Nobuta Shingo, Sato Katsumi, Nakagawa Tomowaki, Hatori Masahito, Itoi Eiji
Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Miyagi 981-8563 Japan.
Ups J Med Sci. 2008;113(2):181-92. doi: 10.3109/2000-1967-228.
Carpal tunnel syndrome (CTS) is one of the most common disease among the entrapment neuropathies. Wrist splinting has been conventionally used for the CTS treatment. The purposes of this study were to assess the efficacy of wrist splinting for CTS, and to evaluate the value of the motor nerve conduction measurement as a prognostic indicator for CTS.
Two hundred and fourteen hands with CTS were treated by wrist splinting, and reviewed after a mean follow up of seven months. Severity of symptoms were minimal lesions in 177 hands, intermediate lesions in 33 hands, and severe lesions in four hands. Motor nerve conduction measurement was performed in all cases before and after treatment, and distal latency (DL) and amplitude on compound muscle action potential (CMAP) from the abductor pollicis brevis (APB) muscle were analyzed.
According to Kelly's grading of outcome, results were excellent in 41 hands, good in 110 hands, fair in 45 hands, and poor in 18 hands. Excellent or good results were obtained in 131 hands (74 percent) with minimal lesions, 20 hands (61 percent) with intermediate lesions, and in no cases with severe lesions. The ratio of excellent or good results was 79 percent in patients in whom DL of pre-treatment APB-CMAP was less than 8 milliseconds (ms), and 62 percent in patients whose DL was 8 ms or more, which showed a significant difference. In nine hands whose pre-treatment APB-CMAP was unrecordable, the results were good in one hand, fair in five, and poor in three.
Wrist splinting is most effective in cases of minimal or intermediate lesions with DL of APB-CMAP less than 8 ms. If relief of symptoms is not obtained after five months of treatment by splinting, that would be the limit of splinting. Surgical release is recommended for cases with severe lesions and with unrecordable APB-CMAP.
腕管综合征（CTS）是最常见的卡压性神经病变之一。传统上，腕部夹板一直用于CTS的治疗。本研究的目的是评估腕部夹板治疗CTS的疗效，并评估运动神经传导测量作为CTS预后指标的价值。
对214例CTS患者的手部进行腕部夹板治疗，平均随访7个月后进行复查。症状严重程度方面，177例为轻度病变，33例为中度病变，4例为重度病变。所有病例在治疗前后均进行运动神经传导测量，并分析拇短展肌（APB）的复合肌肉动作电位（CMAP）的远端潜伏期（DL）和波幅。
根据凯利的疗效分级，41例结果为优，110例为良，45例为可，18例为差。轻度病变的131例（74%）、中度病变的20例（61%）获得优或良的结果，重度病变无一例获得优或良的结果。治疗前APB-CMAP的DL小于8毫秒（ms）的患者中，优或良结果的比例为79%，而DL为8 ms或更长的患者中这一比例为62%，差异有统计学意义。9例治疗前APB-CMAP无法记录的患者中，1例结果为良，5例为可，3例为差。
腕部夹板对APB-CMAP的DL小于8 ms的轻度或中度病变最为有效。如果夹板治疗5个月后症状未缓解，那就是夹板治疗的极限。对于重度病变和APB-CMAP无法记录的病例，建议手术松解。
