背景:高尿酸血症可导致腕关节滑膜增生。在严重的情况下,它可以导致痛风石沉积在腕管中,导致腕管压力增加和正中神经受压,导致腕管综合征(CTS),这被称为痛风性腕管综合征(GCTS)。至于痛风性腕管综合征的外科治疗,对于是否需要切除屈浅腱,学者们有不同的看法。目的比较修剪和切除病变浅屈肌腱治疗痛风性腕管综合征的临床疗效。
方法:从2016年5月至2021年7月收集了10例诊断为痛风性腕管综合征的患者(13例受影响的腕关节)的临床数据,并根据手术方式分为两组:痛风侵蚀的浅表指腱的患病部分在9个腕部进行了修剪,4只手腕切除患病的浅表指屈肌腱。与屈曲和伸展功能相关的值,2-PD,DASH,BCTQ,比较两组患者手术前后的VAS评分及患指复发情况。
结果:所有患肢都清除了痛风性结石,手指麻木改善,没有发生皮肤坏死,所有切口均在I期愈合,随访(13.58±5.53个月),屈伸功能组间无显著差异,2-PD,DASH,BCTQ,和VAS相对于受影响的手指,两组患者手术前后均有明显改善。仅一个腕关节的治疗包括修剪以去除肌腱的病变部位,手术后1年再次出现,并且在两种手术中都有一例从较大的梨状肌萎缩中恢复不良。
结论:关于痛风性腕管综合征患者的手术治疗,其中痛风性结石已侵入手指的浅屈肌腱,可以选择性地切除患病的浅屈肌腱,并且受影响的手指的术后活动性可能不会受到损害。
BACKGROUND: Hyperuricemia can lead to synovial hyperplasia in the wrist. In severe cases, it can lead to the deposition of gouty stone in the carpal tunnel, resulting in increased pressure in the carpal tunnel and compression of the median nerve to cause carpal tunnel syndrome (CTS), which is called gouty carpal tunnel syndrome (GCTS). As for the surgical treatment of gouty carpal tunnel syndrome, scholars have different opinions on whether it is necessary to remove the superficial flexor tendon. The purpose of this study was to compare the clinical efficacy of
trimming and resection of the diseased superficial flexor tendon in the treatment of gouty carpal tunnel syndrome.
METHODS: Clinical data were collected from May 2016 to July 2021 from 10 patients (13 affected wrists) diagnosed with gouty carpal tunnel syndrome and classified into two groups according to the surgical modality: the diseased portion of the gout-eroded superficial finger tendon was trimmed in 9 wrists, and the diseased superficial finger flexor tendon was excised in 4 wrists. Values related to flexion and extension functions, 2-PD, DASH, BCTQ, VAS and recurrence in the affected fingers were compared between the two groups as well as before and after surgery in each group.
RESULTS: All affected limbs used were cleared of gouty stones, finger numbness improved, no skin necrosis occurred, and all incisions healed at stage I. At follow-up (13.58 ± 5.53 months), there was no significant difference between groups in flexion and extension function, 2-PD, DASH, BCTQ, and VAS with respect to the affected fingers, and patients in both groups improved significantly before and after surgery. Treatment of only one wrist involved
trimming to remove lesion-affected portions of tendon, which reappeared 1 year after surgery, and there was one case of poor recovery from greater piriformis muscle atrophy in both procedures.
CONCLUSIONS: Regarding surgical treatment of patients with gouty carpal tunnel syndrome in which the gouty stone has invaded the superficial flexor tendons of the fingers, the diseased superficial flexor tendons can be selectively excised, and the postoperative mobility of the affected fingers may not be impaired.