Uchiyama Shigeharu, Itsubo Toshirou, Nakamura Koichi, Kato Hiroyuki, Yasutomi Takashi, Momose Toshimitsu
Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan.
J Orthop Sci. 2010 Jan;15(1):1-13. doi: 10.1007/s00776-009-1416-x. Epub 2010 Feb 12.
The current concepts of carpal tunnel syndrome (CTS) with respect to its pathophysiology, treatment, and evaluation are discussed. With regard to the pathophysiology of idiopathic CTS, biomechanical studies to determine the kinematics of the flexor tendon, and the median nerve inside the carpal tunnel may provide valuable insights. Different degrees of excursion between the flexor tendons and the median nerve could cause strain and microdamage to the synovial tissue; this has been microscopically observed. A biomechanical approach for elucidating the events that trigger the development of CTS seems interesting; however, there are limitations to its applications. Endoscopic carpal tunnel release (ECTR) is a useful technique for achieving median nerve decompression. However, it is not considered superior to conventional open carpal tunnel release in terms of fast recovery of hand function. Unless the effect of inserting a cannula into the diseased carpal tunnel on the median nerve function is quantitatively elucidated, ECTR will not be regarded as a standard procedure for relieving the median nerve from chronic compression. The treatment of CTS should be evaluated on the basis of patient-oriented questionnaires as well as conventional instruments because these questionnaires have been validated and found to be highly responsive to the treatment. It should be noted that nerve conduction studies exclusively evaluate the function of the median nerve, whereas patient-oriented questionnaires take into account not only the symptoms of CTS but other accompanying pathologies as well, such as flexor tenosynovitis. In Japan, the number of CTS patients is expected to rise; this may be attributed to a general increase in the life-span of the Japanese and increase in the number of diabetic patients. Thus, more efforts should be directed toward elucidating the pathophysiology of so-called idiopathic CTS, so that new treatment strategies can be established for CTS of different pathologies.
本文讨论了腕管综合征（CTS）在病理生理学、治疗和评估方面的当前概念。关于特发性CTS的病理生理学，通过生物力学研究来确定屈肌腱和腕管内正中神经的运动学，可能会提供有价值的见解。屈肌腱和正中神经之间不同程度的移动可能会导致滑膜组织的应变和微损伤，这已在显微镜下观察到。一种用于阐明引发CTS发展的事件的生物力学方法似乎很有趣，然而，其应用存在局限性。内镜下腕管松解术（ECTR）是实现正中神经减压的一种有用技术。然而，就手部功能的快速恢复而言，它并不被认为优于传统的开放性腕管松解术。除非定量阐明将套管插入患病腕管对正中神经功能的影响，否则ECTR不会被视为缓解正中神经慢性压迫的标准程序。CTS的治疗应基于以患者为导向的问卷以及传统工具进行评估，因为这些问卷已经过验证，并且发现对治疗反应高度敏感。需要注意的是，神经传导研究仅评估正中神经的功能，而以患者为导向的问卷不仅考虑CTS的症状，还考虑其他伴随的病理情况，如屈指腱鞘炎。在日本，CTS患者的数量预计会增加，这可能归因于日本人寿命的普遍延长和糖尿病患者数量的增加。因此，应更加努力阐明所谓特发性CTS的病理生理学，以便为不同病理类型的CTS建立新的治疗策略。
