中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (09): 625-628.doi: 10.3969/j.issn.1671-4091.2014.09.004

• 临床研究 • 上一篇    下一篇

透析相关淀粉样变致腕管综合征外科治疗20例疗效分析

杨雨润1,张凌2,林朋1,陈瀛1,刘成刚1   

  1. 1. 中日友好医院 创伤骨科
    2. 卫生部中日友好医院肾内科
  • 收稿日期:2014-05-08 修回日期:2014-07-28 出版日期:2014-09-12 发布日期:2014-09-02
  • 通讯作者: 刘成刚 lcgzryy@126.com 张凌 zhangling5@medmail.com.cn E-mail:lcgzryy@126.com

Surgical treatment of carpal tunnel syndrome due to dialysis-related amyloidosis: clinical analysis of 20 cases

  • Received:2014-05-08 Revised:2014-07-28 Online:2014-09-12 Published:2014-09-02

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摘要： 目的总结透析相关的β2微球蛋白淀粉样变，导致腕管综合征(Carpal tunnel syndrome, CTS)的临床特点，评估腕管松解术疗效。方法回顾性调查中日友好医院从2010 年3 月～2014 年3 月完成的透析相关腕管综合征患者20 例，所有患者均行腕管松解术。患者男11 例、女9 例，年龄58.45±8.95(46～75)岁，血液透析时间18.05±2.60(14～23)年。其中表现为单侧症状为主的4 例(左腕2 例，右腕2 例)，双侧症状16 例；肌电图示平均神经传导速度为18.1±3.2m/s，平均潜伏期为5.1±1.2m/s。麻醉方式：局麻、臂丛麻醉18 例，全麻2 例。结果术后随访20 例术后症状改善或消失，未见症状复发，手指功能逐渐恢复。肌电图提示神经传导速度及动作电位波幅逐渐恢复。所有患者BCTQ 评分较术前降低。其中症状评分术前为3.67±0.19、术后为2.42±0.14(t=19.112, P＜0.01)；功能评分术前为3.5± 0.26、术后为2.48±0.18(t=12.329, P＜0.01)。结论随着长透析龄患者增多，透析相关CTS 也逐渐高发。外科腕管松解术是晚期CTS的有效治疗措施，可以明显改善患者手腕症状，促进手功能恢复。

关键词: 透析, 腕管综合征, 淀粉样变, 治疗结果

Abstract: Objective To study the clinical features of carpal tunnel syndrome (CTS) caused by dialysis-related β2 microglobulin amyloidosis, and to evaluate the effectiveness of surgical treatment. Methods A total of 20 cases (male 11 cases, female 9 cases) subjected to operation due to carpal tunnel syndrome during the period from March 2010 to March 2014 were retrospectively studied. They were 58.45±8.95 (46 to 75) years old with the dialysis duration of 18.05±2.60 (14 to 23) years. CTS affected both hands in 16 patients, left hand in 2 patients, and right hand in 2 patients. The mean nerve conduction velocity was 18.1±3.2 m/s and the mean latency was 5.1±1.2 m/s. Operation was done under local axillary nerve block (n=18) or general anesthesia (n= 2). Results Symptoms and strength improved after the surgery in all patients. Nerve conduction velocity recovered gradually. BCTQ score became lower than that before surgery in all patients. Conclusion With the increase of dialysis patients, the incidence of dialysis-related CTS increases. Carpal tunnel release surgery is the effective measure for the treatment of CTS.

Key words: dialysis, carpal tunnel syndrome, amyloidosis, treatment outcome