液体扩张法在腕管综合征治疗中的临床应用
摘要
目的：探讨腕管综合征手术治疗的方法，以及神经外膜下注射地塞米松和利多卡因混合液即液体扩张方法的临床疗效。
方法：我院在2009年4月至2010年11月，对25例（29侧）年龄在43~68岁的自发性腕管综合征患者行手术治疗。术中根据神经粘连的程度及术前临床症状选择仅行腕横韧带切开减压术或行腕横韧带切开及外膜液体扩张术或行腕横韧带及神经外膜切开松解术。其中外膜液体扩张术的具体手术方法是切开皮肤、皮下组织、筋膜及全部腕横韧带，显露正中神经，见正中神经弹性略差，表面有不同程度痕迹，在近端正常神经组织（离卡压病变组织约2cm处）用5ml注射器于与神经呈45°的角度在神经外膜下向远端病变方向注入适量0.5%-1℅利多卡因与地塞米松的混合液，边注射边观察，发现正中神经外膜卡压处被注入的液体逐渐扩张隆起并与粘连的神经束分离，拔出注射器后注入的液体也很快从针眼处流出，10分钟后隆起消失。随访4个月，观察临床疗效并用Kelly的评定方法评价。
结果：
本组25例29侧，其中6例侧仅行腕横韧带切开减压术，19例侧行腕横韧带切开减张及外膜扩张术，4例侧行腕横韧带及神经外膜切开松解术，切口均一期愈合。未见血管、神经和屈肌腱损伤等并发症。全组术后第二天自觉症状减轻，夜间痛全部消失。术后随访4个月，全组4～6周桡侧三个半指感觉恢复至S3或以上。6例大鱼际肌萎缩、拇对掌功能障碍者术后8周～12周肌力恢复至M3或以上，捏握功能良好。按照Kelly的评定方法评价，4个月后评定结果：全部29例侧中21例侧优（功能完全恢复正常），8例侧良（偶有轻度症状）。
结论：
1.腕横韧带的完全充分切开减压是治疗腕管综合征的最基本条件。
2.在部分病例中神经外膜下液体扩张法是判断神经外膜粘连程度的有效方法，同时也是治疗轻中度神经外膜粘连的有效方法。
Objective: To explore the surgical treatment methods of carpal tunnelsyndrome and the clinical efficacy of the epineurial injection of dexamethasoneand lidocaine or liquid expanded methods.
Methods: From April 2009 to November 2010,25 essential patients(29cases)were treated by Open carpal tunnel release. The subjects were allspontaneous, and ages varied form 43 to 68. According to the degree of nerveadhesion select transverse carpal ligament incision decompression, or cut thetransverse carpal ligament and liquid dilatation treatment, or the release oftransverse carpal ligament and median nerve epineurium. The detailed methodsof liquid dilation is skin incision, subcutaneous tissue, fascia, and all thetransverse carpal ligament to expose the median nerve, see median nerveelasticity slightly worse, and the surface has obvious signs of compression. Inthe proximal of normal nerve tissue( about 2cm away from the lesions) with a45°angle use a 5ml syringe to the distal nerve lesions under epineurium injectthe amount of 0.5%-1℅ mixture of lidocaine and dexamethasone, in the sametime, found that the pressure mark of median nerve gradually expanded upliftand separation with the adhesion of the nerve. After pulled out the syringe, theliquid flowed out from the eye of a needle and bulge was disappeared.Followed up for 4 months, clinical efficacy was observed and evaluated byKelly's evaluation method.
Result: The group of 25 patients with 29 sides, 6 cases only transversecarpal ligament incision decompression, 19 cases was cutted the transversecarpal ligament and liquid dilatation treatment, 4 cases was released oftransverse carpal ligament and median nerve epineurium, the incision all healed. The next day the whole group were to reduce symptoms, night paindisappeared. No blood vessels, nerve and tendon injury complications.Followed up for 4 months, the sensation of radial three and a half fingers of allpatients recover to the S3 or above after 4 weeks to 6 weeks.6 cases of thenarmuscle atrophy, dysfunction of thumb recovered to M3 or above, a good pinchfunction after 8 weeks to 12 weeks. After 4 months the evaluation results withthe evaluation method of Kelly was that 21 cases was superior (functionreturned to normal), 8 cases was good (occasional mild symptoms).
Conclusion: 1. The completely full decompression of transverse carpalligament is the basic conditions of the treatment of carpal tunnel syndrome.
2. In some cases the liquid dilation under the epineurium is the effectivemethod to judge the extent of adhesion, but also the effective way to treatmentof mild and moderate adhesion .
方法：我院在2009年4月至2010年11月，对25例（29侧）年龄在43~68岁的自发性腕管综合征患者行手术治疗。术中根据神经粘连的程度及术前临床症状选择仅行腕横韧带切开减压术或行腕横韧带切开及外膜液体扩张术或行腕横韧带及神经外膜切开松解术。其中外膜液体扩张术的具体手术方法是切开皮肤、皮下组织、筋膜及全部腕横韧带，显露正中神经，见正中神经弹性略差，表面有不同程度痕迹，在近端正常神经组织（离卡压病变组织约2cm处）用5ml注射器于与神经呈45°的角度在神经外膜下向远端病变方向注入适量0.5%-1℅利多卡因与地塞米松的混合液，边注射边观察，发现正中神经外膜卡压处被注入的液体逐渐扩张隆起并与粘连的神经束分离，拔出注射器后注入的液体也很快从针眼处流出，10分钟后隆起消失。随访4个月，观察临床疗效并用Kelly的评定方法评价。
结果：
本组25例29侧，其中6例侧仅行腕横韧带切开减压术，19例侧行腕横韧带切开减张及外膜扩张术，4例侧行腕横韧带及神经外膜切开松解术，切口均一期愈合。未见血管、神经和屈肌腱损伤等并发症。全组术后第二天自觉症状减轻，夜间痛全部消失。术后随访4个月，全组4～6周桡侧三个半指感觉恢复至S3或以上。6例大鱼际肌萎缩、拇对掌功能障碍者术后8周～12周肌力恢复至M3或以上，捏握功能良好。按照Kelly的评定方法评价，4个月后评定结果：全部29例侧中21例侧优（功能完全恢复正常），8例侧良（偶有轻度症状）。
结论：
1.腕横韧带的完全充分切开减压是治疗腕管综合征的最基本条件。
2.在部分病例中神经外膜下液体扩张法是判断神经外膜粘连程度的有效方法，同时也是治疗轻中度神经外膜粘连的有效方法。
Objective: To explore the surgical treatment methods of carpal tunnelsyndrome and the clinical efficacy of the epineurial injection of dexamethasoneand lidocaine or liquid expanded methods.
Methods: From April 2009 to November 2010,25 essential patients(29cases)were treated by Open carpal tunnel release. The subjects were allspontaneous, and ages varied form 43 to 68. According to the degree of nerveadhesion select transverse carpal ligament incision decompression, or cut thetransverse carpal ligament and liquid dilatation treatment, or the release oftransverse carpal ligament and median nerve epineurium. The detailed methodsof liquid dilation is skin incision, subcutaneous tissue, fascia, and all thetransverse carpal ligament to expose the median nerve, see median nerveelasticity slightly worse, and the surface has obvious signs of compression. Inthe proximal of normal nerve tissue( about 2cm away from the lesions) with a45°angle use a 5ml syringe to the distal nerve lesions under epineurium injectthe amount of 0.5%-1℅ mixture of lidocaine and dexamethasone, in the sametime, found that the pressure mark of median nerve gradually expanded upliftand separation with the adhesion of the nerve. After pulled out the syringe, theliquid flowed out from the eye of a needle and bulge was disappeared.Followed up for 4 months, clinical efficacy was observed and evaluated byKelly's evaluation method.
Result: The group of 25 patients with 29 sides, 6 cases only transversecarpal ligament incision decompression, 19 cases was cutted the transversecarpal ligament and liquid dilatation treatment, 4 cases was released oftransverse carpal ligament and median nerve epineurium, the incision all healed. The next day the whole group were to reduce symptoms, night paindisappeared. No blood vessels, nerve and tendon injury complications.Followed up for 4 months, the sensation of radial three and a half fingers of allpatients recover to the S3 or above after 4 weeks to 6 weeks.6 cases of thenarmuscle atrophy, dysfunction of thumb recovered to M3 or above, a good pinchfunction after 8 weeks to 12 weeks. After 4 months the evaluation results withthe evaluation method of Kelly was that 21 cases was superior (functionreturned to normal), 8 cases was good (occasional mild symptoms).
Conclusion: 1. The completely full decompression of transverse carpalligament is the basic conditions of the treatment of carpal tunnel syndrome.
2. In some cases the liquid dilation under the epineurium is the effectivemethod to judge the extent of adhesion, but also the effective way to treatmentof mild and moderate adhesion .
引文
[1]Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L,Putz-Anderson V. The US prevalence of self-reported carpal tunnel syndrome:1988 National Health Interview Survey data. Am J Public Health 1994; 84(11):1846-8.
[2]Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnelsurgery. Instr Course Lect 1995;44:167-72.
[3]Burke FD. Carpal tunnel syndrome: reconciling“demand management”with clinical need. J Hand Surg [Br] 2000;25(2):121-7.
[4]Stevens JC, Sun S, Beard CM, O’Fallon WM, Kurland LT. Carpaltunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 1988;38(1):134-8.
[5]Phalen GS. The carpal-tunnel syndrome. Seventeen years’experiencein diagnosis and treatment of six hundred fifty-four hands. J Bone Joint SurgAm 1966;48(2):211-28.
[6]Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidencein a general population. Neurology 2002;58(2):289-94.
[7]Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnelsyndrome in two areas of the United Kingdom, 1991-2001. J Neurol NeurosurgPsychiatry 2003;74(12):1674-9.
[8]Melhorn JM. CTD: carpal tunnel syndrome, the facts and myths. KansMed 1994;95(9):189-92.
[9]Brian WR, Wright AD. Spontaneous compression of both mediannerves in the carpal tunnel. Lancet 1947; 1:277-82.
[10]Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors andcarpal tunnel syndrome. Am J Ind Med 1987;11(3):343-58.
[11]Werner R, Armstrong TJ, Bir C, Aylard MK. Intracarpal canalpressures: the role of finger, hand, wrist and forearm position. Clin Biomech(Bristol, Avon) 1997;12(1):44-51.
[12]Ham SJ, Kolkman WF, Heeres J, den Boer JA. Changes in the carpaltunnel due to action of the flexor tendons: visualization with magneticresonance imaging. J Hand Surg [Am] 1996; 21(6):997-1003.
[13]Rempel D, Bach JM, Gordon L, So Y. Effects of forearm pronation/supination on carpal tunnel pressure. J Hand Surg [Am] 1998;23(1):38-42.
[14]Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, etal. An evaluation of gender, obesity, age and diabetes mellitus as risk factors forcarpal tunnel syndrome. Clin Neurophysiol 2002;113(9):1429-34.
[15]Gerr F, Letz R. Risk factors for carpal tunnel syndrome in industry:blaming the victim? J Occup Med 1992;34(11):1117-9
[16]Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor forimpaired sensory conduction of the median nerve at the carpal tunnel. J HandSurg [Br] 1988;13(2):167-70.
[17]Garland FC, Garland CF, Doyle EJ, Jr., Balazs LL, Levine R, PughWM, et al. Carpal tunnel syndrome and occupation in U.S. Navy enlistedpersonnel. Arch Environ Health 1996; 51(5):395-407.
[18]Spielholz P, Silverstein B, Morgan M, Checkoway H, Kaufman J.Comparison of self-report, video observation and direct measurement methodsfor upper extremity musculoskeletal disorder physical risk factors. Ergonomics2001;44(6):588-613.
[19]Osorio AM, Ames RG, Jones J, Castorina J, Rempel D, Estrin W, et al.Carpal tunnel syndrome among grocery store workers. Am J Ind Med 1994;25(2):229-45.
[20]Moore JS, Garg A. Upper extremity disorders in a pork processingplant: relationships between job risk factors and morbidity. Am Ind Hyg AssocJ 1994;55(8):703-15.
[21]Lundborg G, Dahlin LB, Danielsen N, Hansson HA, Necking LE,Pyykko I. Intraneural edema following exposure to vibration. Scand J WorkEnviron Health 1987;13(4):326-9.
[22]Buch-Jaeger N, Foucher G. Correlation of clinical signs with nerveconduction tests in the diagnosis of carpal tunnel syndrome. J Hand Surg [Br]1994;19(6):720-4.
[23]Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpaltunnel syndrome signs. Am J Phys Med Rehabil 1997;76(6):451-7.
[24]Kuschner SH, Ebramzadeh E, Johnson D, Brien WW, Sherman R.Tinel’s sign and Phalen’s test in carpal tunnel syndrome. Orthopedics 1992;15(11):1297-302.
[25]Golding DN, Rose DM, Selvarajah K. Clinical tests for carpal tunnelsyndrome: an evaluation. Br J Rheumatol 1986;25(4):388-90.
[26]Heller L, Ring H, Costeff H, Solzi P. Evaluation of Tinel’s andPhalen’s signs in diagnosis of the carpal tunnel syndrome. Eur Neurol 1986;25(1):40-2.
[27]Mondelli M, Passero S, Giannini F. Provocative tests in differentstages of carpal tunnel syndrome. Clin Neurol Neurosurg 2001;103(3):178-83.
[28]Burke DT, Burke MA, Bell R, Stewart GW, Mehdi RS, Kim HJ.Subjective swelling: a new sign for carpal tunnel syndrome. Am J Phys MedRehabil 1999;78(6):504-8.
[29]Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G,Franzblau A, et al. Consensus criteria for the classification of carpal tunnelsyndrome in epidemiologic studies. Am J Public Health 1998;88(10):1447-51.
[30]Chang MH, Liu LH, Lee YC, Wei SJ, Chiang HL, Hsieh PF.Comparison of sensitivity of transcarpal median motor conduction velocity andconventional conduction techniques in electro diagnosis of carpal tunnelsyndrome. Clin Neurophysiol 2006;117(5):984-91.
[31]Bingham RC, Rosecrance JC, Cook TM. Prevalence of abnormalmedian nerve conduction in applicants for industrial jobs. Am J Ind Med 1996;30(3):355-61.
[32]Bodofsky EB, Wu KD, Campellone JV, Greenberg WM, Tomaio AC.sensitive new median-ulnar technique for diagnosing mild Carpal TunnelSyndrome. Electromyogr Clin Neurophysiol 2005;45(3):139-44.
[33]Keles I, Karagulle Kendi AT, Aydin G, Zog SG, Orkun S. Diagnosticprecision of ultrasonography in patients with carpal tunnel syndrome. Am JPhys Med Rehabil 2005;84(6):443-50.
[34]Koyuncuoglu HR, Kutluhan S, Yesildag A, Oyar O, Guler K, Ozden A.The value of ultrasonographic measurement in carpal tunnel syndrome inpatients with negative electro diagnostic tests. Eur J Radiol 2005;56(3):365-9.
[35]El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerveconduction study in patients with carpal tunnel syndrome: substantive orcomplementary tests? Rheumatology (Oxford) 2004;43(7):887-95.
[36]Giannini F, Passero S, Cioni R, Paradiso C, Battistini N, Giordano N,al. Electrophysiologic evaluation of local steroid injection in carpal tunnelsyndrome. Arch Phys Med Rehabil 1991;72(10):738-42.
[37]Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, et al. Arandomized controlled trial of surgery vs. steroid injection for carpal tunnelsyndrome. Neurology 2005;64(12):2074-8.
[38]Racasan O, Dubert T. The safest location for steroid injection in thetreatment of carpal tunnel syndrome. J Hand Surg [Br] 2005;30(4):412-4.
[39]Agarwal V, Singh R, Sachdev A, Wiclaff, Shekhar S, Goel D. Aprospective study of the long-term efficacy of local methyl prednisolone acetateinjection in the management of mild carpal tunnel syndrome. RheumatologyOxford) 2005;44(5):647-50.
[40]Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. Surgicaldecompression versus local steroid injection in carpal tunnel syndrome: aone-year, prospective, randomized, open, controlled clinical trial. ArthritisRheum 2005;52(2):612-9.
[41]Rh oades CE, Mow er y C A and Gelberm an RH. Resul ts of in ternaleurolys is of the median nerve f or s evere carpal tu nnel s yndrome. J BoneJoint Surg ( Am) , 1985, 67: 253.
[42]陈德松,劳杰,蔡佩琴,等.从病理分析讨论腕管综合征的手术方法[J].中华手外科杂志, 1996, 12(增刊) : 29.
[43]刘晋才.国外内窥镜腕管松解术的应用进展[J].中华手外科杂志,1995, 11: 253.
[44]Okut su I, Ninoiya S , T ak t or i Y, et al. Endos copic management ofcarpal tu nnel s yndrome. Arth roscopy, 1989, 5: 11.
[45]Chow JCY. Endoscopic release of the car pal Lig ament : a newtechnique f or carpal tunnel s yndrome. Arthros copy, 1989, 5: 19.
[46]顾玉东,陈德松,史其林,等.腕管综合征128例分析[J].中华手外科杂志,2006,22(5):283-285
[1]浜田良机.腕管综合征治疗效果[J].日本手外科杂志,1985,2:156.
[2]Kelly CP,Pulisteti D,Jamieson AM.Early experimence with endoscopiccarpal tunnel release.J Hand Surg,1994,19(8):18-21.
[3]王振军，侯书健，程国良.腕管综合征的临床研究进展[J].实用手外科杂志，2002，16（3）：162-163.
[4]赵宏，赵宇，等.腕管综合征关节镜下手术与开放手术的疗效比较[J].中国医学科学院学报，2004，26（6）：657-660.
[5]史其林，薛峰，王金武，等.腕管综合征在内窥镜视下手术与常规手术的疗效比较[J].中华手外科杂志，2000，16（3）：152-154.
[6]宫修建，许玉鹏.显微外科技术治疗腕管综合征28例分析[J].实用手外科杂志，2003，6（2）：109.
[7]顾玉东，陈德松，史其林，等.腕管综合征128例分析[J].中华手外科杂志，2006，22（5）：283-285.
[8]田光磊，张胜友.腕管切开松解减压术[J].中华创伤骨科杂志，2004，6（9）：1042-1047.
[9]D. Tuncali，A. Yuksel Barutcu, A. Terzioglu and G. Aslan . Carpaltunnel syndrome: comparison of intraoperative structural changes with clinicaland electrodiagnostic severity. British Journal of Plastic Surgery .Volume 58,Issue 8, December 2005, Pages 1136-1142
[10]虞聪，胡必寺，沈丽英，等.周围神经卡压松解的实验研究[J] .中华手外科杂志，1996，9（4）：50-52.
[11]Mackinnon SE,Dellon At,Hudson AR.Chronic nerve compression anexperimetal model in the rat. Ann Plast Surg,1984,13:112.
[12]Mackinnon SE.A Primate model for chronic nerve compressive.JRecontr Microsurg,1995,1:186.
[13]连勇，邵中周，俊祥，等.周围神经卡压外膜松解范围对手术疗效影响的实验研究[J] .中华手外科杂志，2005，4（21）：124,125.
[14]陈中伟.周围神经损伤基础与临床研究[M].山东科学技术出版社，2000.4 3（4）：180-188.
[2]Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnelsurgery. Instr Course Lect 1995;44:167-72.
[3]Burke FD. Carpal tunnel syndrome: reconciling“demand management”with clinical need. J Hand Surg [Br] 2000;25(2):121-7.
[4]Stevens JC, Sun S, Beard CM, O’Fallon WM, Kurland LT. Carpaltunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 1988;38(1):134-8.
[5]Phalen GS. The carpal-tunnel syndrome. Seventeen years’experiencein diagnosis and treatment of six hundred fifty-four hands. J Bone Joint SurgAm 1966;48(2):211-28.
[6]Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidencein a general population. Neurology 2002;58(2):289-94.
[7]Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnelsyndrome in two areas of the United Kingdom, 1991-2001. J Neurol NeurosurgPsychiatry 2003;74(12):1674-9.
[8]Melhorn JM. CTD: carpal tunnel syndrome, the facts and myths. KansMed 1994;95(9):189-92.
[9]Brian WR, Wright AD. Spontaneous compression of both mediannerves in the carpal tunnel. Lancet 1947; 1:277-82.
[10]Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors andcarpal tunnel syndrome. Am J Ind Med 1987;11(3):343-58.
[11]Werner R, Armstrong TJ, Bir C, Aylard MK. Intracarpal canalpressures: the role of finger, hand, wrist and forearm position. Clin Biomech(Bristol, Avon) 1997;12(1):44-51.
[12]Ham SJ, Kolkman WF, Heeres J, den Boer JA. Changes in the carpaltunnel due to action of the flexor tendons: visualization with magneticresonance imaging. J Hand Surg [Am] 1996; 21(6):997-1003.
[13]Rempel D, Bach JM, Gordon L, So Y. Effects of forearm pronation/supination on carpal tunnel pressure. J Hand Surg [Am] 1998;23(1):38-42.
[14]Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, etal. An evaluation of gender, obesity, age and diabetes mellitus as risk factors forcarpal tunnel syndrome. Clin Neurophysiol 2002;113(9):1429-34.
[15]Gerr F, Letz R. Risk factors for carpal tunnel syndrome in industry:blaming the victim? J Occup Med 1992;34(11):1117-9
[16]Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor forimpaired sensory conduction of the median nerve at the carpal tunnel. J HandSurg [Br] 1988;13(2):167-70.
[17]Garland FC, Garland CF, Doyle EJ, Jr., Balazs LL, Levine R, PughWM, et al. Carpal tunnel syndrome and occupation in U.S. Navy enlistedpersonnel. Arch Environ Health 1996; 51(5):395-407.
[18]Spielholz P, Silverstein B, Morgan M, Checkoway H, Kaufman J.Comparison of self-report, video observation and direct measurement methodsfor upper extremity musculoskeletal disorder physical risk factors. Ergonomics2001;44(6):588-613.
[19]Osorio AM, Ames RG, Jones J, Castorina J, Rempel D, Estrin W, et al.Carpal tunnel syndrome among grocery store workers. Am J Ind Med 1994;25(2):229-45.
[20]Moore JS, Garg A. Upper extremity disorders in a pork processingplant: relationships between job risk factors and morbidity. Am Ind Hyg AssocJ 1994;55(8):703-15.
[21]Lundborg G, Dahlin LB, Danielsen N, Hansson HA, Necking LE,Pyykko I. Intraneural edema following exposure to vibration. Scand J WorkEnviron Health 1987;13(4):326-9.
[22]Buch-Jaeger N, Foucher G. Correlation of clinical signs with nerveconduction tests in the diagnosis of carpal tunnel syndrome. J Hand Surg [Br]1994;19(6):720-4.
[23]Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpaltunnel syndrome signs. Am J Phys Med Rehabil 1997;76(6):451-7.
[24]Kuschner SH, Ebramzadeh E, Johnson D, Brien WW, Sherman R.Tinel’s sign and Phalen’s test in carpal tunnel syndrome. Orthopedics 1992;15(11):1297-302.
[25]Golding DN, Rose DM, Selvarajah K. Clinical tests for carpal tunnelsyndrome: an evaluation. Br J Rheumatol 1986;25(4):388-90.
[26]Heller L, Ring H, Costeff H, Solzi P. Evaluation of Tinel’s andPhalen’s signs in diagnosis of the carpal tunnel syndrome. Eur Neurol 1986;25(1):40-2.
[27]Mondelli M, Passero S, Giannini F. Provocative tests in differentstages of carpal tunnel syndrome. Clin Neurol Neurosurg 2001;103(3):178-83.
[28]Burke DT, Burke MA, Bell R, Stewart GW, Mehdi RS, Kim HJ.Subjective swelling: a new sign for carpal tunnel syndrome. Am J Phys MedRehabil 1999;78(6):504-8.
[29]Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G,Franzblau A, et al. Consensus criteria for the classification of carpal tunnelsyndrome in epidemiologic studies. Am J Public Health 1998;88(10):1447-51.
[30]Chang MH, Liu LH, Lee YC, Wei SJ, Chiang HL, Hsieh PF.Comparison of sensitivity of transcarpal median motor conduction velocity andconventional conduction techniques in electro diagnosis of carpal tunnelsyndrome. Clin Neurophysiol 2006;117(5):984-91.
[31]Bingham RC, Rosecrance JC, Cook TM. Prevalence of abnormalmedian nerve conduction in applicants for industrial jobs. Am J Ind Med 1996;30(3):355-61.
[32]Bodofsky EB, Wu KD, Campellone JV, Greenberg WM, Tomaio AC.sensitive new median-ulnar technique for diagnosing mild Carpal TunnelSyndrome. Electromyogr Clin Neurophysiol 2005;45(3):139-44.
[33]Keles I, Karagulle Kendi AT, Aydin G, Zog SG, Orkun S. Diagnosticprecision of ultrasonography in patients with carpal tunnel syndrome. Am JPhys Med Rehabil 2005;84(6):443-50.
[34]Koyuncuoglu HR, Kutluhan S, Yesildag A, Oyar O, Guler K, Ozden A.The value of ultrasonographic measurement in carpal tunnel syndrome inpatients with negative electro diagnostic tests. Eur J Radiol 2005;56(3):365-9.
[35]El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerveconduction study in patients with carpal tunnel syndrome: substantive orcomplementary tests? Rheumatology (Oxford) 2004;43(7):887-95.
[36]Giannini F, Passero S, Cioni R, Paradiso C, Battistini N, Giordano N,al. Electrophysiologic evaluation of local steroid injection in carpal tunnelsyndrome. Arch Phys Med Rehabil 1991;72(10):738-42.
[37]Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, et al. Arandomized controlled trial of surgery vs. steroid injection for carpal tunnelsyndrome. Neurology 2005;64(12):2074-8.
[38]Racasan O, Dubert T. The safest location for steroid injection in thetreatment of carpal tunnel syndrome. J Hand Surg [Br] 2005;30(4):412-4.
[39]Agarwal V, Singh R, Sachdev A, Wiclaff, Shekhar S, Goel D. Aprospective study of the long-term efficacy of local methyl prednisolone acetateinjection in the management of mild carpal tunnel syndrome. RheumatologyOxford) 2005;44(5):647-50.
[40]Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. Surgicaldecompression versus local steroid injection in carpal tunnel syndrome: aone-year, prospective, randomized, open, controlled clinical trial. ArthritisRheum 2005;52(2):612-9.
[41]Rh oades CE, Mow er y C A and Gelberm an RH. Resul ts of in ternaleurolys is of the median nerve f or s evere carpal tu nnel s yndrome. J BoneJoint Surg ( Am) , 1985, 67: 253.
[42]陈德松,劳杰,蔡佩琴,等.从病理分析讨论腕管综合征的手术方法[J].中华手外科杂志, 1996, 12(增刊) : 29.
[43]刘晋才.国外内窥镜腕管松解术的应用进展[J].中华手外科杂志,1995, 11: 253.
[44]Okut su I, Ninoiya S , T ak t or i Y, et al. Endos copic management ofcarpal tu nnel s yndrome. Arth roscopy, 1989, 5: 11.
[45]Chow JCY. Endoscopic release of the car pal Lig ament : a newtechnique f or carpal tunnel s yndrome. Arthros copy, 1989, 5: 19.
[46]顾玉东,陈德松,史其林,等.腕管综合征128例分析[J].中华手外科杂志,2006,22(5):283-285
[1]浜田良机.腕管综合征治疗效果[J].日本手外科杂志,1985,2:156.
[2]Kelly CP,Pulisteti D,Jamieson AM.Early experimence with endoscopiccarpal tunnel release.J Hand Surg,1994,19(8):18-21.
[3]王振军，侯书健，程国良.腕管综合征的临床研究进展[J].实用手外科杂志，2002，16（3）：162-163.
[4]赵宏，赵宇，等.腕管综合征关节镜下手术与开放手术的疗效比较[J].中国医学科学院学报，2004，26（6）：657-660.
[5]史其林，薛峰，王金武，等.腕管综合征在内窥镜视下手术与常规手术的疗效比较[J].中华手外科杂志，2000，16（3）：152-154.
[6]宫修建，许玉鹏.显微外科技术治疗腕管综合征28例分析[J].实用手外科杂志，2003，6（2）：109.
[7]顾玉东，陈德松，史其林，等.腕管综合征128例分析[J].中华手外科杂志，2006，22（5）：283-285.
[8]田光磊，张胜友.腕管切开松解减压术[J].中华创伤骨科杂志，2004，6（9）：1042-1047.
[9]D. Tuncali，A. Yuksel Barutcu, A. Terzioglu and G. Aslan . Carpaltunnel syndrome: comparison of intraoperative structural changes with clinicaland electrodiagnostic severity. British Journal of Plastic Surgery .Volume 58,Issue 8, December 2005, Pages 1136-1142
[10]虞聪，胡必寺，沈丽英，等.周围神经卡压松解的实验研究[J] .中华手外科杂志，1996，9（4）：50-52.
[11]Mackinnon SE,Dellon At,Hudson AR.Chronic nerve compression anexperimetal model in the rat. Ann Plast Surg,1984,13:112.
[12]Mackinnon SE.A Primate model for chronic nerve compressive.JRecontr Microsurg,1995,1:186.
[13]连勇，邵中周，俊祥，等.周围神经卡压外膜松解范围对手术疗效影响的实验研究[J] .中华手外科杂志，2005，4（21）：124,125.
[14]陈中伟.周围神经损伤基础与临床研究[M].山东科学技术出版社，2000.4 3（4）：180-188.