本文選題：腕管綜合征　切入點：小切口　出處：《揚州大學》2017年碩士論文

【摘要】：目的分別采用腕橫紋處小切口和傳統(tǒng)縱切口手術(shù)治療需要手術(shù)的腕管綜合征患者,根據(jù)患者術(shù)前及術(shù)后手功能評分變化評價腕橫紋處小切口是否具有更優(yōu)的療效。方法自2008年9月至2012年9月,在我院分別采用傳統(tǒng)縱形切口和遠側(cè)腕橫紋處橫形小切口治療84名需要手術(shù)的腕管綜合征患者,共106例患手。其中12名男性患者(14%),72名女性患者(86%);年齡27～81歲,平均年齡53歲。對于既往手腕部外傷史以及腕管內(nèi)有占位性病變等疾病的患者排除在外。依據(jù)患者手術(shù)方式的不同,將84名患者分為兩個組。傳統(tǒng)縱形切口組(open carpal tunnel release,OCTR):4名男性患者、6例患手;34名女性患者、40例患手。遠側(cè)腕橫紋橫形小切口組(small incision carpal tunnel release,SICTR):6名男性患者、10例患手;40女性患者、50例患手。在患者住院期間客觀記錄手術(shù)時間、術(shù)中失血量、住院時間等;在隨訪期間觀察并記錄患者術(shù)后并發(fā)癥的發(fā)生情況及恢復情況,如握力和捏力的恢復情況、柱狀痛的發(fā)生率、感覺恢復情況等。術(shù)后隨訪數(shù)據(jù)采用SSPS16.0統(tǒng)計軟件進行統(tǒng)計學分析,運用完全隨機設計兩樣本比較的秩和檢驗對患者術(shù)前、術(shù)后的手功能評分結(jié)果進行對比分析。結(jié)果在隨訪期內(nèi)(13～24個月),平均11.6個月,其中18名患者失訪,未前往我院門診隨訪(傳統(tǒng)切口組:6名,小切口組:12名)。兩組患者患手術(shù)后均未出現(xiàn)切口感染的情況。傳統(tǒng)切口組術(shù)后7例柱狀痛、8例復發(fā)、2例疤痕過度增生;小切口組術(shù)后均無明顯神經(jīng)損傷情況,但3例柱狀痛、1例復發(fā)、3例感覺異常改善不明顯。腕管綜合征手功能評分傳統(tǒng)切口組:術(shù)前2.97±0.87,術(shù)后6.83±1.15;小切口組:術(shù)前3.41±0.95,術(shù)后10.11±0.99。兩組術(shù)前評分秩和檢驗P0.05(α =0.05),差異無統(tǒng)計學意義;兩組術(shù)后評分秩和檢驗P0.05(α=0.05),差異有統(tǒng)計學意義。結(jié)論傳統(tǒng)縱形切口的術(shù)后并發(fā)癥相對于腕橫紋處橫形小切口較多。腕橫紋處橫形小切口手術(shù)具有安全性相對較高、手術(shù)時間相對短、創(chuàng)傷較小、美容外觀、術(shù)后瘢痕過度增生發(fā)生率低、住院時間短及費用低等優(yōu)點。
[Abstract]:Objective to evaluate the efficacy of small incision of carpal striation and traditional longitudinal incision in the treatment of carpal tunnel syndrome patients before and after operation.Methods from September 2008 to September 2012, 84 patients with carpal tunnel syndrome were treated with traditional longitudinal incision and small transverse incision of distal carpal stria, including 106 patients with carpal tunnel syndrome.Twelve male patients and 72 female patients aged 2781 years with an average age of 53 years.Patients with previous wrist trauma and carpal tunnel lesions were excluded.Eighty-four patients were divided into two groups according to the different operation methods.In the traditional longitudinal incision group, open carpal tunnel release OCTR: 4 male patients had 6 cases of hand and 34 cases of female patients with 40 cases of hand.Small incision carpal tunnel release: six male patients with distal transverse stripe of wrist were divided into 10 cases and 40 cases of female patients, and 50 cases of them were involved in the group of small transverse carpal stripe and small incision group, and 50 cases were involved in the group of small incision carpal tunnel release.The time of operation, the amount of blood lost during the operation, the duration of hospitalization were recorded objectively during the period of hospitalization, and the occurrence and recovery of postoperative complications, such as the recovery of grip strength and pinch strength, the incidence of columnar pain, were observed and recorded during the follow-up period.Feel a recovery, etc.The postoperative follow-up data were statistically analyzed by SSPS16.0 software, and the results of hand function score before and after operation were analyzed by rank sum test, which were compared by completely random design of two samples.Results during the follow-up period, there were 13 ~ 24 months (mean 11.6 months), in which 18 patients lost their visits and did not go to our outpatient clinic to follow up (traditional incision group: 6 cases, small incision group: 12 cases).There was no incision infection in both groups.In the traditional incision group, there were 7 cases of columnar pain and 8 cases of recurrence and 2 cases of hyperplastic scar after operation, while in the small incision group, there was no obvious nerve injury after operation, but in 3 cases of columnar pain, 1 case of recurrence and 3 cases of abnormal sensory improvement were not obvious.Traditional incision group: 2.97 鹵0.87 before operation, 6.83 鹵1.15 after operation, small incision group: 3.41 鹵0.95 before operation, 10.11 鹵0.99 after operation.There was no significant difference between the two groups in the preoperative score rank sum test (偽 -0.05) and the postoperative score rank sum test (P0.05), the difference was statistically significant.Conclusion the postoperative complications of the traditional longitudinal incision are more than those of the transverse incision of wrist.The transversal small incision at transverse striation of wrist has the advantages of relatively high safety, relatively short operation time, less trauma, less cosmetic appearance, low incidence of hypertrophic scar, short hospital stay and low cost.
【學位授予單位】：揚州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R688

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