Thurston A, Lam N
Department of Surgery, Wellington School of Medicine, New Zealand.
Aust N Z J Surg. 1997 May;67(5):283-8. doi: 10.1111/j.1445-2197.1997.tb01964.x.
Many recent reports of the results of decompression of the median nerve in the carpal tunnel have concentrated on only one aspect of recovery (numbness, grip etc.), and there are no reports of a comprehensive study of outcome. The aim of the present study was to review comprehensively the results of the direct visualization method of decompression of the carpal tunnel and to compare them with the published results of endoscopic release.
Patients' perceptions of the severity of pain, numbness and paraesthesiae due to carpal tunnel syndrome (CTS), before and after open carpal tunnel release (CTR) in 188 hands were reviewed retrospectively at a minimum time of follow-up of 18 months. Motor and sensory testing, provocation testing and measurement of scar tenderness in 135 hands were performed at a clinical review.
Subjective results showed that 70% experienced a reduction in the severity of pain after CTR, 78% of hands experienced a reduction in the severity of paraesthesiae and 77% experienced a reduction in the severity of numbness. A total of 49% had improvements in all three symptoms after CTR. At the clinical review, sensory testing revealed that 59% of hands had normal or slightly diminished light touch, 35% had normal static two-point discrimination and 61% had normal dynamic two-point discrimination. Results for Tinel's test, Phalen's test and pressure provocation testing were positive in 10% of hands. There was no scar tenderness in 38%, no persisting thenar atrophy in 90%. Normal grip strength was found in 93% and 91% had normal pinch strength.
It was concluded that open carpal tunnel release remains a safe and reliable treatment for carpal tunnel syndrome. The very low incidence of serious complications from the open technique of CTR, when compared with endoscopic CTR as published by different authors in the literature, and the comparable clinical results, appears to make the open technique a safer and preferable option. However, a properly controlled trial of both techniques is necessary to compare them.
近期许多关于腕管综合征正中神经减压术结果的报道仅关注恢复的一个方面（如麻木、握力等），尚无全面研究结局的报道。本研究的目的是全面回顾腕管直接可视化减压术的结果，并将其与已发表的内镜松解术结果进行比较。
回顾性分析188例接受开放性腕管松解术（CTR）患者的手部情况，随访时间至少18个月，了解患者对腕管综合征（CTS）所致疼痛、麻木和感觉异常严重程度的感知。在临床复查时，对135例患者的手部进行运动和感觉测试、激发试验以及瘢痕压痛测量。
主观结果显示，70%的患者在CTR后疼痛严重程度减轻，78%的手部感觉异常严重程度减轻，77%的患者麻木严重程度减轻。共有49%的患者在CTR后三种症状均有改善。在临床复查时，感觉测试显示，59%的手部轻触觉正常或稍有减退，35%的手部静态两点辨别觉正常，61%的手部动态两点辨别觉正常。Tinel试验、Phalen试验和压力激发试验结果在10%的手部为阳性。38%的患者无瘢痕压痛，90%的患者无持续性大鱼际萎缩。93%的患者握力正常，91%的患者捏力正常。
得出结论，开放性腕管松解术仍然是治疗腕管综合征安全可靠的方法。与文献中不同作者报道的内镜CTR相比，开放性CTR技术严重并发症的发生率极低，且临床结果相当，这似乎使开放性技术成为更安全、更可取的选择。然而，需要对两种技术进行适当的对照试验以进行比较。
