Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong SAR, The People's Republic of China.
Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China.
AJR Am J Roentgenol. 2021 Feb;216(2):464-470. doi: 10.2214/AJR.20.23066. Epub 2020 Nov 25.
The purpose of this study was to study changes in the median nerve, retinaculum, and carpal tunnel on MRI after successful endoscopic carpal tunnel release (ECTR). In this prospective study, 35 wrists in 32 patients (five men, 27 women; mean age, 56.7 ± 6.8 [SD] years) with nerve conduction test-confirmed primary carpal tunnel syndrome were evaluated from May 2013 to September 2016. Clinical scores ranging from 0 to 4 (no improvement to symptoms completely resolved) and MRI morphologic features of median nerve and carpal tunnel were evaluated at baseline and 3 and 12 months after ECTR. The paired test was used to compare MRI parameters before and after ECTR and their relationships to clinical improvement scores. All patients' conditions improved after ECTR with mean clinical improvement scores of 2.94 ± 1.0 at 3 months and 3.49 ± 0.56 at 12 months. Although median nerve swelling did decrease proximally, the nerve remained swollen (> 15 mm) and flattened in all areas, even 12 months after ECTR. Additional changes occurred in median nerve caliber-change ratio, relative signal intensity, and carpal tunnel cross-sectional area. A retinacular gap was present in 33 (94%) wrists 3 months and six (17%) wrists 12 months after ECTR, and increased retinacular bowing persisted. After ECTR, undue swelling and flattening of the median nerve persist as long as 12 months after surgery, even in patients with a good surgical outcome. One should be wary of using these MRI findings as signs of persistent neural compression. The retinaculum reforms in most patients within 12 months of surgery but with a more bowed configuration.
本研究旨在探讨内镜下腕管松解术（ECTR）后正中神经、屈肌支持带和腕管的磁共振成像（MRI）变化。 在这项前瞻性研究中，2013 年 5 月至 2016 年 9 月，对 32 例（5 例男性，27 例女性；平均年龄 56.7 ± 6.8[SD]岁）经神经传导试验证实的原发性腕管综合征患者的 35 只手腕进行了评估。临床评分为 0 至 4 分（无改善至症状完全缓解），并在 ECTR 前、后 3 个月和 12 个月评估正中神经和腕管的 MRI 形态特征。采用配对 t 检验比较 ECTR 前后 MRI 参数及其与临床改善评分的关系。所有患者 ECTR 后症状均有改善，术后 3 个月临床改善评分为 2.94 ± 1.0，术后 12 个月评分为 3.49 ± 0.56。尽管正中神经近端肿胀有所减轻，但神经在所有区域仍肿胀（>15mm）且变平，即使在 ECTR 后 12 个月也是如此。正中神经口径变化率、相对信号强度和腕管横截面积也发生了变化。3 个月时有 33 只（94%）手腕存在屈肌支持带间隙，6 只（17%）手腕存在屈肌支持带间隙 12 个月后，屈肌支持带弯曲持续存在。ECTR 后，即使手术效果良好，正中神经的过度肿胀和变平也会持续 12 个月以上。因此，不应将这些 MRI 发现视为持续神经压迫的迹象。大多数患者在术后 12 个月内屈肌支持带重建，但形态更弯曲。
