| Objective:This research mainly through autopsy observation carpal tunnel,wrist with transverse ligament,and the median nerve and vessels of the structure characteristics,provide anatomical reference for clinical needle knife treatment of carpal tunnel syndrome,and on this basis,in theory under the guidance of design conforms to the carpal tunnel in acupotomology anatomical shape,good curative effect and damage of small needle knife surgery,and local closed treatment,observe its clinical curative effect,and to explore the mechanism of action of needle knife treatment of carpal tunnel syndrome,provide an idea for the clinical treatment of carpal tunnel syndrome and methods.Methods:Anatomical observation:six human upper limb specimens treated by formalin were selected,and the wrist joints were dissected according to the normal method,the carpal canal was exposed,and the tendons and nerves inside the carpal canal were found,and the blood supply of the nerve tendon inside the carpal canal was observed.Measure the front and back diameter and inner and outer diameter of the wrist;Find the position of the median nerve and observe its shape.The length,width and thickness of the transverse ligament of the wrist were measured with a stainless steel vernier caliper.Clinical research:collect in September 2016 to December 2018 in hubei university of Chinese medicine example,needle knife of hospital of 40 patients with carpal tunnel syndrome,treated with random number table,according to the proportion of 1:1 were randomly divided into treatment group and control group,treatment group with needle knife therapy and control group treated with topical closed treatment,1 week treatment in both groups 1,3 weeks for a period of treatment,the treatment of one period of treatment.VAS visual pain simulation score and Levine carpal tunnel syndrome questionnaire score were evaluated at the end of 1 course of treatment before,3 weeks after treatment and 3 months after treatment,and clinical efficacy was evaluated.Statistical analysis of the data obtained was conducted using SPASS20.0 software to draw conclusions.Resu ts:Anatomical observation results:The carpal tube was a fibrous bone tube,slightly flat cylindrical,and was male:the anterior and posterior diameter of the carpal tube(10.2±1.1)mm,and the internal and external diameter(25.0±2.6)mm.Female:anterior and posterior diameter(10.4±1.5)mm,inner and outer diameter(17.0±2.5)mm.The carpal transverse ligament has a clear boundary,thick and tough.The radial,ulnar and median branches of the ligaments respectively enter the radial,ulnar and median arteries to provide nutrition.Men:length(25.5±4.7)mm,width(22.1±2.2)mm,thickness 2.3mm;Women:length(22.7±3.3)mm,width(20.1±2.5)mm,thickness 3.1mm.The radial artery divides 2～3 branches in the upper carpal canal and enters the carpal canal to be distributed in the tendon and median nerve.The ulnar artery divides 1 to 2 branches above the pea bone and enters the carpal canal,distributing on the tendon.The carpal volar arterial network divides 1～2 branches to release the tendon from the dorsal side of the carpal canal.The arteries that enter the carpal canal go down with the nerves and tendons.Clinical research results:The 40 patients with carpal tunnel syndrome were randomly divided into two groups.The baseline data of the two groups were compared before treatment with comparability(P>0.05).The general situation of the two groups was balanced,and the study was scientific and credible.1.VAS score:in the analysis of baseline data before treatment,VAS score of the two groups was comparable(P>0.05).After 1 course of treatment,VAS score of the acupotomy group and the closed group decreased,and pain was relieved.However,the VAS score in the acupotomy group decreased more significantly than that in the closed group(P<0.05).Acupotomy release has significant analgesic effect in patients with carpal tunnel syndrome.2.Levine score:in the analysis of baseline data before treatment,Levine score of the two groups was comparable(P>0.05).After 1 treatment course,Levine score of both the acupotomy group and the closed group decreased,clinical symptoms were relieved,and the function of the wrist was restored to different degrees.However,the VAS score in the acupotomy group decreased more significantly than that in the closed group(P<0.05).Acupotoma can significantly improve the clinical symptoms of carpal tunnel syndrome patients,and is more helpful for the recovery of local function of patients.3.Clinical curative effect analysis:according to clinical curative effect statistics,the clinical curative effect of acupotomology group was 8 cases,3 cases showed significant effect,6 cases were effective,3 cases were ineffective,and the total effective rate was 85%.In the closed group,3 patients were cured,4 were obviously effective,7 were effective,6 were ineffective,and the total effective rate was 70%.After statistical analysis,the clinical efficacy of acupotomology group was better than that of the closed group(P<0.05).Conclusion:1.Hyperplasia and hypertrophy of the carpal transverse ligament,and the changes in the anatomical morphology of the carpal tunnel caused by the increased tension are the anatomical basis for the carpal tunnel syndrome.When bending the wrist,the transverse ligament of the wrist is tightened,the carpal canal area is reduced,the pressure inside the carpal canal is increased,and the median nerve and its accompanying vessels are easy to be compressed inside the carpal canal.The release method was used to cut part of the transverse ligament of the wrist,which solved the problem of compression of the median nerve caused by the lesion of the ligament.2.The clinical application of this operation has good functional evaluation and significant curative effect,which is superior to the clinical effect of local closure therapy.It is confirmed that the release method of acupotomy is a minimally invasive surgical method that conforms to the anatomical structure,has high safety,little trauma and satisfactory curative effect,and has a high prospect of clinical promotion and application. |
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