复发性腕管综合征——
临床评估和翻修适应证
河北医科大学第三医院 王 立
2021-08 西安
什么是复发性腕管综合征？
Persistent Symptoms
三组不同症状
Recurrent Symptoms
New Symptoms
Persistent Symptoms
incidence: 7%-10% , and 43% of patients who underwent revision CTR
Three primary reasons:
Tung TH, Mackinnon SE: Secondary carpal tunnel surgery. Plast Reconstr Surg 2001; 107:1830-1933; quiz
1844,1933
Jones NF, Ahn HC, Eo S: Revision surgery for persistent and recurrent carpal tunnel syndrome and
for failed carpal tunnel release. Plast Reconstr Surg 2012;129: 683-692.
Tung TH, Mackinnon SE: Secondary carpal tunnel surgery. Plast Reconstr Surg 2001; 107:1830-1933;
quiz 1844,1933
Keese GR, Wongworawat MD, Frykman G: The clinical significance of the palmaris longus tendon in
the pathophysiology of carpal tunnel syndrome. J Hand Surg 2006; 31:657-660.
Dailiana ZH, Bougioukli S, Varitimidis S, et al: Tumors and tumor-like lesions mimicking carpal tunnel
syndrome. Arch Orthop Trauma Surg 2014;134:139-144.
Cagle PJ Jr, Reams M, Agel J, Bohn D: An outcomes protocol for carpal tunnel release: A comparison
of outcomes in patients with and without medical comorbidities. J Hand Surg 2014;39:2175-2180.
Cagle PJ Jr, Reams M, Agel J, Bohn D: An outcomes protocol for carpal tunnel release: A comparison
of outcomes in patients with and without medical comorbidities. J Hand Surg 2014;39:2175-2180.
Recurrent Symptoms
incidence: 4%-57%
6-month symptom-free interval postoperatively, with new EMG
confirming median nerve compression at the wrist.
correct diagnosis and adequate decompression at the initial surgery
Louie D, Earp B, Blazar P: Long-term outcomes of carpal tunnel release: A critical review of the literature.
Hand (N Y) 2012;7: 242-246.
Zieske L, Ebersole GC, Davidge K, Fox I, Mackinnon SE: Revision carpal tunnel surgery: A 10-year review
of intraoperative findings and outcomes. J Hand Surg Am 2013;38:1530-1539.
Recurrent Symptoms
Potential etiologies:
Tung TH, Mackinnon SE: Secondary carpal tunnel surgery. Plast Reconstr Surg 2001; 107:1830-1933; quiz
1844,1933
Mosier BA, Hughes TB: Recurrent carpal tunnel syndrome. Hand Clin 2013;29: 427-434.
New Symptoms
医源性损伤 15%-67% ：神经主干损伤 42%
掌皮支损伤 32%
鱼际返支损伤 33%
可发生在：手术部位、麻醉部位
手术后或麻醉退散后即可出现的：严重的、持续性的灼性痛、
刺痛；大鱼际肌的功能障碍
Jones NF, Ahn HC, Eo S: Revision surgery for persistent and recurrent carpal tunnel syndrome and for
failed carpal tunnel release. Plast Reconstr Surg 2012;129: 683-692.
Stutz N, Gohritz A, van Schoonhoven J, Lanz U: Revision surgery after carpal tunnel release–analysis of
the pathology in 200 cases during a 2 year period. J Hand Surg 2006;31:68-71.
详细的病史
全面的查体
必要的辅助检查
病史：
查体：
辅助检查：
保守治疗：没有明显神经功能损恶化、没有明显的医源性
损伤表现——支具、物理治疗、滑移训练6-9个月
手术治疗：
Jones NF, Ahn HC, Eo S: Revision surgery for persistent and recurrent carpal tunnel syndrome and for
failed carpal tunnel release. Plast Reconstr Surg 2012;129: 683-692.
Jones NF, Ahn HC, Eo S: Revision surgery for persistent and recurrent carpal tunnel syndrome and for
failed carpal tunnel release. Plast Reconstr Surg 2012;129: 683-692.
Jones NF, Ahn HC, Eo S: Revision surgery for persistent and recurrent carpal tunnel syndrome and for
failed carpal tunnel release. Plast Reconstr Surg 2012;129: 683-692.
Stutz N, Gohritz A, van Schoonhoven J, Lanz U: Revision surgery after carpal tunnel release–analysis of
the pathology in 200 cases during a 2 year period. J Hand Surg 2006;31:68-71.
Stutz N, Gohritz A, van Schoonhoven J, Lanz U: Revision surgery after carpal tunnel release–analysis of
the pathology in 200 cases during a 2 year period. J Hand Surg 2006;31:68-71.
Jones NF, Ahn HC, Eo S: Revision surgery for persistent and recurrent carpal tunnel syndrome and for
failed carpal tunnel release. Plast Reconstr Surg 2012;129: 683-692.
Stutz N, Gohritz A, van Schoonhoven J, Lanz U: Revision surgery after carpal tunnel release–analysis of
the pathology in 200 cases during a 2 year period. J Hand Surg 2006;31:68-71.
41%-90%患者仍有遗留不同程度的症状
年龄、性别、优势手、职业、吸烟史....均无明显相关性
神经的严重的纤维粘连、滑膜增生、淀粉样变....预后差
重建神经周围的软组织覆盖，优于单纯的神经松解
Soltani AM, Allan BJ, Best MJ, et al: A systematic review of the literature on the outcomes of treatment for
recurrent and persistent carpal tunnel syndrome. Plast Reconstr Surg 2013;132: 114-121..
Mosier BA, Hughes TB: Recurrent carpal tunnel syndrome. Hand Clin 2013;29: 427-434.
Sayegh ET, Strauch RJ: Open versus endoscopic carpal tunnel release: A metaanalysis of randomized
controlled trials. Clin Orthop Relat Res 2015;473: 1120-1132.