RESULTS OF SURGICAL TREATMENT OF CARPAL TUNNEL SYNDROME USING TWO VARIATIONS OF OPEN TECHNIQUE

ABSTRACT Transverse carpal ligament (TCL) opening is the treatment of choice for carpal tunnel syndrome. However, complications such as loss of grip strength and anterior displacement of the median nerve are described as common complications associated with this technique. Thus, techniques that reconstruct or extend TCL are described to reduce the incidence of these complications. Objective: To evaluate the effectiveness of TCL enlargement through Z-plasty and the reduction of complications by comparing it with the complete opening of the ligament. Materials and Methods: A prospective and randomized intervention study was conducted in 56 patients. They were divided into 2 groups: 1) complete opening of TCL 2) TCL enlargement via Z-plasty. We evaluated grip strength, sensitivity, and functional evaluation using the QuickDASH questionnaire. Results: There was no statistically significant difference in the improvement of scores with QuickDASH between the two techniques. The sensitivity test was better in patients subjected to TCL enlargement, whereas grip strength increased in the group subjected to complete TCL opening. Conclusion: According to the results of this study, the complete opening of the TCL showed no reduction in grip strength, although it showed inferior recovery to postoperative sensitivity. Both techniques were equivalent in functional improvement. Thus, Z-plasty showed no identifiable benefits for TCL enlargement. Level of Evidence III, Randomized Clinical Trial.

摘要：腕横韧带（Transverse carpal ligament, TCL）切开术是腕管综合征的首选治疗方案。然而，该术式相关常见并发症包括握力下降及正中神经前移位。为此，现有研究提出了重建或延长腕横韧带的术式，以降低此类并发症的发生率。
研究目的：对比Z成形术（Z-plasty）扩大腕横韧带术式与韧带完全切开术式的有效性，并评估二者的并发症发生情况。
材料与方法：本研究纳入56例患者，采用前瞻性随机对照干预研究设计，将其分为两组：1）腕横韧带完全切开组；2）Z成形术扩大腕横韧带组。本研究通过握力测试、感觉功能测试以及QuickDASH问卷对患者进行功能评估。
结果：两组患者的QuickDASH评分改善情况无统计学显著差异。接受腕横韧带扩大术的患者感觉功能测试结果更优，而完全切开腕横韧带组患者的握力提升更为显著。
结论：基于本研究结果，完全切开腕横韧带并未出现握力下降的情况，但其术后感觉功能恢复效果劣于扩大术组。两种术式在功能改善方面效果相当，Z成形术用于腕横韧带扩大术未展现出明确获益。
证据等级：Ⅲ级，随机临床试验。