Observation on the preliminary efficacy of high frequency ultrasound-guided small incision in treating carpal tunnel syndrome
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摘要:
目的探讨高频超声在小切口入路治疗腕管综合征（CTS）中的临床应用价值。 方法将2009年1月~2014年12月收治的66例经保守治疗无效需行小切口入路手术的CTS患者分为实验组和观察组，各33例。实验组患者术前行高频超声检查腕管受损情况，对照组术前未行高频超声检查。比较两组患者的治疗有效率、手术时间、术中出血量、平均住院时间、术后瘢痕长度、术后疼痛发生率及术后并发症发生率。 结果术后随访12月，实验组与对照组术中出血量（16.39±4.44 mL vs 18.97±5.05 mL）、手术时间（12.55±1.75 min vs 13.48±2.02 min）、术后总并发症发生率（9.1% vs 33.3%）的差异均有统计学意义（P<0.05）；实验组平均住院时间、术后疤痕长度、术后疼痛发生率及治疗有效率与对照组比较差异均无统计学意义（P>0.05）。 结论高频超声引导下小切口入路行腕管切开松解减压术是治疗CTS的一种安全、可靠的治疗方法，有利于患者术后早日恢复健康。 Abstract:ObjectiveTo investigate the clinical application value of high frequency ultrasound examination in carpal tunnel syndrome with a small incision. MethodsA total of 66 patients diagnosed with CTS who failed in conservative treatment and required minimal-access carpal tunnel release technique were divided into ultrasound group and control group, with 33 cases in each. The effective rate, operative time, blood loss volume, average hospital day, scar length, incidence of postoperative pain and complications were compared between the two groups. ResultsAll patients were followed up for 12 months, the efficacy of blood loss volume(16.39±4.44 mL vs 18.97±5.05 mL, P<0.05), operative time(12.55±1.75 min vs 13.48±2.02 min, P<0.05), incidence of postoperative complications(9.1% vs 33.3%, P<0.05) were improved significantly in ultrasound group. There was no significant difference between the two groups in average hospital day, scar length and incidence of postoperative pain and complications (P>0.05). ConclusionMinimal-access carpal tunnel release technique assisted with high frequency ultrasound is a safe and reliable method for carpal tunnel syndrome. It is beneficial for patients to recover from operation. -
Key words:
- carpal tunnel syndrome /
- high frequency ultrasound /
- median nerve /
- small incision
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表 1 两组手术情况及术后疤痕长度比较（Mean±SD）
分组 术中出血量
（mL）手术时间
（min）住院时间
（d）术后疤痕长度
（mm）实验组 16.39±4.44 12.55±1.75 4.03±0.88 20.06±2.70 对照组 18.97±5.05 13.48±2.02 4.27±0.94 20.61±2.40 t 2.201 2.020 1.077 0.867 P 0.031 0.048 0.286 0.389 
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表 2 两组术后并发症及治疗效果比较[n（%）]
分组 术后疼痛发生率 总并发症 治疗有效率 实验组 2（6.1） 3（9.1） 29（87.9） 对照组 5（15.2） 11（33.3） 27（81.8） χ2 − 4.442 − P 0.427* 0.035** 0.733* *采用Fisher精确概率法; **采用Yates′ continuity correction.
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[1] Martins RS, Siqueira MG. Conservative therapeutic management of carpal tunnel syndrome[J]. Arq Neuropsiquiatr, 2017, 75(11): 819-24. doi: 10.1590/0004-282x20170152 [2] Wipperman J, Goerl K. Carpal tunnel syndrome:diagnosis and management[J]. Am Fam Physician, 2016, 94(12): 993-9. [3] Huisstede BM, Hoogvliet P, Franke TP, et al. Carpal tunnel syndrome:effectiveness of physical therapy and electrophysical modalities.an updated systematic review of randomized controlled trials[J]. Arch Phys Med Rehabil, 2018, 99(8): 1623-34. doi: 10.1016/j.apmr.2017.08.482 [4] Basson A, Olivier B, Ellis R, et al. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis[J]. J Orthop Sports Phys Ther, 2017, 47(9): 593-615. doi: 10.2519/jospt.2017.7117 [5] Lu YJ, Meng ZD, Pan XE, et al. Value of high-frequency ultrasound in diagnosing carpal tunnel syndrome[J]. Int J Clin Exp Med, 2015, 8(12): 22418-24. [6] Georgiev GP, Karabinov V, Kotov G, et al. Medical ultrasound in the evaluation of the carpal tunnel:a critical review[J]. Cureus, 2018, 10(10): e3487-99. [7] 王文利, 林锦德, 林礼务, 等. 实时超声评价正中神经活动度联合横截面积测量诊断腕管综合征[J]. 中国超声医学杂志, 2015, 31(12): 1083-5. [8] Huisstede BM, Randsdorp MS, Coert JH, et al. Carpal tunnel syndrome.Part 2:effectiveness of surgical treatments--a systematic review[J]. Arch Phys Med Rehabil, 2010, 91(7): 1005-24. doi: 10.1016/j.apmr.2010.03.023 [9] Franklin GM, Friedman AS. Work-related carpal tunnel syndrome: diagnosis and treatment guideline[J]. Phys Med Rehabil Clin N Am, 2015, 26(3): 523-35. doi: 10.1016/j.pmr.2015.04.003 [10] Apard T, Candelier G. Surgical ultrasound-guided carpal tunnel release[J]. Hand Surgery & Rehabilit, 2017, 36(5): 333-7. [11] Huisstede BM, van den Brink J, Randsdorp MS, et al. Effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome-a systematic review[J]. Arch Phys Med Rehabil, 2018, 99(8): 1660-80. doi: 10.1016/j.apmr.2017.04.024 [12] Munns JJ, Awan HM. Trends in carpal tunnel surgery: an online survey of members of the American society for surgery of the hand[J]. J Hand Surg Am, 2015, 40(4): 767-71. doi: 10.1016/j.jhsa.2014.12.046 [13] 白 杰, 许玉本, 夏 雷, 等. 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[J]. 中国组织工程研究, 2016, 20(33): 5009-16. [14] 叶钧联, 曾 亮, 陈永斌, 等. 小切口治疗腕管综合征74例临床分析[J]. 广州医科大学学报, 2015, 43(2): 84-6. [15] 王 晔, 李彦蓉, 史建伟. 腕部小切口手术和传统切开手术治疗腕管综合征的疗效比较[J]. 深圳中西医结合杂志, 2018, 28(4): 22-4. [16] Smith NJ. Nerve conduction studies for carpal tunnel syndrome: essential prelude to surgery or unnecessary luxury[J]. J Hand Surg Br, 2002, 27B(1): 83-5. [17] Roll SC, Case-Smith J, Evans KD. Diagnostic accuracy of ultrasonography vs.electromyography in carpal tunnel syndrome: a systematic review of literature[J]. Ultrasound Med Biol, 2011, 37(10): 1539-53. doi: 10.1016/j.ultrasmedbio.2011.06.011 [18] Wilder-Smith EP, Seet RC, Lim EC. Diagnosing carpal tunnel syndrome - clinical criteria and ancillary tests[J]. Nat Clin Pract Neurol, 2006, 2(7): 366-74. [19] Ziswiler HR, Reichenbach S, Vogelin E, et al. Diagnostic value of sonography in patients with suspected carpal tunnel syndrome - a prospective study[J]. Arthritis Rheum, 2005, 52(1): 304-11. doi: 10.1002/art.20723 [20] Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis[J]. Clin Orthop Relat Res, 2011, 469(4): 1089-94. doi: 10.1007/s11999-010-1637-5 [21] 魏 鹏, 项 泱, 王扬剑, 等. 小切口Swiss推刀治疗腕管综合征的疗效分析[J]. 同济大学学报:医学版, 2016, 37(5): 62-6. [22] Tarallo M, Fino P, Sorvillo V, et al. Comparative analysis between minimal access versus traditional accesses in carpal tunnel syndrome: a perspective randomised study[J]. J Plast Reconstr Aesthet Surg, 2014, 67(2): 237-43. doi: 10.1016/j.bjps.2013.10.033 [23] Yamazaki T, Kawahara N, Arai K, et al. Utility of ultrasonography of the median nerve with a High-Frequency probe for the diagnosis of dialysis-related carpal tunnel syndrome[J]. Ther Apher Dial, 2016, 20(5): 483-91. doi: 10.1111/tap.2016.20.issue-5 [24] Petrover D, Richette P. Treatment of carpal tunnel syndrome : from ultrasonography to ultrasound guided carpal tunnel release[J]. Joint Bone Spine, 2018, 85(5): 545-52. doi: 10.1016/j.jbspin.2017.11.003 [25] 陈 涛, 郭 稳, 秦晓婷, 等. 腕管处正中神经超声成像研究[J]. 中国超声医学杂志, 2014, 30(2): 162-6. [26] Moschovos C, Tsivgoulis G, Kyrozis AA, et al. The diagnostic accuracy of high-resolution ultrasound in screening for carpal tunnel syndrome and grading its severity is moderated by age[J]. Clin Neurophysiol, 2019, 130(3): 321-30. doi: 10.1016/j.clinph.2018.12.005 -
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