Yamagami T, Higashi K, Handa H, Minouchi K, Fujii M, Nishihara K, Kaji R
Department of Neurosurgery, Ijinkai Takeda General Hospital, Kyoto, Japan.
No Shinkei Geka. 1994 Jul;22(7):617-20.
Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. Appropriate diagnosis and therapy contribute to obtaining good results. We performed carpal tunnel release in 61 patients including 8 cases with chronic renal failure. They included 18 males and 43 females. Age distribution was from 28 to 76 years of age among the males, and from 29 to 82 years of age among the female patients. Bilateral operations were performed in 13 cases (male 5, female 8). Operations were carried out with local anesthesia in all cases except one. The skin incision was about 5 cm on the palmar skin. Hypertrophy of the transverse carpal ligament was found in all cases, with a thickness of 4 mm on the average. Usually, the ligament was as hard as gum in consistency. There were also hypertrophy of the subcutaneous connective tissue and palmar aponeurosis or aberrant muscle in some cases. In CTS following long-term hemodialysis for chronic renal failure, the ligament was very hard and appeared to be partly calcified. All patients improved clinically after the operation. We should understand the characteristic clinical symptoms and signs of CTS. Clinical worsening was prominent at night and/or early in the morning. Definite diagnosis was performed by electrophysiological means. Operative indications are 1) cases whose daily activities are disturbed due to severe symptoms with progressive aggravation, 2) cases with muscle weakness in the distribution of the median nerve, 3) cases with thenar atrophy, 4) cases which, electrophysiologically, are suspected of demyelination of the median nerve. As there were many unpredictable anomalies and variations among the lesions, correct decompression of the median nerve under direct vision is necessary during surgery.
腕管综合征（CTS）是最常见的卡压性神经病变。恰当的诊断和治疗有助于取得良好效果。我们对61例患者进行了腕管松解术，其中包括8例慢性肾衰竭患者。患者包括18名男性和43名女性。男性年龄分布在28至76岁之间，女性患者年龄分布在29至82岁之间。13例患者（男性5例，女性8例）接受了双侧手术。除1例患者外，所有病例均采用局部麻醉进行手术。手掌皮肤切口约5厘米。所有病例均发现腕横韧带肥厚，平均厚度为4毫米。通常，韧带质地如口香糖般坚硬。部分病例还存在皮下结缔组织、掌腱膜肥大或肌肉变异。在慢性肾衰竭长期血液透析后的CTS患者中，韧带非常坚硬，似乎部分钙化。所有患者术后临床症状均有改善。我们应了解CTS的特征性临床症状和体征。临床症状在夜间和/或清晨明显加重。通过电生理手段进行明确诊断。手术指征为：1）因严重症状且进行性加重而日常活动受到干扰的病例；2）正中神经分布区出现肌肉无力的病例；3）大鱼际萎缩的病例；4）电生理检查怀疑正中神经脱髓鞘的病例。由于病变中存在许多不可预测的异常和变异，手术中在直视下对正中神经进行正确减压是必要的。
