LONG-TERM EFFECTIVENESS OF TRANSVERSE CARPAL LIGAMENT RELEASE WITH ARTHROSCOPIC“TWO-PORTAL”TECHNIQUE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGJiangtao ^1,2 ,  LIUYujie ¹ , QIWei ¹ , QUFeng ¹ , SHENXuezhen ¹ , ZHAOGang ¹ , YUANBangtuo ¹ , LIHongliang ¹ , GUOQi ¹ , LUXi ¹ , LIUYang ¹ , ZHUJuanli ¹

1. Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;
2. Department of Orthopaedics, the 66013 Military Hospital of Chinese PLA;

Corresponding author：

LIUYujie, Email: liuyujie301@163.com

Keywords：

Carpal tunnel syndrome; Arthroscopy; "Two-portal" technique; Long-term effectiveness

DOI：

10.7507/1002-1892.20150116

Video：

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Objective To study the effectiveness of transverse carpal ligament release for carpal tunnel syndrome (CTS) with arthroscopic "two-portal" technique under local anesthesia. Methods Transverse carpal ligament was released with arthroscopic "two-portal" technique in 31 patients with CTS between November 2002 and August 2008. There were 4 males and 27 females, aged 24-71 years (mean, 52 years). The disease duration was 1 month to 14 years (mean, 42 months). According to the guidelines of Bin Tian, 20 sides were rated as grade I, 16 sides as grade Ⅱ, and 5 sides as grade Ⅲ before operation. The sensation was S_2⁺ in 7 cases, S₃ in 19 cases, and S_3⁺ in 5 cases. The muscle strength of the abductor pollicis brevis and opponens pollicis muscles was grade 2 in 5 cases, grade 3 in 14 cases, and grade 4 in 7 cases. Michigan hand function scoring system (MHQ) was used to evaluate the function of the hand before and after operation. Results All incisions healed primarily, and no complications of median nerve injury and adhesion occurred. All of the 31 patients were followed up 6-11.8 years (mean, 9.6 years). After operation, numbness and paresthesia of fingers were relieved (S₄); the muscle power returned to grade 4 in 8 cases, and to grade 5 in 23 cases. The MHQ scores of function, daily life, work, pain, appearance, and satisfaction were improved significantly at 6 months postoperatively when compared with preoperative ones (P<0.05). There was no relapse. Conclusion Arthroscopic "two-portal" technique is an effective surgical procedure for relieving the compression symptoms on the median nerve from carpal canal, so it is helpful to functional recovery of the median nerve. The long-term effectiveness is definite.

Citation： WANGJiangtao, LIUYujie, QIWei, QUFeng, SHENXuezhen, ZHAOGang, YUANBangtuo, LIHongliang, GUOQi, LUXi, LIUYang, ZHUJuanli. LONG-TERM EFFECTIVENESS OF TRANSVERSE CARPAL LIGAMENT RELEASE WITH ARTHROSCOPIC“TWO-PORTAL”TECHNIQUE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 534-537. doi: 10.7507/1002-1892.20150116 Copy

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2.	谭鸿, 陈曦, 谢德, 等. 内窥镜下应用组合式带槽透明扩张管治疗腕管综合征. 中国修复重建外科杂志, 2010, 24(9):1066-1068.
3.	冯仕明, 高顺红. 腕管综合征治疗研究进展. 中国修复重建外科杂志, 2011, 25(5):628-630.
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14.	Ghasemi-Rad M, Nosair E, Vegh A, et al. A handy review of carpal tunnel syndrome:From anatomy to diagnosis and treatment. World J Radiol, 2014, 6(6):284-300.
15.	LeBlanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician, 2011, 83(8):952-958.
16.	Bland JD, Rudolfer S, Weller P. Prospective analysis of the accuracy of diagnosis of carpal tunnel syndrome using a web-based questionnaire. BMJ Open, 2014, 4(8):e005141.
17.	Fowler JR, Munsch M, Tosti R, et al. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome:study using a validated clinical tool as the reference standard. J Bone Joint Surg (Am), 2014, 96(17):e148.
18.	Meems M, Den Oudsten B, Meems BJ, et al. Effectiveness of mechanical traction as a non-surgical treatment for carpal tunnel syndrome compared to care as usual:study protocol for a randomized controlled trial. Trials, 2014, 15:180.
19.	Baker NA, Livengood HM. Symptom severity and conservative treatment for carpal tunnel syndrome in association with eventual carpal tunnel release. J Hand Surg (Am), 2014, 39(9):1792-1798.
20.	Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release:a Meta-analysis of randomized controlled trials. Clin Orthop Relat Res, 2015, 473(3):1120-1132.
21.	Osei DA, Calfee RP, Stepan JG, et al. Simultaneous bilateral or unilateral carpal tunnel release? A prospective Cohort study of early outcomes and limitations. J Bone Joint Surg (Am), 2014, 96(11):889-896.
22.	Means KR Jr, Dubin NH, Patel KM, et al. Outcomes following single-portal endoscopic carpal tunnel release. Hand (N Y), 2014, 9(3):384-388.
23.	Kamrani RS, Farhadi L, Emamzadehfard S, et al. Arthroscopic ablation of osteoid osteoma in the wrist. Arch Bone Jt Surg, 2013, 1(1):38-40.
24.	王晓, 刘玉杰, 王志刚, 等. 关节镜下双孔道技术治疗腕管综合征. 军医进修学院学报, 2010, 31(10):959-960.
25.	刘玉杰, 王志刚, 李众力, 等. 关节镜技术在关节外手术的临床应用. 解放军医学杂志, 2003, 28(3):275-276.

1. Lam CH, Yeung SH, Wong TC. Endoscopic carpal tunnel release:experience of surgical outcome in a Chinese population. Hong Kong Med J, 2010, 16(2):126-131.
2. 谭鸿, 陈曦, 谢德, 等. 内窥镜下应用组合式带槽透明扩张管治疗腕管综合征. 中国修复重建外科杂志, 2010, 24(9):1066-1068.
3. 冯仕明, 高顺红. 腕管综合征治疗研究进展. 中国修复重建外科杂志, 2011, 25(5):628-630.
4. Kim PT, Lee HJ, Kim TG, et al. Current approaches for carpal tunnel syndrome. Clin Orthop Surg, 2014, 6(3):253-257.
5. Noszczyk BH, Krzesniak N, Nowak M. Superficial plane endoscopy for carpal tunnel release. Wideochir Inne Tech Malo Inwazyjne, 2014, 9(2):262-266.
6. 孙贵新, 史其林, 李文军, 等. 内镜下切断屈肌支持带远侧纤维束治疗腕管综合征. 中国微创外科杂志, 2006, 6(7):494-496.
7. Shiri R, Miranda H, Heliövaara M, et al. Physical work load factors and carpal tunnel syndrome:a population-based study. Occup Environ Med, 2009, 66(6):368-373.
8. 吴江,肖海军. 腕管综合征生物力学研究进展. 国际骨科学杂志, 2013, 34(1):58-60.
9. You D, Smith AH, Rempel D. Meta-analysis:association between wrist posture and carpal tunnel syndrome among workers. Saf Health Work, 2014, 15(5):27-31.
10. Petiot P, Bernard E. Diagnostic pitfalls in carpal tunnel syndrome. Rev Neurol (Paris), 2011, 167(1):64-71.
11. Kim HS. Carpal tunnel syndrome caused by tophaceous gout. Korean J Intern Med, 2014, 29(4):544-545.
12. Utrobičić I, Novak I, Marinović-Terzić I, et al. Carpal tunnel syndrome is associated with high fibrinogen and fibrinogen deposits. Neurosurgery, 2014, 75(3):276-285.
13. Burger M, de Wet H, Collins M. The COL5A1 gene is associated with increased risk of carpal tunnel syndrome. Clin Rheumatol, 2014, 26(6):644-652.
14. Ghasemi-Rad M, Nosair E, Vegh A, et al. A handy review of carpal tunnel syndrome:From anatomy to diagnosis and treatment. World J Radiol, 2014, 6(6):284-300.
15. LeBlanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician, 2011, 83(8):952-958.
16. Bland JD, Rudolfer S, Weller P. Prospective analysis of the accuracy of diagnosis of carpal tunnel syndrome using a web-based questionnaire. BMJ Open, 2014, 4(8):e005141.
17. Fowler JR, Munsch M, Tosti R, et al. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome:study using a validated clinical tool as the reference standard. J Bone Joint Surg (Am), 2014, 96(17):e148.
18. Meems M, Den Oudsten B, Meems BJ, et al. Effectiveness of mechanical traction as a non-surgical treatment for carpal tunnel syndrome compared to care as usual:study protocol for a randomized controlled trial. Trials, 2014, 15:180.
19. Baker NA, Livengood HM. Symptom severity and conservative treatment for carpal tunnel syndrome in association with eventual carpal tunnel release. J Hand Surg (Am), 2014, 39(9):1792-1798.
20. Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release:a Meta-analysis of randomized controlled trials. Clin Orthop Relat Res, 2015, 473(3):1120-1132.
21. Osei DA, Calfee RP, Stepan JG, et al. Simultaneous bilateral or unilateral carpal tunnel release? A prospective Cohort study of early outcomes and limitations. J Bone Joint Surg (Am), 2014, 96(11):889-896.
22. Means KR Jr, Dubin NH, Patel KM, et al. Outcomes following single-portal endoscopic carpal tunnel release. Hand (N Y), 2014, 9(3):384-388.
23. Kamrani RS, Farhadi L, Emamzadehfard S, et al. Arthroscopic ablation of osteoid osteoma in the wrist. Arch Bone Jt Surg, 2013, 1(1):38-40.
24. 王晓, 刘玉杰, 王志刚, 等. 关节镜下双孔道技术治疗腕管综合征. 军医进修学院学报, 2010, 31(10):959-960.
25. 刘玉杰, 王志刚, 李众力, 等. 关节镜技术在关节外手术的临床应用. 解放军医学杂志, 2003, 28(3):275-276.

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Chinese Journal of Reparative and Reconstructive Surgery

LONG-TERM EFFECTIVENESS OF TRANSVERSE CARPAL LIGAMENT RELEASE WITH ARTHROSCOPIC“TWO-PORTAL”TECHNIQUE

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