Kimura Mahiro, Ikeguchi Ryosuke, Noguchi Takashi, Nankaku Manabu, Yamawaki Rie, Yoshimoto Koichi, Sakamoto Daichi, Iwai Terunobu, Fujita Kazuaki, Matsuda Shuichi
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.
J Hand Microsurg. 2024 Sep 21;17(1):100162. doi: 10.1016/j.jham.2024.100162. eCollection 2025 Jan.
Carpal tunnel syndrome is a challenging condition when conventional carpal tunnel revision surgery fails to alleviate symptoms. This study aims to assess the outcomes of combining carpal tunnel revision surgery with a synovial wrap for cases of recurrent carpal tunnel syndrome in patients who had adhered median nerve, with a minimum 1-year follow-up.
A retrospective analysis was conducted on 10 patients (mean age: 73.7 years, nine females and one male) who underwent treatment for recurrent carpal tunnel syndrome. The approach involved carpal tunnel revision surgery coupled with a median nerve synovial wrap. Patients were followed up for a minimum of 1 year. The procedure involved harvesting a 3.5 cm × 4 cm section of the flexor synovial membrane with a distal ulnar pedicle, which was then wrapped around the adherent site of the median nerve. Physical assessments included the pain visual analogue scale (VAS), Tinel sign in the carpal tunnel, thenar muscle atrophy, the Semmes-Weinstein monofilament test (SW test), manual muscle test (MMT) as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent), and the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. The physical variables were compared before surgery and at final follow-up.
All patients showed some improvement in SW test. The MMT for the abductor pollicis brevis showed significant improvement at final follow-up (3 for four patients, 4 for four patients, and 5 for two patients) compared to pre-surgery assessments (2 for six patients, 3 for two patients, and 4 for two patients). The mean VAS score and DASH score at final follow-up (13.0 ± 10.3, 19.3 ± 12.7, respectively) were significantly lower than those recorded before surgery (76.5 ± 11.1, 52.4 ± 17.1, respectively). The Tinel sign and the thenar muscle atrophy significantly improved from before surgery to final follow-up.
Carpal tunnel release with a synovial wrap demonstrated significant improvements in muscle strength, pain relief and function. The synovial wrap method is an effective procedure for treating recurrent carpal tunnel syndrome.
当传统的腕管修复手术无法缓解症状时，腕管综合征是一种具有挑战性的病症。本研究旨在评估对于正中神经粘连的复发性腕管综合征患者，将腕管修复手术与滑膜包裹相结合的治疗效果，并进行至少1年的随访。
对10例接受复发性腕管综合征治疗的患者（平均年龄：73.7岁，9名女性和1名男性）进行回顾性分析。治疗方法包括腕管修复手术以及正中神经滑膜包裹。对患者进行至少1年的随访。该手术过程包括切取一段带尺侧远端蒂的3.5厘米×4厘米屈肌滑膜，然后将其包裹在正中神经的粘连部位。体格评估包括疼痛视觉模拟量表（VAS）、腕管内的Tinel征、大鱼际肌萎缩情况、Semmes-Weinstein单丝试验（SW试验）、根据英国医学研究委员会5分制量表（5/5为正常；0/5为无功能）评估的徒手肌力测试（MMT）以及上肢、肩部和手部功能障碍（Quick DASH）问卷。对术前和最终随访时的体格变量进行比较。
所有患者的SW试验均有一定改善。与术前评估相比（6例患者为2级，2例患者为3级，2例患者为4级），最终随访时拇短展肌的MMT有显著改善（4例患者为3级，4例患者为4级，2例患者为5级）。最终随访时的平均VAS评分和DASH评分（分别为13.0±10.3、19.3±12.7）显著低于术前记录的评分（分别为76.5±11.1、52.4±17.1）。从术前到最终随访，Tinel征和大鱼际肌萎缩情况有显著改善。
滑膜包裹的腕管松解术在肌肉力量、疼痛缓解和功能方面有显著改善。滑膜包裹法是治疗复发性腕管综合征的一种有效方法。
