Anatomic Study And Clinical Study Of Median Nerve Release With Modified Longitudinal Minimal Incision At Wrist Stripe

Objective: To explore the anatomical basis and clinical effect of modified longitudinal minimal incision median nerve release in the treatment of carpal tunnel syndrome.Methods: Anatomical studies: Twelve complete human upper limb specimens(24 sides in total)that were treated with formalin preservative were selected from the Anatomy Teaching and Research Department of Inner Mongolia Medical University.The 12 cases specimens were dissected according to the operation steps of local anatomy under the guidance of anatomy professors.The relevant structures(including superficial palmar arch,palmar cutaneous branch of median nerve,dorsal branch of median nerve,transverse carpal ligament,etc)were observed and the relevant data were measured under the modified incision for statistical analysis.Clinical research: During the period from November 2021 to December2022,we collected clinical records of patients with definite carpal tunnel syndrome admitted to the Affiliated Hospital of Inner Mongolia Medical University.According to the different surgical operation after admission,they were successively divided into the control group("S" minimal incision in the wrist)and the experimental group(modified longitudinal minimal incision in the wrist),40 cases in each group,a total of 80 cases.Visual analog score and Levine carpal tunnel syndrome questionnaire were used to evaluate the wrist pain and function of the patients before treatment,one month,a quarter after treatment.At the time of discharge,the two-point discerning sense of fingertip and the basic conditions of operation were observed for objective assessment.Postoperative complications(such as columnar pain,median nerve branch injury,superficial arch injury,tendon collateral injury,etc)were observed and evaluated.At the last follow-up,the patients’ satisfaction with the operation was investigated and the clinical efficacy was evaluated by Kelly evaluation method.Results: Anatomical results: The modified incision was far away from the important structures of the palmar arch,palmar cutaneous branch of median nerve,and recurrent branch of median nerve to ensure the rationality of incision selection.Clinical research results: By analyzing the data of 80 patients,there was no statistical difference between the baseline data of the general data of patients(P> 0.05),which could be compared between groups.Intragroup comparison between the two groups showed that postoperative visual simulation scores and Levine carpal tunnel syndrome questionnaire scores were observably lower than those before surgery,with statistical significance(P<0.05).Compared between the two groups,there was no significant difference in visual simulation scores and Levine carpal tunnel syndrome questionnaire scores one month and three months after surgery(P>0.05).There were no observable differences in the time spent in the hospital,the average incision length,the operation time,fingertip two-point resolution and postoperative complications(P>0.05).At the last follow-up,there was no observable difference in satisfaction and clinical efficacy evaluated by Kelly evaluation method between the two groups(P>0.05).Conclusion: In terms of anatomy,the modified longitudinal minimal incision at the wrist line can avoid the important structure of the wrist,so as to reduce the occurrence of complications.Clinically,the overall effect of the modified longitudinal minimal incision in the transverse wrist is similar to that of the "S" shaped minimal incision in the palm of the wrist,so it can provide an idea and surgical measure for the clinical treatment of carpal tunnel syndrome for surgeons.