Bull Hosp Jt Dis (2013). 2022 Jun;80(2):213-217.
The objective of this study was to determine the role of ad- junctive surgical procedures on the median nerve for carpal tunnel syndrome as measured by somatosensory evoked potentials (SEPs) on the nerve. Fifty-five median nerves in 47 patients were studied. In each patient, a base-line SEP was recorded in the operating room prior to incision and then intraoperatively following each of three sequential pro- cedures: division of the transverse carpal ligament, an epi- neurolysis of the nerve, and finally, either an epineurotomy or epineurectomy that we refer to as a "limited internal neu- rolysis" since it did not involve any intraneural dissection of fascicles. Comparison of the baseline mean SEP latency for the median nerve, referred to as N19 (negative polarity = 19 msec), showed a statistically significant improvement following each of the three procedures. The average reduc- tion of latency after ligament release alone was 1.52 msec, and the total improvement in latency from baseline through limited internal neurolysis was 4.72 msec. Our study showed that epineurolysis followed by a limited internal neurolysis using either an epineurotomy or epineurectomy produced a significant electrophysiologic improvement in the median nerve. There was no significant difference when comparing epineurotomy and epineurectomy.
本研究旨在通过正中神经体感诱发电位（SEP）来确定辅助性手术对正中神经在腕管综合征中的作用。对 47 名患者的 55 根正中神经进行了研究。在每位患者中，在切口前的手术室记录基线 SEP，然后在三种连续手术中的每一种之后记录术中 SEP：腕横韧带切开、神经外膜松解，最后是神经外膜切开或神经切除术，我们称之为“有限的神经内松解”，因为它不涉及任何束内神经分离。正中神经基线平均 SEP 潜伏期（负相为 19 毫秒）的比较显示，三种手术均有统计学意义的改善。仅释放韧带后潜伏期平均降低 1.52 毫秒，从基线到有限神经内松解的总潜伏期改善为 4.72 毫秒。我们的研究表明，神经外膜松解后行有限的神经内松解，无论是神经外膜切开还是神经切除术，均可显著改善正中神经的电生理功能。神经外膜切开术和神经切除术之间无显著差异。
