| ObjectiveBy following up the hand function of patients after carpal tunnel release through traditional incision and small incision,to explore the clinical efficacy of the two in the treatment of severe carpal tunnel syndrome,and help to choose the treatment method scientifically.Methodswe followed up 42 patients with carpal tunnel syndrome from the hand surgery department of China-Japan Union hospital during January 2016 to December 2017.7male aged 33-73,average of 50.14 years,35 female aged 29-84 years,average age of61.57 years.There are 5 cases on the left,12 cases on the right and 25 cases on both sides.Patients were divided into two groups,including 34 patients with 55 sides in traditional incision and 8 patients with 12 sides in small incision.In the traditional incision group,there were 34 patients with 55 sides,8 patients with 12 sides in small incision group.15 patients with 24 sides were followed up after 6 months,including 12 patients 19 sides of the traditional incision and 3 patients 5 sides of the small incision.27 patients with 43 sides were followed up 12 months,including 22 patients with 36 sides of traditional incision.5 patients with 7 sides of smallincision.Evaluated the hand function of all the patients,compare the patients of the two groups with operation time,incidence of scar pain,time to return daily life and work,Two point discrimination,grip and pinching force.Choose 5 patients with 8 sides who with a similar duration of illness and follow-up time from the two groups,the electromyography is performed to detect the latency of the abductor pollicis brevis.ResultThe numbness and pain in the hands of all patients were improved.Postoperative recovery time and the incidence of scar pain in the small incision group were significantly lower than those in the traditional incision group,with statistically significant results(P < 0.05).Follow-up at 6 months after surgery: the excellent rate of hand function in traditional incision group was higher than that in small incision(89.5% vs.60.0%),p=0.04,the results were statistically significant.In the traditional incision group,the mean value of two-point discrimination was 5.63±1.92 mm preoperatively,and 5.37±1.77 mm postoperatively.In the small incision group,the two-point discrimination was 5.40±0.89 mm preoperatively,and 5.20±0.84 mm postoperatively,p were 0.056 and 0.374,with no statistical significance.The preoperative average grip strength of the traditional incision group was 11.53±3.24 kg,and the postoperative was 15.62±3.07 kg.The preoperative average grip strength of the small incision group was 10.57±1.19 kg,and the postoperative was 13.10±1.96 kg.,the two groups campared,p were 0.003 and 0.038,and the results were statistically significant.The preoperative mean pinch strength of the traditional incision group was3.23±2.77 kg,and the postoperative was 5.72±2.41 kg.The postoperative mean pinch strength of the small incision group was 3.46±0.92 kg,and the postoperative was4.81±0.89 kg.P were 0.005 and 0.046,with statistically significant.Follow-up after 12months: the excellent rate of hand function in the traditional incision group was similar to that in the small incision group(86.1% vs.85.7%),p=0.69 compared with the two groups,with no statistically significant.In the traditional incision group,the meantwo-point discrimination was 5.47±1.84 mm preoperatively,and 4.67±1.01 mm postoperatively.In the small incision group,the mean two-point discrimination was5.28±1.10 mm preoperatively,and 4.29±0.76 mm postoperatively.P were 0.001 and0.018,with statistically significant.The preoperative average grip strength of the traditional incision group was 11.39±3.75 kg,and the postoperative was 18.46±7.83 kg.The preoperative average grip strength of the small incision group was 9.87±3.03 kg,and the postoperative was 14.76±4.90 kg,the two groups campared,p were 0.000 and0.044,with statistically significant.The preoperative mean pinch strength of the traditional incision group was 3.79±2.06 kg,and the postoperative was 6.74±3.15 kg.The pretoperative mean pinch strength of the small incision group was 4.12±1.26 kg,and 5.61±1.14 kg postoperatively.P were 0.000 and 0.038,with statistically significant.In traditional incision group,the postoperative mean latency of the abductor pollicis brevis is 9.61±4.18 ms,the preoperative latency was 4.65±1.11 ms,in small incision group,the postoperative was 7.29±2.44 ms,and 4.91±0.88 ms postoperatively,p were0.004 and 0.012 with statistically significant.The lantency improved 5.20±3.75 ms in traditional incision group,2.08 ± 1.89 ms in small incision group,p were 0.031 with statistically significant.ConclusionBoth traditional incision and small incision carpal tunnel release can get excellent results in treatment of severe carpal tunnel syndrome.For severe carpal tunnel syndrome patients who with thenar atrophy,it is significative to release recurrent branch of the median nerve. |
