcates into separate carpal bones. Failure of differentiation of parts results in carpal coalition, the most common of which occurs between the lunate and triquetrum. Lunate-triquetral coalitions can be subdivided into four types according to the degree of union. Four types are identified. A case report of type I is presented that responded to a lunate-triquetral fusion.     

Traumatic carpal instability

In general, two patterns of traumatic carpal instability can be discerned: palmar flexion intercalated segmental instability (PISI deformity) and dorsiflexion intercalated segmental instability (DISI deformity). Two case reports are described, demonstrating both types and their treatment. PISI deformity, seen less frequently, may require Kirschner wiring as well as plaster immobilization. DISI deformity with malunion may require osteotomy. The underlying causes should be sought before treatment is initiated.     

Ulnar carpal instabilities

Ulnar carpal instabilities are more common than previously suspected. To date, instability patterns have been described at the triquetrolunate and triquetrohamate joints. In this article, the pathomechanics, diagnosis, and treatment of these instability patterns are reviewed and several pertinent case reports are presented.