腕管综合征的发病过程与腕关节过度屈伸和劳损有关，为探究用超声辅助内镜技术治疗腕管综合征的疗效及安全性，选择2019年6月至2020年12月南通大学第二附属医院收治的51例单侧腕管综合征患者，在超声辅助行内镜下腕横韧带松解术，分别于术前、术后1个月、术后3个月进行波士顿腕管量表的症状严重程度评分（SSS）及功能状态评分（FSS）、测量钩骨水平正中神经扁平率（FR），最终评估其疗效及安全性。术后51例患者均获得随访，患者术后1个月、术后3个月SSS评分及FSS评分较术前均明显下降，有统计学意义（P<0.05）； FR在术后1个月、术后3个月逐渐下降，有统计学意义（P<0.05）；根据腕管综合征与肘管综合征功能评定标准的现状与建议，优良率94.1%，术后均未有血管神经损伤、感染等并发症发生。借助超声辅助内镜技术治疗腕管综合征的术野清晰、安全性高、创伤小，患者症状缓解迅速、术后恢复快，值得临床推广。
The pathogenesis of the carpal tunnel syndrome is related to the excessive flexion and extension of the wrist joint and the strain, such as due to the improper posture of grasping the snowstick when skiing. This paper evaluates the effect and the safety of ultrasound-assisted endoscopic carpal tunnel release. 51 patients with unilateral carpal tunnel syndrome admitted to our hospital from June 2019 to December 2020 are selected to be treated with the endoscopic transverse carpal ligament release assisted by ultrasound. In addition, the Boston Carpal Tunnel Scale Symptom Severity Scale (SSS), the Boston Carpal Tunnel Scale Functional Status Scale (FSS), the median nerve flattening rate at the level of the hamate bone (FR) are recorded before the surgery, and 1 month and 3 months after the surgery. According to the follow-up among the 51 patients, the SSS score and the FSS score of patients 1 month and 3 months after the surgery are significantly lower than those before the surgery, with statistical significance (P<0.05) and the FR is decreased gradually 1 month and 3 months after the surgery, with statistical significance (P<0.05). According to the current status and the suggestions in the functional evaluation standard for the carpal tunnel syndrome and the cubital tunnel syndrome, the good rate is 98.0%, because of no vascular nerve injury, infection and other complications. Endoscopic transverse carpal ligament release assisted by ultrasound can visualize the transverse carpal ligament and its surrounding anatomical structure through a small incision to evaluate the release effect of the transverse carpal ligament and to reduce the complications of the vascular and nerve injury. Besides, the postoperative patients have recovered well and are satisfied with the treatment effect, so the treatment is worthy of clinical promotion.
[1] McCall D, Safran M R. Injuries about the shoulder in skiing and snowboarding[J]. British Journal of Sports Medicine, 2009, 43(13):987-992.
[2] Bladin C, McCrory P, Pogorzelski A. Snowboarding injuries[J]. Sports Medicine, 2004, 34(2):133-138.
[3] Kim S, Endres N K, Johnson R J, et al. Snowboarding injuries:Trends over time and comparisons with alpine skiing injuries[J]. The American Journal of Sports Medicine, 2012, 40(4):770-776.
[4] 童劲松, 董震. 周围神经卡压的诊疗进展[J]. 中华手外科杂志, 2021, 37(3):219-222.
[5] 顾玉东. 腕管综合征与肘管综合征的临床分型现状与建议[J]. 中华骨科杂志, 2011, 31(7):818-819.
[6] 周晓玲, 李学渊, 俞淼, 等. 全清醒无止血带局部麻醉技术在腕管综合征手术中的临床应用及分析[J]. 中华手外科杂志, 2021, 37(2):84-86.
[7] 茅天, 谢仁国, 汤锦波. 腕管综合征术后柱状痛的临床研究[J]. 中华手外科杂志, 2010, 26(6):369-371.
[8] 顾玉东, 史其林, 孙贵新. 内窥镜下松解腕管综合征的神经并发症[J]. 中华手外科杂志, 2003, 19(3):25-26.
[9] 顾玉东. 腕管综合征与肘管综合征功能评定标准的现状与建议[J]. 中华创伤骨科杂志, 2011, 13(1):6-7.
[10] Makowiec R L, Nagle D J, Chow J C. Outcome of first time endoscopic carpal tunnel release in a teaching environment[J]. Arthroscopy, 2002, 1(18):27-31.
[11] Hankins C L, Brown M G, Lopez R A, et al. A 12-year experience using the Brown two-portal endoscopic procedure of transverse carpal ligament release in 14, 722 patients:Defining a new paradigm in the treatment of carpal tunnel syndrome[J]. Plastic & Reconstructive Surgery, 2007, 120(7):1911-1921.
[12] Quintero J I, Molina C S, Kaufman C, et al. Safety parameters during endoscopic carpal tunnel release:An anatomic study[J]. Journal of Orthopaedics, 2020, 17:116-119.
[13] 孙建永, 付孝英, 赖育鹏, 等. 掌浅弓及其分支的解剖学研究进展[J]. 解剖学研究, 2017, 39(4):286-287.
[14] Vasiliadis H S, Tokis A V, Andrikoula S I, et al. Microsurgical dissection of the carpal tunnel with respect to neurovascular structures at risk during endoscopic carpal tunnel release[J]. Arthroscopy, 2006, 22(8):807-812.
[15] Elsharif M, Papanna M, Helm R. Long-term follow up outcome results of Knifelight carpal tunnel release and conventional open release following a departmental randomized controlled trial. A prospective study[J]. Polish Orthopedics & Traumatology, 2014, 79:67-70.
[16] Yung P S, Hung L K, Tong C W, et al. Carpal tunnel release with a limited palmar incision:Clinical results and pillar pain at 18 months follow-up[J]. Hand Surgery, 2005, 10(1):29-35.
[17] 丁洁, 梁炳生, 贾英伟, 等. 正中神经掌皮支的局部解剖与临床意义[J]. 中华手外科杂志, 2013, 29(4):205-207.
[18] 刘靖波, 劳杰, 刘宇洲, 等. 正中神经掌皮支尺侧支损伤——腕管综合征术后柱状痛的重要病因[J]. 中华手外科杂志, 2018, 34(4):270-272.
[19] Gurpinar T, Polat B, Polat A E, et al. Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life:A prospective comparative study[J]. Pakistan Journal of Medical Sciences, 2019, 35(6):1532-1537.
[20] 纪柳. 正中神经横断面积及扁平率的超声参数与腕管综合征严重程度的相关性分析[J]. 新疆医科大学学报, 2021, 44(8):5.
[21] 周丽哲, 郭媛, 张绪树, 等. 手、腕部运动姿势和角度的改变对腕管及正中神经影响的生物力学分析[J]. 医用生物力学, 2021, 36(Suppl 1):140.
