Clinical Analysis Of The Effect Of Loosening And Dissolving The Median Epicardium On Carpal Tunnel Syndrome

Objective: Carpal tunnel syndrome is one of the most common diseases that plague most artisanal and postmenopausal women.Early detection can often improve clinical symptoms,alleviate the progress of the disease,and even achieve clinical cure through conservative treatment.Moderate or severe patients with ineffective conservative treatment still need surgical release of the carpal tunnel.In this paper,the transverse carpal ligament and median nerve were loosened by longitudinal incision.In the process of nerve release,the epicardial incision helps to relieve the nerve compression,but it often destroys the blood supply of the nerve and increases the risk of painful scar adhesion after hand residual surgery.In this paper,the postoperative effects of medial nerve epineuron release and unloosening during carpal tunnel incision and decompression were compared and analyzed by means of retrospective study.The pathophysiological mechanism of median nerve injury and remission was discussed.Methods: A total of 72 female patients,aged ≥ 40 years old,with carpal tunnel syndrome admitted from January 2015 to January 2018 were enrolled.The age,duration,and injury were collected and the injury was assessed using Hamada classification.In the observation group,32 cases(49 sides)did not undergo medial nerve adventitia incision during the operation,aged was 41-74 years,the average age was 50.10 ±7.39 years,the average course of disease was 3.84 ±4.56 months,15 cases were unilateral,17 cases were bilateral,Hamada grade I type 12 sides,type II 30 sides,type III 7 sides;follow-up time averaged 22.87 ± 10.87 months.In the control group,40 cases(60 sides)of the median epicardial incision were 40-65 years old,with an average of 51.75±7.23 years old,with an average duration of 2.89±4.13 months,20 cases on one side and 20 cases on both sides.Hamada grade I type 18 sides,type II 34 sides,type III 8 sides,the average follow-up time was 25.49±10.49 months.The transverse carpal ligament was exposed and cut open to release the median nerve by longitudinal small incision.The hospitalization time was recorded,and the subjective evaluation methods such as Boston carpal tunnel questionnaire and Kelly standard were used to evaluate the sensory and functional recovery of wrist,and the postoperative complications were recorded.Results: All 72 patients were followed up for an average of 25 months from August to 43 months after operation.There were no significant differences in age,course of disease,injury side,preoperative condition and follow-up time between the two groups.The average hospitalization time of the observation group and the control group was 6.42 ±2.08 days and 5.89 ±1.44 days respectively.The Boston sensory score was 13.58 ±3.81,13.18 ±3.31,and the functional score was 8.52 ±1.06 and 8.31 ±0.79,respectively.there was no significant difference between the two groups.The excellent and good rates of postoperative recovery according to kelly standard were 87.1% and 89.7%,respectively.Although the excellent and good rate of the control group was higher than that of the observation group,the difference was not statistically significant.There were no postoperative infection,poor healing,vascular and nerve injury and other complications in both groups.There were 5 patients who still complained of discomfort after operation,and 3 patients needed surgical treatment because of scar physique,obvious scar after bilateral carpal canal operation and tissue adhesion in carpal canal.The other two patients were mainly severe nerve entrapment before operation,atrophy of thenar muscle and poor functional recovery after operation.Conclusion: It can also relieve the symptoms of the patients,and does not affect the recovery of hand function and the improvement of the quality of life of the patients.Therefore,in the future diagnosis and treatment,we can choose a small incision to simply cut the transverse carpal ligament,and do not have to choose a large incision to release the median nerve to cause greater trauma,so as to reduce the occurrence of columnar pain and scar pain.