Objective: To evaluate the clinical efficacy of ultrasound-guided needle knife release with different pathways for carpal tunnel syndrome (CTS).
Methods: Sixty CTS patients were randomly divided into a transverse group and a longitudinal group, with 30 patients in each group. The transverse group received the needle knife release under ultrasound above and below the median nerve along the short axis, while the longitudinal group received the needle knife release under ultrasound above the median nerve along the long axis. The patients' visual analogue scale (VAS) scores, Levine scores, and median nerve cross-section area (CSA) were assessed before treatment, on the 7th, 14th, and 30th days after treatment. The median nerve conduction indexes (motor conduction: latency [Lat], amplitude[Amp], motor conduction velocity [MCV]; sensory conduction: Lat, Amp, sensory conduction velocity [SCV]) were evaluated before treatment and on the 30th day after treatment.
Results: Compared before treatment, the VAS scores, Levine scores, and median nerve CSA were reduced in both groups on the 7th, 14th, and 30th days after treatment (P<0.05); the transverse group showed lower VAS and Levine scores and smaller CSA than those in the longitudinal group (P<0.05). On the 30th day after treatment, motor and sensory Lat was reduced (P<0.05), motor and sensory Amp was increased (P<0.05), and MCV and SCV were faster (P<0.05) in both groups. The transverse group had shorter Lat, higher Amp, and faster MCV and SCV than those in the longitudinal group (P<0.05).
Conclusion: The ultrasound-guided needle knife release with transverse and longitudinal pathways could both effectively alleviate pain and improve median nerve conduction in CTS patients, with the transverse pathway showing superior efficacy to longitudinal pathway.
目的：评估超声引导不同路径下的针刀松解术治疗腕管综合征的临床疗效。方法：将60例腕管综合征患者随机分成横向组和纵向组，每组30例。横向组于超声引导下沿正中神经短轴上下方进行针刀松解；纵向组于超声引导下沿正中神经长轴上方进行针刀松解。观察两组患者治疗前、治疗后第7天、治疗后第14天、治疗后第30天疼痛视觉模拟量表（VAS）评分、Levine评分、受压处正中神经横截面积（CSA），于治疗前及治疗后第30天检测两组患者正中神经传导[运动传导：潜伏期（Lat）、波幅（Amp）、运动传导速度（MCV），感觉传导：Lat、Amp、感觉传导速度（SCV）]。结果：治疗后第7、14、30天，两组患者VAS评分、Levine评分均较治疗前降低（P<0.05），受压处正中神经CSA较治疗前缩小（P<0.05）；横向组VAS评分、Levine 评分低于纵向组 （P<0.05），受压处正中神经CSA小于纵向组（P<0.05）。治疗后第30天，两组患者运动及感觉传导Lat较治疗前缩短（P<0.05），运动及感觉传导Amp较治疗前升高（P<0.05），MCV、SCV较治疗前加快（P<0.05）；横向组Lat短于纵向组（P<0.05），Amp高于纵向组（P<0.05），MCV、SCV快于纵向组（P<0.05）。结论：超声引导横向及纵向路径下的针刀松解术均能缓解腕管综合征患者的疼痛症状，改善正中神经传导功能，横向路径疗效优于纵向路径。.
Keywords: carpal tunnel syndrome; different pathways; needle knife release; randomized controlled trial (RCT); ultrasound guidance.