【摘要】 目的 比较正中神经压迫试验对腕管综合征（carpal tunnel syndrome，CTS）患者正中神经传导速度的影响。 方法 设置CTS组和对照组两个组别，共29例受试者纳入研究。CTS组为14例CTS患者，对照组为15例健康受试者。神经传导速度测定包括正中神经和尺神经的感觉传导末端潜伏期（distal sensory latency，DSL）、感觉神经动作电位（sensory nerve action potential， SNAP）、跨腕关节感觉传导速度（sensory conduction velocity，SCV）、运动传导末端潜伏期（distal motor latency，DML）及复合肌肉动作电位（compound muscle action potential，CMAP）。先测感觉传导，再测运动传导。正中神经压迫试验5 min后再次测量上述指标。 结果 正中神经压迫试验前后电生理检查考虑诊断CTS分别为22侧和24侧。压迫正中神经后，CTS组正中神经DSL较压迫前显著延长（Plt;0.05）。CTS组尺神经和对照组正中神经及尺神经的各参数在压迫前后均无显著改变（Pgt;0.05）。与对照组相比，在压迫试验前后CTS组的正中神经DSL和DML均明显延长（Plt;0.05），尺神经DSL和DML均无显著改变（Pgt;0.05）。 结论 正中神经压迫试验5 min能使CTS患者正中神经的感觉传导末端潜伏时明显延长，有助于提高神经传导测定对早期CTS的诊断率。【Abstract】 Objective To determine the effect of median nerve compression on median nerve conduction speed in patients with carpal tunnel syndrome (CTS). Methods In this case-control study, 29 subjects were enrolled. CTS group included 14 patients (22 hands) with CTS confirmed by electrodiagnostic studies, while the control group included 15 healthy subjects (30 hands). The across wrist nerve conduction of median and ulnar nerve was measured when the wrist was in neutral position. Measured parameters included distal sensory latency (DSL), sensory nerve action potential (SNAP), sensory conduction velocity (SCV), distal motor latency (DML) and compound muscle action potential (CMAP). Sensory nerve conductions were tested first, and then the motor nerve conduction. The patients were asked to perform the median nerve compression test by flexing elbows, pronating forearm and pushing the dorsal surfaces of both hands together into maximum wrist flexion for 5 minutes. Then the above parameters were measured again. Results By electrodiagnostic studies, 22 hands and 24 bands were diagnosed with CTS before and after the median nerve compression test, respectively. After the compression test, the median nerve DSL were significantly prolonged in CTS group (Plt;0.05) but no significant differences were found in the median nerve DML (Pgt;0.05). The parameters of ulnar nerve in group CTS and median nerve and ulnar nerve in control group failed to show any significant change (Pgt;0.05). The CTS group had longer median nerve DSL and DML than the control groups (Plt;0.05), but the differences in ulnar nerve DSL and DML were not significantly between the two groups. Conclusion A 5-minute median nerve compression test may make the median nerve DSL prolonged and may be a helpful diagnosis of early CTS.
Objective To investigate the etiology, diagnosis, and treatment of acute carpal tunnel syndrome (ACTS) after reduction of Colles’ fracture. Methods Between December 2006 and June 2010, 22 patients with ACTS after reduction of Colles’ fracture were treated with expectant treatment and surgical treatment. There were 9 males and 13 females with an average age of 46.2 years (range, 23-60 years). Fractures were caused by traffic accident in 9 cases, fall ing in 8 cases, fall ing from height in 2 cases, hitting in 2 cases, and crushing in 1 case. The mechanism of fracture was direct violence in 3 cases and indirect violence in 19 cases. According to Gartland ＆ Werley classification, there were 2 cases of type I, 5 cases of type II, 14 cases of type III, and 1 case of type IV. Closed reduction was performed in 19 cases and open reduction and internal fixation (ORIF) in 3 cases. The average symptom time of ACTS after reduction of Colles’ fracture was 11.6 hours (range, 1 hour 30 minutes to 48 hours) in patients undergoing closed reduction and was 24 hours in 1 patient and 2 weeks in 2 patients undergoing ORIF. Expectant treatment was performed first, the forearms were put in neutral position in closed reduction cases; if there was no rel ief of ACTS symptom 1 week later, the mixture of 1 mL glucocorticosteroid and 1 mL 2% l idocaine was injected into carpal tunnel once a week for 2 weeks. The mixture was injected into carpal tunnel directly once a week for 2 weeks in ORIF cases. In the patients who failed to expectant treatments, ORIF was performed. Results In 7 cases of type III that failed expectant treatment, ACTS symptoms were rel ief completely after ORIF. All the 22 patients were followed up 12 months on average (range, 8-18 months). The average time of complete disappearance of median nerve compression symptom was 11 days (range, 2-25 days). All the patients had normal finger motion, sensation, and opposition of thumb with no sensation of anaesthesia and pinprick. The results of Tinel test, Phalen test, and Reverse Phalen test were all negative. The X-ray film showed good fracture reduction and heal ing with an average heal ing time of 6 weeks (range, 3-14 weeks). According to GU Yudong’s criteria for functionalassessment, the results were excellent in 18 cases and good in 4 cases; the excellent and good rate was 100%. Conclusion Malposition, displacement of fracture fragments, and ulnar deviation of the wrist after plaster immobil ization are the mostimportant risk factors for ACTS. Expectant treatments are recommended in patients with Colles’ fracture of types I, II, and IV,but surgical treatment is the first choice for Colles’ fracture of type III.
Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent l iterature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist spl inting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more cl inical researches, and surgical treatment is one method recommended by some scholars.
Objective To study the effect of surgical treatment of carpal tunnel syndrome (CTS) by endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament. Methods Between April 2003 and April 2008, 56 patients with CTS were treated with endoscopic carpal tunnel release through a transparent combined with dilation conductor. There were 8 males and 48 females with an average age of 50 years (range, 38-65 years). CTS was caused bywrist injury in 5 cases, by forearm fracture in 12 cases, and by wrist strain in 39 cases. The locations were left hand in 14 cases and right hand in 42 cases with a disease duration range of 2-7 years (4 years on average). According to Hamada classification of CTS, 38 cases were classified as stage I, 12 cases as stage II, and 6 cases as stage III. Results All cases achieved the primary heal ing of incision. All patients were followed up 14-68 months (40 months on average). According to Kelly’ s evaluation, the results were excellent in 25 cases, good in 22 cases, fair in 4 cases, and poor in 5 cases with an excellent and good rate of 83.93%. The distal motor latency of median nerve was (4.48 ± 0.50) ms at 1 months, (4.06 ± 0.35) ms at 3 months, (3.79 ± 0.25) ms at 6 months, and (3.42 ± 0.24) ms at 12 months after operation, showing significant differences when compared with the preoperative one [(5.09 ± 0.61) ms, P lt; 0.05]. There were significant differences among different time points after operation (P lt; 0.05). Conclusion The method of endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament is a simple and effective surgical procedure for treament of CTS, which can precisely cut the transverse carpal l igament and completely release the pressure of carpal tunnel.
Objective To pay attention to the diagnosis and treatment of the complications associated with closed multifractures in metacarpals. Methods From 1997 to 2000, out of 382 patients with closed multi-fractures in metacarpals, 12 had complications. In 7 cases of fractures at the second , third , fourth and fifth metacarpal shaft, complicated by acute compartment syndrome in hand, compartmental fascia were incised for decompress; open reduction and internal fixation were performed. In 4 cases of fractures at the metacarpal base, complicated by acute carpal tunnel syndrome, the fracture was reduced and fixed without transection of the transverse carpal ligament. In 1 case of fracture at metacarpalbase, complicated by direct contusion of the median nerve, the fracture was reduced without treatment of the median nerve. Results All patients were followed up for 3 months. Fracture healed 46 weeks postoperatively. No claw deformity anddysfunction of the median nerve occurred. The arc of motion of the proximal interphalangeal and distal interphalangeal joints were normal.Conclusion During fracture reduction, we should pay attention to the complications associated with closed multi-fractures at metacarpal to decrease hand malfunction.
ObjectiveTo study the effectiveness of transverse carpal ligament release for carpal tunnel syndrome (CTS) with arthroscopic "two-portal" technique under local anesthesia. MethodsTransverse 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 S2+ in 7 cases, S3 in 19 cases, and S3+ 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. ResultsAll 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. ConclusionArthroscopic "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.
Objective To investigate the effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist. Methods Thirty-one patients of median nerve double entrapment at wrist were treated between April 2011 and May 2014. There were 8 males and 23 females with an age of 33-69 years (mean, 56.4 years). In palm lateral three and a half finger, the two-point discrimination was 7-14 mm (mean, 9.5 mm), in which 24 cases were 4-10 mm and 7 cases were more than 10 mm. Carpal tunnel median nerve Tinel sign was positive; there was weak and acid swollen felling when press big thenar muscle on median nerve return branch palm surface projection points. Electromyography examination showed that median nerve endings movement incubation period was 4.5-10 ms in 22 cases, more than 10 ms in 9 cases; fibrillation potentials and positive phase voltage happened in 6 cases; the median nerve sensory conduction velocity of all patients was slow, and the motor conduction velocity also slowed down; the motor amplitude was 5-10 mV in 19 cases, less than 5 mV in 12 cases. The disease duration was 3-8 months (mean, 5.5 months). Surgical exploration of wrist median nerve in carpal tunnel and median nerve return branch outside carpal tunnel were performed in patients, especially completely released the variety entrapment factors such as thickening bow at starting point of short hallux flexor tendon, fiber bundles at ulnar side of short hallux flexor tendon, deep layer fiber of the palmar aponeurosis, and variant shallow head of short hallux flexor. Results All the wounds healed by first intention without wound scar pain. The patients were followed up 24-59 months (mean, 33 months). Night numbness and pain disappeared, and weak and acid swollen feeling in big thenar muscle on median nerve return branch points also disappeared. The sensation recovered to S4 in 28 patients in palm lateral three and a half finger, the index and middle fingertip sensation recovered to \begin{document}$ \small{{\rm{S}}_{{{ 3}^ + }}} $\end{document} in 3 cases. In the median nerve innervation area, the two points discrimination was 4-6 mm (mean, 4.8 mm). The thumb opposition function returned to normal in 29 cases and mild confinement in 2 cases. The grip strength of all the 31 cases recovered, and 1 of them increased significantly. In preoperative big thenar muscle atrophy cases, muscle strength recovered to S5 in 4 cases, S4 in 2 cases. At 2 years after operation, according to the functional assessment of carpal tunnel syndrome recommend by GU Yudong, the results were excellent in 29 cases and good in 2 cases, with an excellent and good rate of 100%. Conclusion When treating the nerve double entrapment in wrist using wrist tube inside and outside releasing method, the variety entrapment factors of return branch of median nerve should be completely released, so the effectiveness can be improved.
Platelet-rich plasma (PRP) is a platelet-rich plasma protein concentrate extracted from autologous peripheral blood, which contains a variety of blood-derived growth factors and cytokines. As an autologous blood product, PRP is widely used in many fields such as tissue repair and regeneration because of its minimally invasive process, simple preparation process and good biological properties. The acquisition of PRP is mainly achieved by collecting peripheral blood through density gradient centrifugation. Various growth factors and cytokines in PRP can repair various tissues. With the deepening of PRP research, it is now gradually applied to rotator cuff injury, lateral epicondylitis of humerus, carpal tunnel syndrome, knee joint injury, gluteal muscle tendinopathy, achilles tendinopathy, plantar fasciitis, and other soft tissue injuries, and some progress has been made. This article reviews the progress on clinical applications of PRP in chronic soft tissue injuries to provide a theoretical basis.