【摘要】：目的探討腕管內(nèi)、外松解治療腕部正中神經(jīng)雙卡征的療效。方法 2011年4月—2014年5月,收治31例腕部正中神經(jīng)雙卡征患者。男8例,女23例;年齡33~69歲,平均56.4歲。手掌橈側(cè)3個(gè)半指皮膚兩點(diǎn)辨別覺7~14 mm,平均9.5 mm;其中4~10 mm 24例,10 mm 7例。腕管正中神經(jīng)Tinel征(+),正中神經(jīng)返支手掌體表投影點(diǎn)處按壓大魚際肌有乏力、酸脹不適感。神經(jīng)電生理檢查:正中神經(jīng)末梢運(yùn)動(dòng)潛伏期4.5~10 ms 22例,10 ms 9例;出現(xiàn)纖顫電位和正相電位6例;所有患者正中神經(jīng)感覺傳導(dǎo)速度減慢,運(yùn)動(dòng)傳導(dǎo)速度減慢;運(yùn)動(dòng)神經(jīng)波幅5~10 mV 19例,5 mV 12例。病程3~8個(gè)月,平均5.5個(gè)月。行腕管內(nèi)正中神經(jīng)及腕管外正中神經(jīng)返支手術(shù)探查,尤其對正中神經(jīng)返支存在的多種易卡壓因素如拇短屈肌起點(diǎn)增厚腱弓、拇短屈肌淺頭尺側(cè)緣腱纖維束、掌腱膜深層纖維膜及變異的拇短屈肌淺頭起點(diǎn)等給予徹底松解,解除卡壓因素。結(jié)果術(shù)后患者傷口均Ⅰ期愈合,未出現(xiàn)傷口瘢痕痛。31例患者均獲隨訪,隨訪時(shí)間24~59個(gè)月,平均33個(gè)月。所有患者夜間麻痛癥狀消失,正中神經(jīng)返支穿入大魚際處酸脹感消失。28例手掌橈側(cè)3個(gè)半指皮膚感覺恢復(fù)至S4,3例示、中指指尖感覺恢復(fù)至S_(3+);正中神經(jīng)支配區(qū)皮膚兩點(diǎn)辨別覺4~6 mm,平均4.8 mm。拇指對掌功能恢復(fù)正常29例,輕度受限2例;31例握力均恢復(fù),其中1例有明顯增加。術(shù)前大魚際肌萎縮者,術(shù)后肌力恢復(fù)至S_5 4例,S_4 2例。術(shù)后2年根據(jù)顧玉東推薦的腕管綜合征功能評定標(biāo)準(zhǔn)評價(jià),優(yōu)29例,良2例,優(yōu)良率100%。結(jié)論腕管內(nèi)、外松解治療腕部正中神經(jīng)雙卡征時(shí),正中神經(jīng)返支存在較多易卡因素,應(yīng)徹底松解,可提高臨床療效。
[Abstract]:Objective to investigate the effect of internal and external release of carpal canal in the treatment of double card sign of median nerve of wrist. Methods from April 2011 to May 2014, 31 patients with double card sign of median nerve of wrist were treated. There were 8 males and 23 females with an average age of 56.4 years (33 / 69). The average 9. 5 mm; of 2-point discrimination of 3 hemi-finger skin was 9. 5 mm; (4 / 10 mm in 24 cases and 10 mm in 7 cases). The Tinel sign of median nerve of carpal tunnel showed that pressing the projection point of the back branch of (), median nerve had fatigue and acid distension at the projection point of the palmar body surface of the median nerve of carpal tunnel. Neuroelectrophysiological examination: motor latency of median nerve endings was 4.5 脳 10 ms in 22 cases and 10 ms in 9 cases, fibrillation potential and normal phase potential appeared in 6 cases, sensory conduction velocity and motor conduction velocity of median nerve slowed down in all patients. Motor nerve amplitudes were 5-10 mV in 19 cases and 5 mV in 12 cases. The course of disease was 3 months and 8 months (mean 5.5 months). Surgical exploration of the median nerve and the reentrant branch of the median nerve outside the carpal canal was performed, especially in the presence of the recurrent branch of the median nerve, such as the thickening of the tendon arch at the beginning of flexor pollicis brevis and the fibrous bundle of the ulnar edge of the flexor pollicis brevis muscle. The deep fiber membrane of palpal aponeurosis and the starting point of the superficial head of variant flexor pollicis brevis were completely loosened and the clamping factors were relieved. Results all the patients healed in stage 鈪，

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