Lutsky Kevin, Ilyas Asif, Kim Nayoung, Beredjiklian Pedro
The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA.
Hand (N Y). 2015 Sep;10(3):403-6. doi: 10.1007/s11552-014-9724-9.
There is a well-documented association between carpal tunnel syndrome (CTS) and thumb carpometacarpal (CMC) arthritis, and these conditions commonly coexist. We have observed that patients who have previously undergone thumb basal joint arthroplasty (BJA) seem rarely to present subsequently with CTS. Our hypothesis is that BJA decreases the pressure within the carpal tunnel.
Twenty-eight patients (6 with coexistent CTS) undergoing BJA were enrolled in the study. The pressure within the carpal tunnel immediately before and after BJA was measured using a commercially available pressure monitor device (Stryker STIC; Kalamazoo, MI). In patients with concomitant CTS undergoing both BJA and carpal tunnel release (CTR), the pressure was measured after BJA but prior to release of the transverse carpal ligament.
The pressure within the carpal tunnel decreased after BJA in all patients. There were 3 patients with stage II arthritis, 15 patients with stage III arthritis, and 10 patients with stage IV arthritis. The mean pressure prior to BJA among all patients was 23.9 mmHg and decreased to 11.0 mmHg after BJA. Patients with concomitant CTS had a mean pre-BJA pressure of 26.5 mmHg, which decreased to 7.3 mmHg after BJA.
BJA decompresses the carpal tunnel and decreases the pressure within. In patients with concomitant CTS, the BJA alone (without additional release of the transverse carpal ligament) decreases the carpal tunnel pressure. Further study is warranted to determine the need for discrete release of the transverse carpal ligament in patients with CTS who are undergoing BJA.
Level II, diagnostic.
腕管综合征（CTS）与拇指腕掌关节（CMC）关节炎之间存在充分记录的关联，且这些病症常同时存在。我们观察到，先前接受拇指掌指关节置换术（BJA）的患者随后似乎很少出现CTS。我们的假设是BJA可降低腕管内压力。
本研究纳入了28例接受BJA的患者（其中6例合并CTS）。使用市售压力监测装置（史赛克STIC；密歇根州卡拉马祖）测量BJA前后即刻的腕管内压力。对于同时接受BJA和腕管松解术（CTR）的合并CTS患者，在BJA后但在横腕韧带松解前测量压力。
所有患者在BJA后腕管内压力均降低。有3例II期关节炎患者、15例III期关节炎患者和10例IV期关节炎患者。所有患者BJA前的平均压力为23.9mmHg，BJA后降至11.0mmHg。合并CTS的患者BJA前平均压力为26.5mmHg，BJA后降至7.3mmHg。
BJA可使腕管减压并降低其内部压力。对于合并CTS的患者，单独进行BJA（无需额外松解横腕韧带）即可降低腕管压力。有必要进一步研究以确定接受BJA的CTS患者是否需要单独松解横腕韧带。
II级，诊断性。
