改良小切口腕管松解术的临床疗效与电生理 分析：随机对照研究

Clinical Efficacy and Electrophysiological Analysis of Modified Mini-Incision Carpal Tunnel Release: A Randomized Controlled Trial

摘要: 背景：腕管综合征(CTS)中重度患者往往需要手术治疗。本研究比较新型帆形切口与传统纵行切口在腕管松解术中的临床疗效。方法：41例中重度CTS患者随机分为帆形切口组(n = 21)和纵行切口组(n = 20)。主要观察指标为切口长度、手术时间、术中出血量；患者报告结局为BCTQ-SSS和BCTQ-FSS评分；电生理指标为SCV和SNAP。于术后2周、4周及6个月随访评估。结果：帆形切口组切口更短(2.26 ± 0.46 cm vs 4.78 ± 0.89 cm, p < 0.001)，手术时间更少(23.46 ± 2.67 min vs 30.00 ± 4.71 min, p < 0.001)，出血量更低(7.26 ± 1.70 mL vs 15.00 ± 5.02 mL, p < 0.001)，住院时间更短(4.63 ± 0.91天vs 6.38 ± 1.48天，p = 0.002)。两组6个月功能恢复相当，但帆形切口组术后2周早期康复更优(BCTQ-SSS: 2.28 ± 0.11 vs 2.40 ± 0.13, p = 0.002)。帆形切口组6个月电生理改善更显著(SCV: p = 0.041; SNAP: p = 0.009)，并发症率更低(9.5% vs 25%, p = 0.012)。结论：帆形切口可提升手术效率、减轻组织创伤、促进早期恢复、降低并发症，6个月中期疗效与传统术式相当。

Abstract: Background: Patients with moderate or severe carpal tunnel syndrome (CTS) often need surgery. In this study, the clinical effect of new sail incision and traditional longitudinal incision in carpal tunnel release was compared. Methods: 41 patients with moderate and severe CTS were randomly divided into sail incision group (n = 21) and longitudinal incision group (n = 20). The main outcome measures were incision length, operation time and intraoperative blood loss. The outcome of the patient report was BCTQ-SSS and BCTQ-FSS scores; the electrophysiological indexes were SCV and SNAP. Follow-up evaluation was performed at 2 weeks, 4 weeks and 6 months after operation. Results: In the sail incision group, the incision was shorter (2.26 ± 0.46 cm vs 4.78 ± 0.89 cm, p < 0.001), the operation time was shorter (23.46 ± 2.67 min vs 30.00 ± 4.71 min, p < 0.001), the blood loss was lower (7.26 ± 1.70 mL vs 15.00 ± 5.02 mL, p < 0.001), and the hospital stay was shorter (4.63 ± 0.91 days vs 6.38 ± 1.48 days, p = 0.002). The functional recovery of the two groups was similar in 6 months, but the early recovery of the sail incision group was better in 2 weeks after operation (BCTQ-SSS: 2.28 0.11 vs 2.40 0.13, p = 0.002). The electrophysiological improvement in sail incision group was more significant in 6 months (SCV: P = 0.041; Snap: P = 0.009), and the complication rate was lower (9.5% vs 25%, p = 0.012). Conclusion: Sail incision can improve the operation efficiency, reduce tissue trauma, promote early recovery and reduce complications, and the intermediate efficacy at 6 months was comparable to that of conventional surgical techniques.