The Clinical Application Of Liquid Dilation In The Treatment Of Carpal Tunnel Syndrome

Objective: To explore the surgical treatment methods of carpal tunnelsyndrome and the clinical efficacy of the epineurial injection of dexamethasoneand lidocaine or liquid expanded methods.Methods: From April 2009 to November 2010,25 essential patients(29cases)were treated by Open carpal tunnel release. The subjects were allspontaneous, and ages varied form 43 to 68. According to the degree of nerveadhesion select transverse carpal ligament incision decompression, or cut thetransverse carpal ligament and liquid dilatation treatment, or the release oftransverse carpal ligament and median nerve epineurium. The detailed methodsof liquid dilation is skin incision, subcutaneous tissue, fascia, and all thetransverse carpal ligament to expose the median nerve, see median nerveelasticity slightly worse, and the surface has obvious signs of compression. Inthe proximal of normal nerve tissue( about 2cm away from the lesions) with a45°angle use a 5ml syringe to the distal nerve lesions under epineurium injectthe amount of 0.5%-1℅ mixture of lidocaine and dexamethasone, in the sametime, found that the pressure mark of median nerve gradually expanded upliftand separation with the adhesion of the nerve. After pulled out the syringe, theliquid flowed out from the eye of a needle and bulge was disappeared.Followed up for 4 months, clinical efficacy was observed and evaluated byKelly's evaluation method.Result: The group of 25 patients with 29 sides, 6 cases only transversecarpal ligament incision decompression, 19 cases was cutted the transversecarpal ligament and liquid dilatation treatment, 4 cases was released oftransverse carpal ligament and median nerve epineurium, the incision all healed. The next day the whole group were to reduce symptoms, night paindisappeared. No blood vessels, nerve and tendon injury complications.Followed up for 4 months, the sensation of radial three and a half fingers of allpatients recover to the S3 or above after 4 weeks to 6 weeks.6 cases of thenarmuscle atrophy, dysfunction of thumb recovered to M3 or above, a good pinchfunction after 8 weeks to 12 weeks. After 4 months the evaluation results withthe evaluation method of Kelly was that 21 cases was superior (functionreturned to normal), 8 cases was good (occasional mild symptoms).Conclusion: 1. The completely full decompression of transverse carpalligament is the basic conditions of the treatment of carpal tunnel syndrome.2. In some cases the liquid dilation under the epineurium is the effectivemethod to judge the extent of adhesion, but also the effective way to treatmentof mild and moderate adhesion .