Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Tokyo, 300-0395, Japan.
Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan.
BMC Musculoskelet Disord. 2020 Jan 11;21(1):22. doi: 10.1186/s12891-019-3033-y.
The objective of this study is to investigate the prognostic values of median nerve strain and applied pressure measurement for the assessment of clinical recovery after carpal tunnel release.
Forty-five wrists, from 45 idiopathic carpal tunnel syndrome patients who treated with open carpal tunnel release, were evaluated by ultrasound. Median nerve strain, pressure applied to the skin, and ratio of pressure-strain were measured at the proximal part of the carpal tunnel. In addition, distal latencies in the motor and sensory nerve conductions studies and cross-sectional area of median nerve were measured. The parameters were compared before and after the open carpal tunnel release. According to patient recovery, the receiver operating characteristic curves were generated to evaluate the prognostic values of the parameters. The areas under the receiver operating characteristic curves were compared among parameters.
There was a significant increase in the median nerve strain, and significant decreases in the pressure applied to the skin and ratio of pressure-strain after carpal tunnel release (P < 0.01). There were significant decreases in the distal latencies and the cross-sectional area after carpal tunnel release (P < 0.01). The areas under the curves were 0.689, 0.773, 0.811, 0.668, 0.637, and 0.562 for the pressure, strain, pressure-strain ratio, motor latency, sensory latency, and area, respectively.
The results suggest that elasticity of the median nerve and pressure around the nerve recover quickly after carpal tunnel release. Pressure-strain ratio was the most reliable parameter to reflect clinical recovery. The measurement of strain and applied pressure can be useful indicators to evaluate effectiveness of the carpal tunnel release.
Registered as NCT04027998 at ClinicalTrials.gov. Retrospectively registered on July 22, 2019.
本研究旨在探讨正中神经应变和应用压力测量在评估腕管松解术后临床恢复中的预后价值。
对 45 例特发性腕管综合征患者（45 腕）进行超声评估。在腕管近端测量正中神经应变、皮肤压力和压力应变比，并测量运动和感觉神经传导的远端潜伏期和正中神经的横截面积。比较腕管松解前后的参数。根据患者的恢复情况，生成受试者工作特征曲线以评估参数的预后价值。比较各参数的受试者工作特征曲线下面积。
腕管松解后正中神经应变明显增加，皮肤压力和压力应变比明显降低（P<0.01）。腕管松解后远端潜伏期和横截面积均显著降低（P<0.01）。曲线下面积分别为压力 0.689、应变 0.773、压力应变比 0.811、运动潜伏期 0.668、感觉潜伏期 0.637 和横截面积 0.562。
结果表明，正中神经的弹性和神经周围的压力在腕管松解后迅速恢复。压力应变比是反映临床恢复最可靠的参数。应变和应用压力的测量可以作为评估腕管松解效果的有用指标。
在美国临床试验注册中心注册，注册号为 NCT04027998。2019 年 7 月 22 日进行回顾性注册。
