Minimally invasive surgical treatment for carpal tunnel syndrome with synovial hyperplasia / 中华显微外科杂志

ABSTRACT

Objective To explore the clinical effect of endoscopic treatment of carpal tunnel syndrome(CTS) with subsynovial hyperplasia.Methods Thirty-eight wrists of idiopathic CTS (control group) without subsynovial connective tissue (SSCT) hyperplasia and 41 wrists of idiopathic CTS with SSCT hyperplasia (experimental group) were surgically treated under endoscope from May,2000 to September,2015,and they were retrospectively studied at clin ic.The endoscopic release of the transverse ligament of wrist was done in the control group.While in the experimental group,the SSCT around the flexor tendons in the carpal tunnel was removed additionally after transverse ligament re lease through the same incision.The varieties of sensory nerve conduction velocity (SNCV),distal motor lantacy(DML),two points of discrimination (TP).Tinel sign,Phalen sign,grip and pinch force before and after operation in both groups were statistically calculated and compared,then the excellent and good rate according to Kelly classification was calculated.The difference was considered as statistically signifcant when P＜0.05.Results For the control group and experimental group①According to Kelly classification,the overall excellent and good rate were 94.7％ and 95.1％ respectively.There was no statistical difference between 2 groups (P＞0.05).②The positive rate of Tinel sign and Phalen sign were significantly reduced to 2.6％ and 2.4％ respectively (P＜0.05).But there was no statistical difference between 2 groups (P＞0.05).③The average TP were (3.7±1.1) mm and (3.5±0.9) mm respectively.There was no statistical difference between 2 groups (P＞0.05).④The SNCV of the 2 groups were (14.3±5) m/s and (16.1±6) m/s,and the DML of the 2 groups were (0.8±0.3) ms and(0.7±0.4) ms respectively,while there was no statistic differences regarding SNCV and DML before and after operation between the 2 groups (P＞0.05).Conclusion Similar and satisfactory recent clinical effect can be harvested with cutting transverse ligament under endoscope and removing SSCT around the flexor tendons for idiopathic CTS with SSCT hyperplasia or not.Classical open operation is not necessary for idiopathic CTS with SSCT hyperplasia.