严重腕管综合征手术后拇指对掌功能恢复：一项临床、放射学和电生理学的初步研究

Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study.

作者信息

Garg Bhavuk, Manhas Vikrant, Vardhan Anand, Srivastava Deep Narayan, Das Chandan J, Vibha Deepti, Gupta Vivek, Malhotra Rajesh, Kotwal Prakash

机构信息

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

出版信息

J Hand Surg Am. 2019 Feb;44(2):157.e1-157.e5. doi: 10.1016/j.jhsa.2018.05.004. Epub 2018 Jun 20.

DOI:10.1016/j.jhsa.2018.05.004

PMID:29934085

Abstract

PURPOSE

To objectively assess recovery of thumb opposition in patients with carpal tunnel syndrome (CTS) after open carpal tunnel release and to evaluate electrophysiological and magnetic resonance (MR) neurography findings as predictors of thumb opposition recovery.

METHODS

A total of 22 patients with severe CTS and thenar atrophy were included in this study. A detailed clinical, electrophysiological, and MR neurography evaluation was done both before and after surgery at 6 months to assess thumb opposition recovery.

RESULTS

The median duration of symptoms was 12 months (interquartile range, 12-20 months). The compound muscle action potential of the abductor pollisis brevis (CMAP-APB) also showed statistically significant improvement of 0.5 + 0.2 mV after surgery. Tip-tip pulp pinch strength increased from 1.2 ± 0.4 to 2.0 ± 0.4 kg at 6-month follow-up, lateral pulp pinch strength increased from 1.9 ± 0.6 to 2.8 ± 0.9 kg at 6-month follow-up, and 3-point pulp pinch also improved from 1.9 ± 0.5 to 2.8 ± 0.9 at final follow-up. On MR neurogram, the proportion of patients with abnormal median nerve morphology decreased from 81.8% to 68.2%, abnormal thenar branch morphology decreased from 63.6% to 36.4% and denervation edema deceased from 59.1% to 13.6%.

CONCLUSIONS

Patients suffering from severe CTS with thenar atrophy and detectable CMAP-APB showed promising improvement following open carpal tunnel release.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

摘要

目的

客观评估开放性腕管松解术后腕管综合征（CTS）患者拇指对掌功能的恢复情况，并评估电生理和磁共振（MR）神经成像结果作为拇指对掌功能恢复预测指标的价值。

方法

本研究共纳入22例重度CTS合并大鱼际萎缩的患者。在手术前及术后6个月进行详细的临床、电生理和MR神经成像评估，以评估拇指对掌功能的恢复情况。

结果

症状的中位持续时间为12个月（四分位间距为12 - 20个月）。术后拇短展肌复合肌肉动作电位（CMAP - APB）也有统计学意义的改善，增加了0.5±0.2 mV。在6个月随访时，指尖对指腹捏力从1.2±0.4 kg增加到2.0±0.4 kg，外侧指腹捏力从1.9±0.6 kg增加到2.8±0.9 kg，三点指腹捏力在最终随访时也从1.9±0.5改善到2.8±0.9。在MR神经成像上，正中神经形态异常的患者比例从81.8%降至68.2%，大鱼际分支形态异常的比例从63.6%降至36.4%，失神经水肿从59.1%降至13.6%。