Clinical Study Of Transverse Carpal Ligament Reconstruction For The Treatment Of Carpal Tunnel Syndrome

Objective: Through the analysis of clinical effect between traditionalopen carpal tunnel(OCTR) release and three methods of transverse carpalligament(TCL) reconstruction, to evaluate the necessity of reconstruction inoperative treatment for carpal tunnel syndrome(CTS) and to explore areasonable methods for TCL reconstruction. CTS is the most commonperipheral nerve entrapment syndrome clinically, which can be definitelydiagnosed despite its various causes. At present, a generally accepted principleis conservative treatment for mild ones, while operation for the moderate andsevere ones or the patients failed to the former. All the operative methods canbe divided into two categories: OCTR and endoscopic carpal tunnelrelease(ECTR). TCL release is the core of both OCTR and ECTR, withoutqualitative difference between them. However, as an vital structure of wrist,the destruction of TCL would result in the loss of biomechanics function ofthe wrist. In our study, we illustrated the necessity and processes of transversecarpal ligament, and investigated the methods of reconstruction for the TCLafter median nerve release.Methods: Standard of cases selected were as following:1.Patientsdiagnosed with CTS: certified by medical history, physical examination,electrophysiologic and ultrasonographic test.2.According to the Gu Yudong’sclassification of CTS, the moderate or severe patients who needed to undergosurgery.3.Patients without central nervous system disease or other peripheralnerve entrapment syndromes.4.Patients without metabolic disease, pregnancy,wrist arthritis and fracture history or operation history on the suffered side.5.Patient without systemic disease. From September2012to September2013in the Hand Surgery Department of Hebei Medical University Third Hospital,there were35selected patients(with40sides) in our study. They were divided into4groups: OCTR group:9cases(10sides), layered-cut reconstructiongroup:8cases(10sides), zigzag-cut reconstruction group:9cases(10sides),overlapping suture of TCL and PA(palmar aponeurosis) group:9cases(10sides).Grip strength and DASH score were used to evaluate thefunction of the hand preoperatively and1,3,6months postoperatively. Analyzethe data by SPSS13.0statistical software and the results of measurement dataare expressed as the mean±SE, dealt with variance analysis and t-test withingroups. The results of categorical data are dealt with Chi-squares test. Thesignificance levelα=0.05.Results:1Totally31cases(36sides) have been followed from3to6monthspostoperatively, including8cases(9sides) with the treatment of traditionalOCTR,7cases(9sides) with layered-cut TCL reconstruction,7cases(8sides)with zigzag-cut TCL reconstruction,9cases(10sides) with TCL-PAoverlapping suture reconstruction. All incisions healed by first intentionwithout infection, hematoma, etc. At the end of6months postoperatively, nocase showed bowstring deformity of the flexor tendons, pillar pain ordysfunction.The symptoms of all the followed patients improved in someextent such as negative Tinel sign and Phalen test and normal outcomes ofelectrophysiology test.2Postoperative outcome:According to Gu Yudong’s CTS function standard, traditional OCTRgroup: excellent in7cases, good in1case, fair in1case, no bad case withexcellent and good rate of88.9%; layered-cut reconstruction group:excellentin6cases, good in2case, no poor case, bad in1case with excellent and goodrate of88.9%; zigzag-cut TCL reconstruction group: excellent in7cases, nogood case, fair in1case, no bad case with excellent and good rate of87.5%;TCL-PA overlapping suture reconstruction: excellent in8cases, good in1case, fair in1case, no bad case with excellent and good rate of90.0%.Therewas no significant difference in the excellent and good rate among4groups(P>0.05). 3Evaluation of grip strength of the suffered extremity result:Result of pre-operation: There was no significant difference among4groups (P>0.05).Result of1month postoperatively: There was no significant differenceamong4groups (P>0.05).Result of3month postoperatively: There was significant differenceamong4groups (P<0.05).Within groups, the difference showed amongtraditional open carpal release group and TCL-PA reconstruction group.Result of6month postoperatively: There was significant differenceamong4groups (P<0.05). Within groups, the difference showed among thetraditional open carpal tunnel release group and other3groups. No significantdifference showed among3reconstruction groups.4Evaluation of DASH score result:Result of pre-operation: There was no significant difference among4groups (P>0.05).Result of1month preoperatively: There was no significant differenceamong4groups (P>0.05).Result of3months preoperatively: There was no significant differenceamong4groups (P>0.05).Result of6months preoperatively: There was significant difference ingrip strength of the suffered extremity among4groups (P<0.05). Withingroups, the difference showed between the traditional open carpal tunnelrelease group, zigzag-cut reconstruction group and layers-cut reconstructiongroups, TCL-PA reconstruction group.Conclusion:1On the basis of traditional open carpal tunnel release, by changing theway of cutting TCL off, TCL reconstruction can both release the median nerveso as to improve the clinical syndrome and enhance patients’ gripstrength.Further more, layers-cut and TCL-PA reconstruction can improvequality of patients’ lives. 2TCL-PA reconstruction is definitely effective in improving quality ofpatients’ lives with the advantages of simpleness, convenience and less pain topatient.So it is a effective and reliable method for CTS treatment.