Rhoades C E, Mowery C A, Gelberman R H
J Bone Joint Surg Am. 1985 Feb;67(2):253-6.
Thirty-six hands in thirty-two patients had internal neurolysis of the median nerve and carpal tunnel release for severe carpal-tunnel syndrome. Median-nerve function was evaluated in all hands using Weber two-point discrimination and electromyography. Thenar-muscle strength or bulk, or both, were recorded in thirty hands. Ten hands also had Semmes-Weinstein monofilament pressure-testing. The indication for neurolysis in these selected patients was the presence of any one of the following: an increase in two-point-discrimination values, thenar-muscle atrophy, or denervation potentials in the thenar muscles. Twenty-two (76 per cent) of the twenty-nine hands that had had diminished two-point discrimination preoperatively regained normal sensibility. Seven (70 per cent) of ten hands that had had thenar-muscle weakness (grade 3 or less) preoperatively regained grade-4 or 5 strength. Nine (50 per cent) of eighteen hands that had had thenar-muscle atrophy regained normal muscle bulk. Seventy-six per cent of the patients in this series recovered sensation and 70 per cent recovered muscle strength, and the procedure was well tolerated. Although no studies comparing the results of treatment of severe carpal-tunnel syndrome with and without internal neurolysis have been reported, we think that neurolysis, if it is done by a surgeon who is skilled in microsurgery, is a safe and effective procedure for severe carpal-tunnel syndrome.
32例患者的36只手因严重腕管综合征接受了正中神经内松解术和腕管松解术。使用韦伯两点辨别法和肌电图对所有手的正中神经功能进行评估。记录了30只手的大鱼际肌力量或体积，或两者。10只手还进行了Semmes-Weinstein单丝压力测试。这些选定患者进行神经松解的指征为存在以下任何一项：两点辨别值增加、大鱼际肌萎缩或大鱼际肌去神经电位。术前两点辨别能力下降的29只手中，有22只（76%）恢复了正常感觉。术前大鱼际肌无力（3级或以下）的10只手中，有7只（70%）恢复到4级或5级力量。术前大鱼际肌萎缩的18只手中，有9只（50%）恢复了正常肌肉体积。该组76%的患者恢复了感觉，70%的患者恢复了肌肉力量，且该手术耐受性良好。虽然尚未有比较有无正中神经内松解治疗严重腕管综合征结果的研究报道，但我们认为，如果由精通显微外科手术的外科医生进行神经松解，对于严重腕管综合征来说是一种安全有效的手术。
