Lee Sang Ki, Hwang Seok Young, An Young Sun, Choy Won Sik
From the Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
Ann Plast Surg. 2020 Aug;85(2):127-134. doi: 10.1097/SAP.0000000000002386.
The main cause of carpal tunnel syndrome (CTS) is pathological changes in the flexor synovium, which is a known cause of pressure elevation in the carpal tunnel. The importance of the transverse carpal ligament (TCL) in the pathogenesis of CTS has hitherto been overlooked. However, the TCL significantly affects carpal biomechanics; the TCL is known to affect the carpal bone to a greater extent when intra carpal tunnel pressure is high. In addition, the effect of TCL properties on the progression course of idiopathic CTS is unknown.Therefore, we hypothesized that TCL thickness, measured using ultrasonography, would influence the results of conservative treatment for CTS patients with mild to moderate symptoms. We aimed to investigate the relationship between the ultrasound-measured TCL thickness and idiopathic carpal tunnel conservative treatment surgery rate.
We analyzed the wrists of 127 patients with mild to moderate symptoms of CTS. The patients were diagnosed on the basis of electrophysiological assessment outcomes, median nerve cross-sectional area in the carpal tunnel, and clinical symptoms. The Boston carpal tunnel questionnaire score was also measured. Patients with a TCL thinner than 1.5 mm were classified into group A (n = 62), and those with a TCL thicker than 1.5 mm were classified into group B (n = 65). Patients with severe symptoms or other diseases were excluded. The patients were initially treated with night splinting after diagnosis. If symptoms were not ameliorated, steroid injection and surgical treatment were performed consecutively. The procedures were determined by a single surgeon.
The mean TCL thickness was 1.51 mm: 0.98 mm in group A and 2.28 mm in group B. The percentages of patients who underwent surgery were 43.0% in group A and 67.7% in group B. Group B was 1.77 times more likely to have surgery, and the interval between diagnosis and surgery and/or steroid injection was shorter. The TCL thickness in group B was also related to cross-sectional area and symptom duration.
Transverse carpal ligament thickness affects disease progression and may affect treatment efficacy, depending on the treatment method. Transverse carpal ligament thickness may be a criterion for deciding between surgical and conservative treatments based on a thickness threshold of 1.5 mm.
腕管综合征（CTS）的主要病因是屈肌滑膜的病理改变，这是腕管内压力升高的已知原因。腕横韧带（TCL）在CTS发病机制中的重要性迄今一直被忽视。然而，TCL对腕部生物力学有显著影响；已知当腕管内压力较高时，TCL对腕骨的影响更大。此外，TCL特性对特发性CTS病程的影响尚不清楚。因此，我们假设，使用超声测量的TCL厚度会影响症状轻至中度的CTS患者的保守治疗结果。我们旨在研究超声测量的TCL厚度与特发性腕管保守治疗手术率之间的关系。
我们分析了127例症状轻至中度的CTS患者的手腕。患者根据电生理评估结果、腕管内正中神经横截面积和临床症状进行诊断。还测量了波士顿腕管问卷评分。TCL厚度小于1.5mm的患者分为A组（n = 62），TCL厚度大于1.5mm的患者分为B组（n = 65）。排除症状严重或患有其他疾病的患者。患者确诊后最初采用夜间夹板治疗。如果症状未改善，则依次进行类固醇注射和手术治疗。治疗方案由一名外科医生确定。
TCL平均厚度为1.51mm：A组为0.98mm，B组为2.28mm。A组接受手术的患者比例为43.0%，B组为67.7%。B组接受手术的可能性是A组的1.77倍，且诊断与手术和/或类固醇注射之间的间隔更短。B组的TCL厚度也与横截面积和症状持续时间有关。
腕横韧带厚度会影响疾病进展，并且可能根据治疗方法影响治疗效果。腕横韧带厚度可能是以1.5mm厚度阈值决定手术治疗和保守治疗的一个标准。
