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Sasifuna ukuhlola imiphumela yokwehliswa okuvulekile kwe-anatomical okusekelwe emgaqweni (MCTR) nge-Palmar Action (MCTR) ngokuqhathanisa nemisebenzi evamile (i-OCTR) .Ukuthola isikolo se-100) Isilinganiso sesimo se-Functional (FSC), kanye nesikali se-visual analog (VAS). Imicimbi engemihle ibonwa.Imicimbi ye-95% ikhombise ama-95% I-0.398), SSS: 1.3 / 1.2 (p = 0.534), i-FSC: 1.3 / 0.2% vs.7 (p = 0.617). Ubuhlungu be-strut, futhi bufushaniswe izikhathi zokubuyiselwa kwezikhathi nezimo zenqubo
I-Carpal Tunnel Syndrome (CTS) yi-Neuropathy1,2,4,4,5,6 yokwanda okubikiwe kwe-3.8% kwi-General PopleAN7.I-COSTIONS YAMABHODISI ESISEKELWE
Ukwelashwa kwe-algorithms okubandakanya ukuhlukaniswa, izidakamizwa ezingezona ze-anti-inflactoral, kanye nemijovo ye-torticosteroid ethosiwe ngokuvamile kutholakale izimpawu zokukhishwa, ukukhishwa komhubhe we-carpal) Ukubona ngeso leso, ukuhlukaniswa okuthembekile kwe-flexor retinacululum, kanye nekhono lokukhomba ukuhlukahluka kwe-anatomical; Kubandakanya izinhlungu zokulimaza ama-postoperative, ukuzwela okucashile, kanye nokuthi kungenzeka yini ukuthi izinkinga ze-stut I-SCRARRING), bese uvumela ukubuyela kwangaphambilini emsebenzini kanye nemisebenzi yokuphila kwansuku zonke5,10,12.Howevever, Kubandakanya ubungozi obukhulayo be-retinacalulum yokukhishwa kwemisipha ye-flevel.mini
Inhloso yalolu cwaningo bekuwukuhlola ukulandela isikhathi eside kwe-MCTR ngokususelwa ku-Anatomical Landmarks echazwe ngaphambilini14 nge-Palmar, ngoba ukuphepha kufana ne-McTR kufana ne-McTR bekukufanele ukuthola amasu ajwayelekile ngokweneliswa kweziguli kanye nokubuyiselwa okusebenzayo.
Iziguli ezingamashumi amahlanu ezazihlangene ne-Unilateral McTR phakathi kukaJanuwari 1, 2008 noDisemba 31, 2015 esigabeni se-ONTRee ye-MCTR kuleli qembu le-MCTR.Iqembu le-AK) Isikhathi esingemuva. Isikhathi sokulandela okuncane phakathi kokuhlinzwa nokuvakasha kweziguli sasiyiminyaka emithathu yokuhlolwa kabusha kokugcina.
Ukuxilongwa kwe-CTS kususelwa ekubakhona kokuphazamiseka kwemizwa kanye / noma ubuthakathaka endaweni ehlinzekwe yi-Erve nerve.
Exclusion criteria included signs of local or systemic inflammation, anatomical deformation, nerve or soft tissue defects, previous wrist and hand surgery, and bilateral CTS symptoms and symptom duration greater than one year.Patients with other comorbidities such as insulin-dependent diabetes mellitus, polyneuropathy, smoking, or rheumatoid arthritis were excluded.
Kusetshenziswe amaphrothokholi ajwayelekile kuwo womabili amaqembu. Kwenziwe nge-Rebonable 5.0 Suture {Polyamide, E-Ethilon 668H, Johnson & Johnson Medical GmbH, Nordersn & Rauschess. Comlents yayisetshenziswa njenge-pad roll ngemuva kokungenisa okulinganiselayo {Lenkelast, i-rausman & rauscher International GmbH & Emva kokukhishwa kwezicucu, kufaka phakathi ukukhishwa kwezicucu kanye nokulawulwa kwemitholampilo, kwenziwa nguSurgeon amahora angama-24 Petroperaictive.Kepha, i-cosmopor, uHartomann AG, Heidenheim, iJalimane} yakhishwa.Izisulu zangemva kokukhetha amasonto amabili futhi zigwema ukuphakanyiswa okunzima ngemuva kwezinsuku eziyi-14 ngemuva kokuhlinzwa (ukulandela kuqala).
Ukuze uthole inqubo ye-OCTR, i-3.5 cm endeitudinal incision yenziwa nge-plalmar crease futhi iyekise i-desistal engu-0.5 cm kwisihlakala esingu-0,5
Eqenjini le-MCTR, zombili izinqubo ze-styloid zihlanganiswe futhi zixhunywe emugqeni ovundlile ngokusebenzisa ipeni.
Okulandelayo, dweba imigqa emide vertical ohlangothini lwe-radial yomunwe wendandatho.Lolu mbumbulu luphela ngqo e-Palmer Longus templon ye-Palmal Feroarm (a) .Indlela yesikhumba)
Ukumelwa okuhlesi kwe-incision yesikhumba ye-MCTR kanye namasu womabili: I-Blue Circle amelela indawo evundlile yomunwe we-OCTR.Umugqa obomvu ikhombisa ubukhulu be-opitudinal ye-CarPer.Ilayini eluhlaza ovundlile ye-CarPerger et.4 Ichazwe.mctr Mini Open Carpal Tunnel Releaser, OCTR ukuvula i-carpal tureelevel releaser.
. Ukuhlinzwa - Kunwebeka kungabi ngaphezu kwe-1-1,5 cm
Ukuvela kwe-1-1,5 cm ye-Palmar kwenziwa ngemfashini ende ende, esimweni ngasinye kusuka ku-Ulna ngokusebenzisa i-aponerosis ye-dupuytren kuvulwa amandla aphezulu (bheka umfanekiso we-pepury artery ophakeme kanye ne-kerch ye-median ye-median Kuhleliwe futhi kuvikelwe (bheka umfanekiso 4).
Uhlelo lwensimbi ye-MCTR: Kuqukethe izingxenye ezimbili: A. Ummese okhethekile wokusika, uSiti Ovikelekile Umhlahlandlela. I-08-0001 ne-08-0003, I-Integra LifeSSciences Corporation Corporation Corporation Corporation Corporation Corporation Corporation Cons I-28147 SA, Germany} D. I-FOMON Retractor, i-E. Mini Suction Tube, F. Amandla omiyane. I-20.50.05, Germany; I-MedifoPlast International GmbH, Art.-no. 770 (107867), Germany; Medicon isib, art.-no. 15.45.1.12, Germany}
Izithombe ze-Intraperative ze-MCTR: Iphuzu lokuphuma le-Median Nerve Everar ephumayo libonakala ngokuphelele kwinkambu yokusebenza. 20 Meyi 2005, iJalimane} .Mctr Mini Open Carpal Trudul Runnel Rungen.
Ukuvela kokuqala engxenyeni ye-distal ye-transverver ye-carpal ligament kwenziwa ngaphansi kombono oqondile nge-ON $ 15 scalnel scalnel blade emhubheni we-carpal, i-carpay} I-carpal ligament esele eselamile iyatholakala (bheka izibalo 3, 5, no-6).
Isithombe se-Intraperative se-MCTR: Kufakwe umhlahlandlela wokuvikela ukuvikela i-Median Nerve.Dued Expert, ama-Fomon Rearactors asetshenziswa kamuva futhi etholwa eRagnell Tructul Runchel Runchel Tructul Tructul, art.-no. I-08-0001, i-Integra LifeSSciencetions Corporation, Medicon isib, art.-no. Meyi 20, 2005, Into No.20.12.20, Germany} .Mctr Mini Open CarPal Tunnel Rungen Rungenen.
Isithombe se-Intraperative se-MCTR: Ukukhishwa kwe-Transverser Carpal Ligament kufinyelelwe Meyi 20, 2005, Art. Cha. 2020.12.20, Germany}
Idatha ehlolwe kabusha yaqoqwa ngokufanelekile kwizimpawu ezikhethekile zesibhedlela i-Database.basic Izici ezibandakanya ubudala, ubulili, uhlangothi oluthintekile, nezimpawu zokuhlinzwa ezizohlinzwa, kanye nezimpawu zokusebenzisana ziqoshwe kumafayela wesiketi.
Iziguli zalandelwa amasonto amabili ngemuva kokuhlinzwa.Ngena ngokulandela kwahlolwa udokotela ohlinzayo (MP noma i-AK).
Ukulandelwa kokugcina kwenziwa ngodokotela abahlinzayo ababili be-Trauma (njengoba ne-GH) ukubhala izinguquko ezimpawuni nezimpawu kanye / noma imicimbi emibi yokukhubazeka (i-FSC) kanye ne-boston carpal Syndrnaire, kufaka phakathi isilinganiselo sokukhubazeka se-vas (i-FSC) kanye nesilinganiso sokusebenza kwe-boston kanye / noma izinhlungu zekholomu endaweni yokuhlinza Ukuqothula.Ukuhlolwa, izinhlungu zeStrut zavivinywa ngokuhlanza kanyekanye ecindezela imicibisholo ye-ke ye-tasear ne-hypothenar, njengokungathi zihlukanisa umhubhe we-carpal.
Isikhathi sokuhlinzwa sibuyele ekubuyiselweni nasekubuyiselweni emsebenzini (ngaphandle kokuthatha umhlalaphansi) kuhlolwe.Retursure kuchazwa njengezikhathi ezingemuva (i-hematoma, ukulimala kwe-neurovascular (i-tendon. Ukukhululeka kwesikhashana.Ungeza, amanani okubuyekezwa kanye nezimbangela nesikhathi sokuhliswa kokuqala ekuhlinzekweni kokubuyekezwa (uma kusebenza).
Ukuhlaziywa kwezibalo kwenziwa kusetshenziswa isoftware ye-SPSS {IBM SPSS Statistics version 26, i-Armonk, e-USA} .Imininingwane evamile kuvezwa njengezimpawu ezijwayelekile, ukuphambuka okujwayelekile (i-SD), kanye nezibalo zedatha ezihlukile zisetshenziselwa ukuguquguquka kwabantu; Ukuhlukahluka okuqhubekayo kufingqiwe kusetshenziswa i-SD kanye / noma ngamanani amanani amancane namanani aphezulu.
Ukuhlolwa kwe-nonparametric kusetshenziselwe ukuhlaziywa kwedatha kokubaluleka.Ususe umehluko phakathi kwe-MCTR nama-Press asetshenzisiwe ka-0.05, usayizi wesampula ka-0.88 wabalwa ngokususelwa ku-test19 enomsila amabili.
Ukuvunyelwa kokuziphatha kwanikezwa ibhodi yokubukeza lesikhungo seBhodi Yesinxephezelo Sabasebenzi base-Austrian's Astrust '(AUVA-EK 03/2019)
Iqembu le-MCTR laliqukethe ama-72% abesifazane (36/50) no-28% (14/50) iziguli zesilisa ezineminyaka engu-61.2 (i-32/50) bezokwesokunxele. Imizuzu engu-9.2 (SD: 2.7; ibanga: 6-18) .I-Advocate Final Ukulandela eqenjini le-MCTR kwakuyizinyanga ezingama-60 (SD: 23.10; Range: 36-108).
Eqenjini le-OCTR, ama-74% (37/50) ngabesifazane kanye nama-26% (13/50) kwakukhona amadoda.Iminyaka engu-20/19: 12) yezandla ezi-10,0 Izinyanga eziyi-5.4 (ukuphambuka okujwayelekile: 1.8; ibanga: 4-12) .I-Advocate Final Ukulandelwa eqenjini le-OCTR kwakuyizinyanga ezingama-54 (SD: 24.3; Range: 37-101).
Kwakunomehluko obalulekile ngokwezibalo phakathi nesikhathi sokuhlinzwa (p = 0.001), kepha hhayi phakathi kwamaqembu ngokuya ngeminyaka (p = 0.621) nesikhathi sokulandela (P = 0.623).
Emavikini amabili ngemuva kokuhlinzwa, kwakungekho ukusabela okunzima kunoma yiliphi iqembu le-MCTR, ukuzwela kwe-str kwahlolwa ngeziguli ezi-3 (i-SD: 26% 0-8)
Azange kube nomehluko ophawuleka ngokwezibalo ezikrinini zokuhlola phakathi kwamaqembu (bheka ithebula 1). Ukuqhubekela phambili kwe-postoperative kunganakwa kakhulu ku-MCTR group (0%) kuqhathaniswa neqembu le-OCTR (12%, 6/50).
Izehlakalo eziphikisayo ze-Privioperative zikhonjiswa eThebula 3.No Recresence libonwe kunoma yiliphi iqembu.Izinga lesibuyekezo lalingu-2% weqembu le-MCTR kanye ne-4%
Kuleli qembu lonke, awekho i-Inkagenic vascular, igatsha lezinzwa, noma ukulimala kwe-tendon kwaqoshwa.Inhlangano ye-volore median yaqinisekiswa e-McTR Group, kuqinisekiswe ngemitholampilo kanye ne-elekthromcography.ovel, isilinganiso sezinkinga jikelele sasingu-4% (4/100 ngenani noma 2/50 eqenjini ngalinye).
Inhloso yalolu cwaningo bekuwukuhlola ukulandela isikhathi eside kwe-CTR e-Palmar ngendlela esetshenzisiwe ye-Palmar kanye nokucaciswa kokuqina okusebenzayo ngemuva kokulandela i-McTR uma kuqhathaniswa nokulandela isikhathi eside (P = 0.007).
UPaine20 uchaza idivaysi yokuqala ngo-1955 esetshenziswa njenge-Bett Belt Cutter.Ledivayisi isetshenziswe kuze kube manje, njengoba isanda kubikwa nguFernandes et al. 21 Ababhali21 babuka imiphumela emifushane- kanye nemiphumela yesikhathi eside babika imiphumela emihle emtholampilo ezigulini ezingaphezu kuka-700 esikhathini eside, kanti amasu ahlukahlukene abikwe ngokuhamba kwesikhathi ku-CTRelinal Sliced. Izifundo23,24 Emiqondweni yesikhathi eside ngemuva kwe-MCTR.
UBai et al2 wenze ukuhlaziya okubuyiselwe kwedatha eqoqwe ngokutholwa okubandakanya iziguli ezingama-85 ezazingezelwe yi-MCTR (MCTR), izinyanga eziyi-6.4) .Izinyanga eziyi-5.4) .Izinyanga eziyi-5.4) .Izinqubo zenqubo (p = 0.130) (MCTR: imizuzu 25.1 Ubuhlungu kwakungu-4.7% eqenjini le-OCTR, kanti abanazo iziguli bathola izinhlungu zobuhlungu ngemuva kweMcTr (P = 0.490).
U-Aslani Et Al25 wahlukanisa isampula yabo yeziguli ezingama-105 emaqenjini amathathu angaphansi (i-MCTR, neqembu elithola ukufikelwa yi-MCTR (lisho ukuthi inzuzo e-Endoscopic) uma kuqhathaniswa ne-McTR group (i-MCTR: kusho ukuthini Izinsuku eziyi-14; I-OCTR: Kusho izinsuku ezingama-20; P = 0.142).
UZhang et al23 uhlaziye iziguli ezingama-207 ezihlelwe ngokungahleliwe ngokufakwa okuncane (n = 73) ku-MCTR, kanye ne-Endoscopic CTR (NORTRICS CTR (N = 69) .Izinyanga ezingama-5.4). I-MCTR ne-OCTR emiphumeleni ye-Boston Carpal Tunnel tunnel tunnel tunneln nerednakee.here, i-SSS kanye ne-FSC yawo womabili amaqembu kwakuyimiphumela yethu.
Ukushintshwa kwezinzwa okwenziwayo kwenzeka ngaphansi kuka-2% kuya ku-25% 26, 27, 28, 27, 30, 37 futhi kungahle kwenzeke eminyakeni engu-3.7% 27 kuya ku-57% 32. Ukuphindaphindeka27 kubhekwe njengokuphindaphinda.Cressell et al24 kubike isilinganiso esiphakeme kakhulu sokwenza izingcezu eziphakeme ezigulini ngemuva kweminyaka engu-3, ngokulandela umlandeli we-MCTR ngokuqhathaniswa ne-MCTR: Izinyanga ezingama-60, i-OCTR: Ezinyangeni ezingama-54)
Isibonakaliso esivamile nesikhulu sokucindezela kwe-nerve okujwayelekile kungahle kuholele ekuqhekekeni okungaphelele kwe-ligament ye-transverse kanye / noma i-fibrosiation ye-fibrosis30,33.it kukhombisa ukuthi i-fibrosis yokuzivocavoca yokuzivocavoca ingahle ibe nomphumela omuhle kakhulu ohlotshaniswa ne-Wrist Ligaments Akunakwenzeka ngemuva kokuhlukaniswa ngokwanele kwe-ligament ye-transverse.in, imicimbi efanayo ephansi yabhekwa kuwo womabili amaqembu.
Enye inzuzo yezobuchwepheshe imelela ukubonwa okuqondile kwegatsha le-nerve ye-waler.In, ukulimala kwe-wetrogenic kwi-superfic arch akwenzeki ngenxa yokukhishwa kwe-methiman group.sizinyene, i-cresswell et al24 ibike nge-1 Median nerve ukulimala ngo-1 Iziguli.Lee noStrickland17 babona ukulimala kwezinzwa ezimbili ze-Median ekukhishweni kwazo ezingama-694 besebenzisa okutholakele kwawo wonke amaqembu amathathu, kuvame ukuthuthukisa ukunwebeka kwesikhumba seziguli ezinamachashazi anzima.
Lolu cwaningo lunokulinganiselwa oluningana Izinqumo eziphathelene nokwelashwa. Lezi zinto azizange zibhekiswe ekufundeni.Finally, akukho kubuyekezwa okwenziwe mayelana nezindleko zezinto zokwakha noma ukwenziwa kokwenziwa kwezezimali noma umthelela wezezimali we-inpatient versus izilungiselelo ezingaphandle.
Njengoba amandla alolu cwaningo isikhathi eside.Ukuqinisekisa inqubo ngokuhlinza ngokukhethekile, sasebenzisa iziguli ezifanayo kanye nokwaziswa okuphezulu kwendlela enobungozi yezakhiwo ezingezinhle kakhulu zezinhlaka ezimbili ye-Median Nerve kanye ne-Palmar Archrch.our ye-Palmar Arch.Ukukhula kwe-anatomical landmark equkethe izindawo ezaziwayo zokuphepha ze-anatomical kanye namasu avulwa ama-micro-et, njengoba kuboniswe uHohenberger et al.in Anatomical Study 14.
Ekuphetheni, inqubo yethu ehlongozwayo futhi ethandwayo ye-MCTR nge-Palmst indlela ikhonjiswe ukuthi isebenze.Izinyathelo ngemuva kokuhlinzwa okufanayo kwe-MCTR kuphansi, futhi amasu amabili aqhathaniswa nalolu hlobo.
Usebenzisa inqubo esichazile, azikho iziguli ezinokubuyiselwa emuva noma ukuhlushwa ebuhlungu strut Izakhiwo zobunikazi.Lokuthi, i-MCTR iyisikhathi esisheshayo, esisebenzayo, esihlaselayo, kanye nenqubo enzima yezobuchwepheshe evumela ukubonwa okuqondile kwe-Anatomy engozini.
I-Anbarasan, a. Hand misesgery.Rev. 09, 006-010 (2017).
I-Bai, J. ET Al.Carpal Rungen Rungen Rungen kwakuyindlela yokuthola amaqembu abuyisiwe esebenzisa indlela entsha encane yokufaka uma iqhathaniswa nendlela yendabuko. Ukuhumusha.J. Iphephabhuku Lokuhlinzwa.52, 105-109 (2018).
UKim, P.-t., uLee, H.-J., Kim, T.-g. & Jeon, i.h. Ukwelashwa kwamanje kweTarpal Tunnel Syndrome.clicical.orthopedics.Surgery Journal.6, 253 (2014).
I-logli, al, Bear, BJ, Schwartz, isib, i-korcek, i-KJ & Foster, i-BJ Ukuqulwa kwezilingo okungahleliwe kwama-splan ture.j. Ukuhlinzwa ngesandla.43 (775), e1-775.e8 (2018).
Isikhathi sePosi: Jun-07-2022