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痛风所构成的腕管归纳征的特色与医治办法

来历:吉林大学 作者:胡时源
发布于:2021-04-27 共5202字

  中文摘要
  
  痛品格腕管归纳征的诊治与作用剖析

 

  
  意图:

  
  评论痛风所构成的腕管归纳征的发病特色及诊治。
  
  材料与办法:
  
  研讨2013年7月至2019年12月间吉林大学榜首医院和二部手足外科收治的痛风石致腕管和(或)肘管归纳征病例,共19例,其间腕管归纳征19例,左边8例,右侧11例,其间1例患者为左腕管归纳征并右肘管归纳征。一切患者均为男性,年纪38岁至68岁,均匀55.1±9.2岁。腕管归纳征病程1个月至60个月,均匀11.3±14.3个月,肘管归纳征病程15天。一切患者均有多年痛风病史,3年至20年,均匀10.6±5.5年,身体可见大小不等痛风石结节拱起。术前血尿酸浓度均偏高,6例患者术前行部分彩超查看,均提示痛风石病灶。查体18侧体现桡侧3个半手指麻痹和感觉减退,1侧为中环指。大鱼际外观无萎缩12侧,萎缩7侧。



痛风所构成的腕管归纳征的特色与医治办法
 

  
  6侧兼并手指屈伸妨碍,14侧手腕部掌侧丰满拱起,3例患者入院时处于急性关节炎期,腕部红、肿、热、痛。
  
  1例肘管归纳征有环指尺侧半及小指麻痹,肘部可见皮肤拱起,无爪形手变形。腕管归纳征患者腕部正中神经Tinel征均(+),肘管归纳征患者尺神经Tinel征(+)。肌电图查看证明了正中神经或尺神经损害。依据顾玉东腕肘管归纳征临床分型,腕管归纳征患者中度11例,重度8例,肘管归纳征患者1例为中度。腕管归纳征患者均选用OCTR术式,肘管归纳征尺神经行前置手术,并针对痛流行归纳医治。
  
  成果:
  
  腕管归纳征患者19例,肘管归纳征1例,悉数经过门诊、电话随访,未见复发,随访6个月~81个月,均匀28个月。患者中度11例,重度8例。术后依据上肢周围神经功用规范[1]
  
  鉴定:优8例(中度6例,重度2例);良8例(中度5例,重度3例);可2例(中度0例,重度2例);差1例(中度0例,重度1例),总优良率84.2%。肘管归纳征患者为中度,术后参照上肢功用尺神经鉴定规范为优。我院2017年计算非痛风所构成的的腕管归纳征患者术后优良率为78.0%。使用 SPSS 23.0 软件,依据病因是否为痛风将两组数据优良率进行费希尔精确查验,P 值大于 0.05,无计算学研讨含义。
  
  定论:
  
  1、痛风所构成的的腕管归纳征患者中,男性更常见,且多有痛风病史。
  
  2、腕管和肘管均为受限的狭隘空间,单钠尿酸盐堆积易引起神经损害,但直接堆积于神经外膜内而构成神经损害者罕见。
  
  3、痛风所构成的的腕管归纳征或肘管归纳征均应前期手术医治,腕管归纳征首选 OCTR 术式,肘管归纳征首选尺神经松解前置术,此类患者术后预后较好。
  
  要害词:   痛风,腕管归纳征 。
  

  Abstract
  
  Diagnosis, treatment and efficacy analysis of carpal tunnel syndrome caused by gout

 

  
  Objective:

  
  To investigate the characteristics, diagnosis and treatment of carpal tunnel syndrome caused by gout.
  
  Materials and Methods:
  
  A retrospective analysis of 19 cases of gout-induced carpal tunnel and/or cubital tunnel syndrome in hand and foot surgery of the First Hospital and Branch of Jilin University from July 2013 to December 2019, including 19 carpal tunnel syndrome There were 8 cases on the left side, 11 cases on the right side, and 1 case on the right cubital tunnel syndrome, of which 1 case was left carpal tunnel syndrome and right cubital tunnel syndrome. All patients were male, aged 38 to 68 years, with an average of 55.1±9.2 years. The duration of carpal tunnel syndrome is 1 month to 60 months, with an average of 11.3±14.3 months, and the duration of cubital tunnel syndrome is 15 days. All patients had a history of gout for many years, ranging from 3 years to 20 years, with an average of 10.6±5.5 years. There were gout nodules of different sizes in other parts of the body. The blood uric acid concentration was high before operation, and 6 patients had undergone local color Doppler ultrasound examination before operation, and all showed gout stone lesions. The 18 sides of the carpal tunnel syndrome showed numbness and sensation of three and a half fingers on the radial side, and the middle ring finger on one side. There were 12 sides with normal fish and 7 sides with atrophy.
  
  Six patients with carpal tunnel syndrome were complicated with flexion and extension of the fingers, and the palms of the 14 wrists were full and bulged. Three patients werein acute arthritis when they were admitted to the hospital. The wrists were red, swollen, hot and painful. One case of cubital tunnel syndrome had numbness of the ulnar half ofthe ring finger and little finger, skin bulge was seen on the elbow, and there was no claw-shaped hand deformity. Tinel sign (+) of the median nerve of the wrist in patientswith  carpal  tunnel  syndrome  and  ulnar  nerve  (+)  in  the  patients  of  cubital  tunnel syndrome.  EMG  examination  confirmed  the  median  nerve  or  ulnar  nerve  injury.
  
  According to Gu Yudong’s clinical classification and treatment of carpal tunnel and cubital tunnel syndrome, there were 11 cases with moderate carpal tunnel syndrome, 8 cases  with  severe  carpal  tunnel  syndrome  and  1  case  with  moderate  cubital  tunnel syndrome.  Patients  with  carpal  tunnel  syndrome  were  treated  with  OCTR,  cubital tunnel syndrome with ulnar nerve preoperative surgery, and comprehensive treatment for gout.
  
  Results:
  
  There were 19 cases of carpal  tunnel syndrome  and 1 case of cubital  tunnel syndrome. All  patients  were  followed  up  by  outpatient,  telephone  or  We Chat.  No patients relapsed. The follow-up time was 6 months to 81 months, with an average of 28 months. Carpal tunnel syndrome was moderate in 11 cases and severe in 8 cases. According to the trial standard of upper limb peripheral nerve function evaluation of the Chinese Medical Association Hand Surgery Society  [1] (Table 18): 8 cases were excellent (moderate 6 cases, severe 2 cases); 8 cases were good (moderate 5 cases, severe 3 cases) ; 2 cases (moderate 0 cases, severe 2 cases); poor 1 case (moderate 0 cases, severe 1 case), the total excellent and good rate was 84.2%. Patients with cubital tunnel syndrome were moderately graded preoperatively, and evaluated postoperatively according to the upper limb function ulnar nerve evaluation standard (Table 15) of the Hand Surgery Society of the Chinese Medical Association. In 2017, the postoperative excellent and good rate of patients with carpal tunnel syndrome who were not the cause of gout was 78.0%. Using SPSS 24.0 software, chi-square test was performed based on whether the cause was gout. The P value was 0.78, which was greater than 0.05, which was not statistically significant.
  
  Conclusion:
  
  1. Among the patients with carpal tunnel syndrome caused by gout, men are more common and have a history of gout.
  
  2. The carpal tunnel and the elbow canal are restricted spaces. Monosodium urate deposition  is  easy  to  cause  nerve  damage,  but  it  is  rare  to  deposit  directly  in  the adventitia and cause nerve damage.
  
  3. Carpal tunnel syndrome or cubital tunnel syndrome caused by gout should be treated with early surgery. Carpal tunnel syndrome is the first choice for OCTR, and cubital tunnel syndrome is the first choice for ulnar nerve lysis. The prognosis is good for these patients.
  
  Key words:     Gout, carpal tunnel syndrome。
  

  第1章  序言

  
  嘌呤代谢紊乱和(或)尿酸排泄妨碍所构成的的痛风,是一种代谢性疾病。尿酸钠晶体能够在关节、肾脏和皮劣等部位堆积,引起急缓慢炎症和安排损害。不同国家患病率有差异,整体患病率 1%~5%[2],女人一般绝经后患病。腕管与肘管归纳征患病率越来越高,逐步成为常见病、多发病,这与社会老龄化降临及代谢性、遗传性疾病的添加有关[3]。周围神经损害患病率的榜首位是腕管归纳征,肘管归纳征第二,但痛风所构成的腕管归纳征或肘管归纳征不常见。因为腕、肘管的解剖特色,当痛风石产生于此处,易引起神经损害。临床关于痛风所构成的腕管与肘管归纳征研讨较少,知道尚有缺乏,或许导致该病确诊推迟或医治不行全面,终究导致患者康复差,留传功用妨碍,致使日子质量下降。正因如此,咱们回忆剖析了我院痛品格腕管和(或)肘管归纳征病例的材料和随访成果,评论其发病特色、确诊及医治办法,然后进步对该病的知道,合理医治。
  
  第2章  总述
  
  2.1、痛风的流行病学特色。

  
  20世纪70年代,痛风在中国大陆的陈述低于30例[4]。而到2000年,查询显现我国痛风患病率为0.9%,依据最新成果,总人口中13.3%为高尿酸血症患者,而痛风患病率在1%~3%[5]。高尿酸血症与痛风在不同人群与区域发病率不同,其种族差异较显着。痛风有年轻化趋势,对全人类的健康构成威胁。
  
  2.2、痛风的病因、发病机制和影响要素。
  
  原发性痛风是由两方面原因一起影响的成果,包含遗传要素和环境要素。咱们现在还不是彻底了解其精确病因和发病机制,但尿酸排泄妨碍是大多数患者的病因,具有必定的宗族易理性。曾经的研讨现已证明了痛风的产生与血尿酸水平有相关。内源性的嘌呤代谢是体内80%以上的尿酸来历,原发性血尿酸生成增多的主要原因之一是先天性酶的缺点;尿酸排泄妨碍所构成的的高尿酸血症主要是因为肾小管排泄的削减、重吸收增多和肾小球滤过削减[6]。尿酸盐阴离子交换器(URAT)基因突变以及尿酸盐转运子(HUAT)表达反常,也会引起尿酸滤过削减和重吸收的增多[7]。
  
  痛风构成的要害性生理指针是高尿酸血症[8]。性别、年纪、饮食、药物、宗族与遗传以及种族和地域是痛风构成的要害性影响要素。男性30岁今后显着添加,女人一般产生在绝经后。研讨标明,饮食中长期富含嘌呤或许是高尿酸的重要原因之一。酒精及其它高嘌呤食物的摄入量与痛风风险添加有关。呈现高尿酸血症的严重要素之一是利尿剂[9]。痛风是多基因遗传病,依据既往获取的数据,有人提出血尿酸盐浓度或许与基因的调控有关[2]。
  
  2.3、腕管、肘管的解剖学研讨。
  
  2.3.1、腕管的解剖构成。

  
  腕管从远侧腕横纹至其远端约3cm处,坐落腕前区[10],是一个空间受限的骨-纤维地道,腕骨组成两侧壁和底,屈肌支撑带构成顶。腕管内有正中神经、屈拇长肌腱和2-5指的浅深屈肌腱经过。正中神经方位相对表浅,坐落腕横韧带与指浅屈肌肌腱之间。桡侧滑膜囊和尺侧滑膜囊别离包裹屈拇长肌腱与其他肌腱。
  
  2.3.2、肘管的解剖构成。
  
  肘管是一个骨性-纤维管道,其空间受限,在尺骨鹰嘴两骨突之间与肱骨内上髁下方存在尺神经沟,纤维性筋膜鞘掩盖其上,二者之间便是肘管。肘管顶部为弓形韧带,从内上髁到鹰嘴;底部为内侧副韧带;后界为三头肌中心头;内上髁为前界;旁边面为尺骨鹰嘴;内容物为尺神经。
  

  【因为本篇文章为硕士龙8,如需全文请点击底部下载全文链接】

  
  2.4、腕管与肘管归纳征的病因
  2.4.1、腕管归纳征
  2.4.2、肘管归纳征
  2.5、确诊.
  2.5.1、临床体现
  2.5.2、印象学查看
  2.5.3、电生理查看
  2.5.4、临床分型
  2.6、治
  2.6.1、非手术医治
  2.6.2、腕管归纳征的手术医治
  2.6.3、肘管归纳征的手术医治
  
  第3章 材料与办法
  
  3.1、一般材料.
  3.1.1、病例来历
  3.1.2、基本状况
  3.2、术前分型
  3.3、手术医治及术前与术后处理.
  3.3.1、术前处理
  3.3.2、腕管归纳征的手术医治
  3.3.3、肘管归纳征的手术医治.
  3.3.4、术后处理
  3.4、计算学办法.
  
  第4章  成果.
  
  4.1、痛风石致腕管与肘管归纳征发病特色.
  4.1.1、性别特色
  4.1.2、腕管与肘管归纳征发病人数
  4.1.3、年纪散布特色.
  4.1.4、病程散布特色
  4.2、术后成果计算.
  4.3、术后作用计算学剖析.
  
  第5章  典型病例
  
  5.1、典型病例一
  5.2、典型病例
  
  第6章  评论
  
  6.1、痛品格腕管或肘管归纳征发病人群特色
  6.2、为什么痛风石会引起腕管或肘管归纳征
  6.3、痛品格腕管与肘管归纳征的确诊主张
  6.4、手术机遇的挑选.
  6.5、医治.
  6.5.1、痛品格腕管归纳征的术式挑选
  6.5.2、痛品格肘管归纳征的术式挑选
  6.6、痛品格腕管归纳征预后
  6.7 、缺乏与展望

  第7章   定论

  1、痛风所构成的的腕管归纳征患者中,男性更常见,且多有痛风病史。

  2、腕管和肘管均为受限的狭隘空间,单钠尿酸盐堆积易引起神经损害,但直接堆积于神经外膜内而构成神经损害者罕见。

  3、痛风所构成的的腕管归纳征或肘管归纳征均应前期手术医治,腕管归纳征首选 OCTR 术式,肘管归纳征首选尺神经松解前置术。此类患者术后预后较好。

  参阅文献.

作者单位:吉林大学
原文出处:胡时源. 痛品格腕管归纳征的诊治与作用剖析[D].吉林大学,2020.
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