腕管综合征的手术治疗进展（下）

腕管综合征1924年首次采用手术治疗获得良好疗效后,开放手术成为腕管综合征的主要治疗方法,各种手术方式运用而生,从经典的单一掌腕前臂切开松解术到腕、掌部的双切开松解减压术。近十年来,腕管综合征的内镜下微创治疗技术逐渐兴起,其术式包括单切口和双切口两种技术。开放手术与内窥镜手术各有利弊,各有适应证,为满足广大基层医务人员及广大患者需求,采用小针刀或结合内镜的微型松解术将具有更广阔的发展前景。     

腕管综合征的手术治疗进展（上）

1924年首次采用手术治疗腕管综合征获得良好疗效后,开放手术成为腕管综合征的主要治疗方法,各种手术方式运用而生,从经典的单一掌腕前臂切开松解术到腕、掌部的双切开松解减压术。近十年来,腕管综合征的内镜下微创治疗技术逐渐兴起,其术式包括单切口和双切口两种技术。开放手术与内窥镜手术各有利弊,各有适应证,为满足广大基层医务人员及广大患者需求,采用小针刀或结合内镜的微型松解术将具有更广阔的发展前景。     

MRI在腕管综合征诊断中的应用

目的：研究腕管综合征的MRI特征及临床治疗中的应用价值。方法：12例腕管综合征术前行MRI检查（以横断面为主），后经手术证实MRI的发现。结果：12例CTS的MRI表现为：正中神经入腕管时胀增粗12例，正中神经肿胀率（MNSR）2．25：1。正中神经腕管内受压变扁12例，正中神经扁平率（MNFR）3．4。T2WI像中正中神经信号增高12例。结论：MRI对腕管综合征的诊断及治疗方式的选择有重要的意义。     

电诊断技术在腕管综合征中的应用

腕管综合征(CTS)在神经卡压性疾病中是最常见的,也是转诊到肌电图室行电诊断检查的最常见原因之一。电诊断检查对于CTS的诊断、预后、治疗方式的选择和术后评估等起着重要作用。为了更好地把电诊断技术应用于腕管综合征诊疗过程中,现将近年来电诊断技术在CTS中的应用情况做一综述。     

腕管综合征治疗的研究进展

腕管综合征（carpal tunnel syndrome,CTS）是最常见的周围神经嵌压综合征[1],是正中神经在腕部受压所致.腕管内增高的压力可导致正中神经缺血,从而出现神经传导受损并伴随麻木、疼痛.CTS是一种神经内科常见疾病,自被普遍认识50多年来,其治疗效果一直不理想,多数治疗方法还没有证据或者没有足够证据支持.     

腕管综合征神经卡压：内镜下腕管松解与有限小切口松解的效果及安全性评价

BACKGROUND:Existing evidence has shown endoscopic carpal tunnel release is superior to the open release in postoperative recovery time, grip and pinch strength, hospitalization time as well as incidence of postoperative scar tissues. OBJECTIVE: To systematically review the efficacy and safety of endoscopic release versus mini-open release for carpal tunnel syndrome. METHODS: A computer-based search of PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, CqVip and Wanfang databases was performed. Randomized controlled trials comparing endoscopic release with mini-open release for patients with carpal tunnel syndrome were included, and the publishing time was up to November 1st, 2015. Two authors independently screened, extracted data and assessed the risk of bias of the included literatures. Then statistical analysis was conducted using RevMan 5.3 software. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials involving 706 patients were included. The results of Meta-analysis demonstrated that: compared with mini-open release, endoscopic release could not only significanthy decrease the hospitalization time postoperative recovery time and complications (P < 0.05), but also achieve better symptom relief (P=0.16). However, there were no significant differences in grip and pinch strength between the two treatments. These results suggest that compared with the mini-open release, the endoscopic release contributes to shorter hospitalization time and postoperative recovery time, better symptom relief and lower risk of complications. But large-sample and high-quality randomized controlled trials are needed to provide more reliable evidence for these findings. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

腕管内容物测量在临床中的应用

目的观测腕管内容物并描述其相互间关系,为临床手外科学和显微外科学中的应用提供参考。方法采用游标卡尺对22具本成人尸体（男16具,女6具）,44侧标本成人尸体标本腕管内容物测量,腕管解剖学观察、腕管内容物、腕横韧带的厚度测量等。结果腕管为纤维性骨管,略呈扁圆柱形,男性：狭窄部内外径（25．0±2．6）mm,前后径（10．2±1．1）mm;女性：狭窄部内外径（17．0±2．5）mm,前后（10．4±1．5）mm。腕横韧带男性：长（25．5±4．7）mm,宽（22．1±2．2）mm,厚2．3mm,下界距腕远纹（28．4±2．6）mm;女性：长（22．7±3．3）mm,宽（20．1±2．5）mm,厚3．1mm,下界距腕远纹（27．5±2．1）mm。腕管的断面,男性第1断面：（189．7±17．5）mm2,第2断面：（182．1±13．7）mm2,第3断面：（223．4±29．8）mm2;女性第1断面：（172．4±15．2）mm2,第2断面：（153．1±17．3）mm2,第3断面：（178．1±11．6）mm2。结论男性腕管宽短,女性腕管狭长,腕横韧带上半部薄,下半部厚,坚韧而缺乏弹性,女性腕管比男性狭窄,可能是好发疾病的原因之一。     

手掌侧单孔入路微创治疗腕管综合征的解剖学研究

目的：报道手掌侧单孔入路微创治疗腕管综合征的解剖入路及手术方法,为手掌侧入路微创治疗腕管综合征手术提供解剖学基础。方法选取16例新鲜成人上肢标本,解剖观测腕管及手掌的相关解剖结构。选取6例新鲜成人上肢标本进行模拟手术,镜视下切开屈肌支持带并进行神经外膜松解。结果手术入路点为拇指呈最大外展位,沿掌指关节尺侧取一平行线,与中、环指间的长轴线交叉点处向尺侧1cm处,操作层面为浅筋膜层与掌腱膜间的腔隙。结论手掌侧单孔入路微创治疗腕管综合征是安全可行的,在镜视下可彻底切开屈肌支持带并进行神经外膜松解,有利于术者进行操作及减轻术中损伤。     

超声诊断腕管综合征的准确性及应用

腕管综合征(carpal tunnel syndrome,CTS)是由Colles骨折、月骨损伤、脱位、退变等多种因素引起腕管内压力升高而导致正中神经被挤压的一系列症状,是临床上手外科中最常见的一类周围神经卡压症.为了快捷、无创又准确地诊断并采取最合适的手术治疗方法,通过临床症状、体征、神经电生理检查等确诊是远远不够的,而具有直观的影像学资料的超声技术就能更准确地诊断腕管综合征.本研究收集17例腕管综合征病例,通过比较超声测量与术中测量的结果,探讨超声测量在诊断腕管综合征方面的应用价值.     

神经肌电图在腕管综合征患者中的应用价值

目的 探讨神经肌电图在腕管综合征(CTS)患者中的诊断应用价值。方法 收集2021年9月至2023年2月在桂林医学院附属医院门诊就诊的患者55例,性别不限,根据临床表现初步诊断为CTS,病程3 d～3年,对其进行肌电图检查,记录正中神经支配拇指、示指感觉纤维的波幅和传导速度、运动传导潜伏期、波幅和传导速度,尺神经的运动及感觉传导,正中神经和尺神经的环指差值,观察肌肉静息状态下有无自发电位。结果 被检的110条正中神经中,有105条(95.4%)正中神经/尺神经环指感觉电位潜伏期差值≥0.4 ms,有104条(94.5%)感觉传导速度减慢,有66条(60%)神经运动传导潜伏期延长,有28条(25.4%)感觉传导波幅降低,有13条(11.8%)神经运动动作电位波幅降低。被检的110块拇短展肌中针极肌电图异常有13块(11.8%),其中有8块出现自发电位(纤颤电位、正锐波),有10块出现运动单位时限延长。尺神经的神经传导及小指展肌等肌肉的针极肌电图结果均正常。55例患者中,8例为轻度异常,26例为中度异常,21例为重度异常。结论 对临床初步诊断CTS的患者进行神经肌电图检查可以提供正中神经受...     

腕管综合征患者的临床与神经电生理研究

目的：观察神经电生理检测对腕管综合征(CTS)的诊断价值。方法：对腕管综合征的临床特征及病因进行了分析，并作神经传导速度(NCV)和肌电图检测和分析。结果：40条患病神经中8条正中神经诱发波形消失，32条正中神经感觉潜伏期延长、波幅降低或(和)感觉神经传导速度减慢。25例患者伴有30条正中神经运动末梢潜伏期延长或(和)动作电位波幅降低。22块正中神经支配肌有去神经电位。结论：神经电生理检查在腕管综合征的诊断与鉴别诊断中有重要意义。     

The precision of ultrasound imaging and its relevance for carpal tunnel syndrome

The carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy in human. The diagnosis is based on symptoms and on physical examination and is supported by nerve conduction tests. The aim of this study was to evaluate the precision and the valence of ultrasound (US) for CTS. An anatomic study was performed on 40 wrists of 20 unfixed human cadavers. The carpal tunnel and its important structures and contents were imaged and measured by ultrasound (7.5-MHz high resolution probe). The dorsopalmar diameter (DPD), the radioulnar diameter (RUD), the perimeter (P) and the cross-sectional area (A) were determined for the carpal canal and for the median nerve. These US images and measurements were directly compared with anatomic cross-sections gained from the same wrists at the same level. Our results showed that ultrasound is a very precise method to display the anatomy of the carpal tunnel and of the median nerve and thus the conditions of the median nerve. Significant differences could not be detected for each of these parameters either for the carpal tunnel or the median nerve. (Ultrasound cross-sectional area of carpal tunnel 162.4 ± 29.3 mm² and of the median nerve 9.2 ± 2.4 mm² anatomy cross-sectional area of carpal tunnel 168.4 ± 31.2 mm² and of median nerve 9.4 ± 2.2 mm²).     

Chemical heterogeneity of amyloid in the carpal tunnel syndrome

Summary 140 biopsies from 108 patients afflicted with the carpal tunnel syndrome were studied, 27 of whom showed deposition of amyloid, in 6 of them to such an extent that the amyloid was considered significant in the pathogenesis of the carpal tunnel syndrome. Morphologically, vessels and ligaments were affected and especially the peritendinous structures. As it was always part of generalized amyloidosis, the amyloid in the carpal tunnel consisted immunohistologically of amyloid A in three cases (including one case with simultaneous amyloid deposition of the AA- and the AB-type), of amyloid A in one case, of amyloid of prealbumin origin in seventeen cases and of AB-amyloid in eight cases. We also described for the first time the manifestation of generalized senile amyloidosis (ASs) in the carpal tunnel. Deposition of amyloid of-2-microglobulin type (AB) in the carpal tunnel was particularly frequent and massive.This paper presents a part of the doctor thesis of K. Stein     

不同传导检测法在腕管综合征诊断中的应用价值

目的：探讨三种神经传导方法在腕管综合征(CTS)诊断中的应用价值。方法：应用常规法、掌刺激法、短段刺激法对43例根据临床表现怀疑为CTS的患者进行检测。结果：常规法显示4例正常，34例为CTS，3例为周围神经病，2例为神经根性损害。掌刺激法显示10例CTS传导减慢主要在经腕管段而不是掌到指节段，3例周围神经病患者则相反。短段刺激法显示5例CTS在腕管段测得的潜伏期与腕管远端各段潜伏期差均大于0．5ms，并发现1例常规法检测结果错误。结论：常规法是确诊CTS并明确其病变程度的重要手段。掌部刺激法有助于鉴别CTS与周围神经病。短段刺激法在诊断CTS时很可靠，且有利于确定远端损害部位。     

腕管综合征的神经电生理检测与容积传导问题

目的：探讨腕管综合征（CTS）患者神经电生理检测中的容积传导误差。方法：对17例患者进行顺向法与逆向法拇、环指感觉潜伏期测定，并对其结果进行比较分析。结果：8例患者顺向与逆向法检测结果不一致。顺向法检测出现二种形式的容积传导干扰。结论：在CTS的神经电生理诊断中，拇、环指潜伏期测定时，逆向法与顺向法并用可排除容积传导的干扰。     

High prevalence of wild-type transthyretin deposition in patients with idiopathic carpal tunnel syndrome: a common cause of carpal tunnel syndrome in the elderly

Carpal tunnel syndrome is the most common type of entrapment neuropathy. However, the cause of carpal tunnel syndrome remains unclear in most cases. Senile systemic amyloidosis, induced by wild-type transthyretin deposition, is a prevalent aging-related disorder and often accompanied by carpal tunnel syndrome. In this study, we measured the frequency of unrecognized wild-type transthyretin deposition in patients with idiopathic carpal tunnel syndrome. One hundred twenty-three patients with carpal tunnel syndrome, including 100 idiopathic patients, treated by carpal tunnel release surgery were analyzed. Tenosynovial tissues obtained at surgery were analyzed by Congo red and immunohistochemical staining. If staining for transthyretin was positive, the entire transthyretin gene was analyzed by direct DNA sequencing. We also analyzed tenosynovial tissues from 32 autopsy cases as controls. Thirty-four patients (34.0%) with idiopathic carpal tunnel syndrome showed amyloid deposition in the tenosynovial tissue, and all amyloid showed specific immunolabeling with antitransthyretin antibody. Direct DNA sequencing of the entire transthyretin gene did not reveal any mutations, indicating that all amyloid deposits were derived form wild-type transthyretin. Statistical analysis using logistic regression showed that the prevalence of transthyretin deposition in the idiopathic carpal tunnel syndrome group was significantly higher than that in controls (odds ratio, 15.8; 95% confidence interval, 3.3-5.7), and age and male sex were independent risk factors for transthyretin amyloid deposition. Our results demonstrate that wild-type transthyretin deposition is a common cause of carpal tunnel syndrome in elderly men. It is likely that many patients develop carpal tunnel syndrome as an initial symptom of senile systemic amyloidosis.     

Diagnostic value of F-wave inversion in patients with early carpal tunnel syndrome

Routine electrophysiological studies usually give normal results in patients with early stage carpal tunnel syndrome (CTS). Diagnostic significance of the F-wave inversion (the median of F-wave minimal latencies (FWML) exceeds a normal ipsilateral ulnar FWML by 1 ms) has not been previously reported in early stage CTS. In this study, our primary aim was to investigate the diagnostic value of F-wave inversion in early stage CTS. Additionally, we aimed to demonstrate any possible relationship between F-wave inversion and symptom scores of the Boston questionnaire and functional capacity in early stage CTS. The study included 60 early stage CTS patients who presented with a median sensory nerve conduction velocity of ≥50 m/s. The symptom severity and functional status of the patients were assessed by using the Boston questionnaire. The control group consisted of 45 healthy volunteers. We compared early stage CTS patients and healthy control subjects in terms of the results obtained from median-ulnar FWML. Existence of F-wave inversion was found in 32 (53.3%) of the early stage CTS patients and in 3 (8.7%) of the healthy controls (p = 0.001). It was also found to be positively correlated with the Boston questionnaire scores (p = 0.001, r = 0.41) and functional capacity scores (p = 0.001, r = 0.41). The sensitivity and specificity of F-wave inversion for the diagnosis of early stage CTS were calculated as 53.3% and 93.3%, respectively. The addition of F-wave inversion measurement to the set of the routine nerve conduction studies can increase the reliability of the electrophysiological studies in patients with early stage CTS.     

Bilateral deficits in fine motor control and pinch grip force in patients with unilateral carpal tunnel syndrome

Subjects with carpal tunnel syndrome (CTS) typically describe self-perceived pinch grip deficits, clumsiness sensations and difficulty with grasping small objects, which suggest the existence of a fine motor control deficit. No previous studies have investigated fine motor control and pinch grip force bilaterally in patients diagnosed with moderate CTS. Our aim was to investigate differences in fine motor control ability and pinch grip force between patients with unilateral CTS and healthy controls. Subtests of the Purdue Pegboard Test (one-hand, bilateral and assembly) and pinch grip force were evaluated bilaterally in 20 women with unilateral CTS (aged 22–66 years), and 20 age and hand dominance-matched healthy women. Differences between sides (affected/unaffected or dominant/non-dominant) and groups (patients or controls) were analysed with an analysis of variance (ANOVA). The ANOVA found significant differences between both groups (F = 65.7; P < 0.001) and between sides (F = 5.4; P = 0.02) for the one-hand pin placement subtest: CTS patients showed bilateral worse scores on one-hand pin placement than controls (P < 0.001). Patients also showed significantly lower scores in bilateral pin placement and assembly subtests when compared to healthy controls (P < 0.001). The ANOVA also revealed significant differences between groups (F = 141.2; P < 0.001), and fingers (F = 142.2; P < 0.001), but not between sides (F = 0.9; P = 0.4) for pinch grip strength: CTS patients showed bilateral lower pinch grip force levels in all fingers when compared to controls (P < 0.001). Fine motor control and pinch grip were negatively related to the hand pain intensity and duration of symptoms history (all, P < 0.01). Our findings revealed bilateral deficits in fine motor control ability and pinch grip force in patients with unilateral moderate CTS when compared to controls.     

Prognostic factors in carpal tunnel syndrome treated with 5% dextrose perineural injection: A retrospective study

Background: Perineural injection therapy with 5% dextrose water (D5W) is a potential and innovative treatment with long-term efficacy for carpal tunnel syndrome (CTS). However, the prognostic factors of this management are lacking; hence, the aim of this retrospective study was to identify the prognostic factors of D5W perineural injection therapy for mild-to-moderate CTS.Methods: A total of 52 patients (52 wrists) diagnosed with mild-to-moderate CTS and treated with a single ultrasound-guided 5cc D5W perineural injection were retrospectively reviewed. Patient-reported injection outcomes (visual analog scale, VAS) at 6 months post-injection were categorized into two groups; (1) Good outcome, when symptom relief ≥50% compared to pre-injection and (2) Poor outcome, when symptom relief < 50% compared to pre-injection. Significant variables between groups were entered into a binary logistic regression with forward stepwise regression to determine the prognostic factors for these outcomes.Results: The treatment outcome was significantly related to body height and sensory nerve conduction velocity (SNCV) (159.1 ± 1.0 vs. 155.0 ± 1.8, p=0.04; 33.6 ± 0.8 vs. 28.3 ± 1.2, p=0.001, good vs. poor outcomes). However, only SNCV remained significantly correlated with the outcomes after conducting stepwise logistic regression (ORs: 1.201; 95% CI 1.05-1.38; p=0.01).Conclusions: SNCV was found to be a significant prognostic factor of treatment outcome for patients with mild-to-moderate CTS 6 months after a D5W perineural injection.