| Objective:To investigate the characteristics,diagnosis and treatment of carpal tunnel syndrome caused by gout.Materials and Methods:A retrospective analysis of 19 cases of gout-induced carpal tunnel and/or cubital tunnel syndrome in hand and foot surgery of the First Hospital and Branch of Jilin University from July 2013 to December 2019,including 19 carpal tunnel syndrome There were 8 cases on the left side,11 cases on the right side,and 1 case on the right cubital tunnel syndrome,of which 1 case was left carpal tunnel syndrome and right cubital tunnel syndrome.All patients were male,aged 38 to 68 years,with an average of 55.1±9.2 years.The duration of carpal tunnel syndrome is 1 month to 60 months,with an average of 11.3±14.3 months,and the duration of cubital tunnel syndrome is 15days.All patients had a history of gout for many years,ranging from 3 years to 20 years,with an average of 10.6±5.5 years.There were gout nodules of different sizes in other parts of the body.The blood uric acid concentration was high before operation,and 6patients had undergone local color Doppler ultrasound examination before operation,and all showed gout stone lesions.The 18 sides of the carpal tunnel syndrome showed numbness and sensation of three and a half fingers on the radial side,and the middle ring finger on one side.There were 12 sides with normal fish and 7 sides with atrophy.Six patients with carpal tunnel syndrome were complicated with flexion and extension of the fingers,and the palms of the 14 wrists were full and bulged.Three patients were in acute arthritis when they were admitted to the hospital.The wrists were red,swollen,hot and painful.One case of cubital tunnel syndrome had numbness of the ulnar half of the ring finger and little finger,skin bulge was seen on the elbow,and there was no claw-shaped hand deformity.Tinel sign?+?of the median nerve of the wrist in patients with carpal tunnel syndrome and ulnar nerve?+?in the patients of cubital tunnel syndrome.EMG examination confirmed the median nerve or ulnar nerve injury.According to Gu Yudong's clinical classification and treatment of carpal tunnel and cubital tunnel syndrome,there were 11 cases with moderate carpal tunnel syndrome,8cases with severe carpal tunnel syndrome and 1 case with moderate cubital tunnel syndrome.Patients with carpal tunnel syndrome were treated with OCTR,cubital tunnel syndrome with ulnar nerve preoperative surgery,and comprehensive treatment for gout.Results:There were 19 cases of carpal tunnel syndrome and 1 case of cubital tunnel syndrome.All patients were followed up by outpatient,telephone or We Chat.No patients relapsed.The follow-up time was 6 months to 81 months,with an average of28 months.Carpal tunnel syndrome was moderate in 11 cases and severe in 8 cases.According to the trial standard of upper limb peripheral nerve function evaluation of the Chinese Medical Association Hand Surgery Society[1]?Table 18?:8 cases were excellent?moderate 6 cases,severe 2 cases?;8 cases were good?moderate 5 cases,severe 3 cases?;2 cases?moderate 0 cases,severe 2 cases?;poor 1 case?moderate 0cases,severe 1 case?,the total excellent and good rate was 84.2%.Patients with cubital tunnel syndrome were moderately graded preoperatively,and evaluated postoperatively according to the upper limb function ulnar nerve evaluation standard?Table 15?of the Hand Surgery Society of the Chinese Medical Association.In 2017,the postoperative excellent and good rate of patients with carpal tunnel syndrome who were not the cause of gout was 78.0%.Using SPSS 24.0 software,chi-square test was performed based on whether the cause was gout.The P value was 0.78,which was greater than 0.05,which was not statistically significant.Conclusion:1.Among the patients with carpal tunnel syndrome caused by gout,men are more common and have a history of gout.2.The carpal tunnel and the elbow canal are restricted spaces.Monosodium urate deposition is easy to cause nerve damage,but it is rare to deposit directly in the adventitia and cause nerve damage.3.Carpal tunnel syndrome or cubital tunnel syndrome caused by gout should be treated with early surgery.Carpal tunnel syndrome is the first choice for OCTR,and cubital tunnel syndrome is the first choice for ulnar nerve lysis.The prognosis is good for these patients. |
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