Zhang X, Li Y, Wen S, Zhu H, Shao X, Yu Y
The Second Hospital of Qinhuangdao, Changli, Qinhuangdao, Hebei, 066600, China.
Shanhaiguan Bridge Plant Hospital, Qinhuangdao, Hebei, 066200, China.
Bone Joint J. 2015 Feb;97-B(2):221-8. doi: 10.1302/0301-620X.97B2.34423.
We report a new surgical technique of open carpal tunnel release with subneural reconstruction of the transverse carpal ligament and compare this with isolated open and endoscopic carpal tunnel release. Between December 2007 and October 2011, 213 patients with carpal tunnel syndrome (70 male, 143 female; mean age 45.6 years; 29 to 67) were recruited from three different centres and were randomly allocated to three groups: group A, open carpal tunnel release with subneural reconstruction of the transverse carpal ligament (n = 68); group B, isolated open carpal tunnel release (n = 92); and group C, endoscopic carpal tunnel release (n = 53). At a mean final follow-up of 24 months (22 to 26), we found no significant difference between the groups in terms of severity of symptoms or lateral grip strength. Compared with groups B and C, group A had significantly better functional status, cylindrical grip strength and pinch grip strength. There were significant differences in Michigan Hand Outcome scores between groups A and B, A and C, and B and C. Group A had the best functional status, cylindrical grip strength, pinch grip strength and Michigan Hand Outcome score. Subneural reconstruction of the transverse carpal ligament during carpal tunnel decompression maximises hand strength by stabilising the transverse carpal arch.
我们报告一种开放性腕管松解并对腕横韧带进行神经下重建的新手术技术，并将其与单纯开放性和内镜下腕管松解术进行比较。2007年12月至2011年10月期间，从三个不同中心招募了213例腕管综合征患者（男70例，女143例；平均年龄45.6岁；29至67岁），并随机分为三组：A组，开放性腕管松解并对腕横韧带进行神经下重建（n = 68）；B组，单纯开放性腕管松解（n = 92）；C组，内镜下腕管松解（n = 53）。在平均24个月（22至26个月）的最终随访中，我们发现三组在症状严重程度或侧方握力方面无显著差异。与B组和C组相比，A组的功能状态、圆柱状握力和捏力明显更好。A组与B组、A组与C组以及B组与C组之间的密歇根手功能结果评分存在显著差异。A组的功能状态、圆柱状握力、捏力和密歇根手功能结果评分最佳。腕管减压时对腕横韧带进行神经下重建可通过稳定腕横弓使手部力量最大化。
