中国组织工程研究 第20卷 第33期 2016–08–12出版Chinese Journal of Tissue Engineering Research August 12, 2016 Vol.20, No.33·循证医学·www.CRTER .org白杰，男，1982年出，陕西省子长县人，汉族，西安交通大学医学院在职硕士，主治医师，主要从事骨科临床研究。
通讯作者：许玉本，主任医师，西安市红会医院手外二科，陕西省西安市 710054中图分类号:R318 文献标识码:B 文章编号:2095-4344 (2016)33-05009-08 稿件接受：2016-06-14腕管综合征神经卡压：内镜下腕管松解与有限小切口松解的效果及 安全性评价白 杰，许玉本，夏 雷，周海振(西安市红会医院手外二科，陕西省西安市 710054)引用本文：白杰，许玉本，夏雷，周海振. 腕管综合征神经卡压：内镜下腕管松解与有限小切口松解的效果及安全性评价[J].中国组织工程研究，2016，20(33):5009-5016.DOI: 10.3969/j.issn.2095-4344.2016.33.020 ORCID: 0000-0002-4534-956X(许玉本)文章快速阅读：文题释义：内镜下腕管松解减压：1987 年，Okutsu 等首次采用内镜下腕管松开减压术，可分两大类：单切口技术和双切口技术。
内镜下腕管松开减压术的优势在于腕横韧带在腕管内被横断，且正中神经的覆盖组织得以保留，这能降低术后复发率，加快术后恢复。
其优点主要是可以缩短术后手部功能障碍的时间，减少术后疼痛及无力的症状，使患者早期自理生活和恢复工作，节省经济费用。
小切口管切开松解：自1991年以来，许多术者通过使用开放式小切口技术(2.0-3.0 cm)。
小切口行腕管松解减压术的疗效确切、切口小、组织创伤小、术后瘢痕小、手术耗时少、康复期短、少有瘢痕增生及疼痛，并可根据需要延长切口，虽然显露不充分，操作不便。
摘要背景：研究已经证实，相比腕管切开减压，内镜下腕管松解减压在术后恢复工作时间、手握力、手捏力、住院时间以及术后瘢痕组织发生率方面有一定的优势。
目的：系统评价内镜下腕管切开减压与小切口开放腕管切开减压治疗腕管综合征的临床疗效和安全性。
方法：计算机检索PubMed 、the Cochrane Library 、EMbase 、Web of Science 、CNKI 、维普和万方数据库，纳入对比内镜下腕管松解减压术与改良小切口管切开松解术治疗腕管综合征的相关随机对照试验，检索时间截止2005年11月1日。
由2位作者独立筛选文献、提取资料以及对纳入研究的质量进行偏倚风险评价。
统计分析采用RevMan 5.3软件。
结果与结论：共纳入11个RCT(706例患者)。
分析结果显示，①相比改良小切口管切开松解，内镜下腕管松解减压能缩短住院时间(P < 0.05)、提高术后症状缓解率(P =0.16)，减少返回工作时间(P < 0.05)和降低术后总并发症(P < 0.05)；②在手握力值和手捏力值方面，两组之间的差异无显著性意义。
③结果说明，与小切口腕管切开减压相比，内镜下腕管松解减压在住院时间、返回工作时间、术后症状缓解率方面有一定的优势，且有更低的术后并发症发生率，但仍需要大样本、高质量的随机对照试验来验证此次分析结果。
关键词：组织构建；组织工程；腕管综合征；腕管切开减压；内镜下；小切口主题词：腕管综合征；减压术，外科；组织工程Bai Jie, Studying for master’s degree, Attending physician, Second Department of Hand Surgery, Honghui Hospital of Xi’an, Xi’an 710054, Shaanxi Province, ChinaCorresponding author: Xu Yu-ben, Chief physician, Second Department of Hand Surgery, Honghui Hospital of Xi’an, Xi’an 710054, Shaanxi Province, ChinaThe clinical efficacy and safety of endoscopic release versus mini-open release for carpal tunnel syndromeBai Jie, Xu Yu-ben, Xia Lei, Zhou Hai-zhen (Second Department of Hand Surgery, Honghui Hospital of Xi’an, Xi’an 710054, Shaanxi Province, China)AbstractBACKGROUND: Existing evidence has shown endoscopic carpal tunnel release is superior to the open release in postoperative recovery time, grip and pinch strength, hospitalization time as well as incidence of postoperative scar tissues.OBJECTIVE: To systematically review the efficacy and safety of endoscopic release versus mini-open release for carpal tunnel syndrome.METHODS: A computer-based search of PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, CqVip and Wanfang databases was performed. Randomized controlled trials comparing endoscopic release with mini-open release for patients with carpal tunnel syndrome were included, and the publishing time was up to November 1st , 2015. Two authors independently screened, extracted data and assessed the risk of bias of the included literatures. Then statistical analysis was conducted using RevMan 5.3 software.RESULTS AND CONCLUSION: A total of 11 randomized controlled trials involving 706 patients were included. The results of Meta-analysis demonstrated that: compared with mini-open release, endoscopic release could not only significanthy decrease the hospitalization time postoperative recovery time andcomplications (P < 0.05), but also achieve better symptom relief (P =0.16). However, there were no significant differences in grip and pinch strength between the two treatments. These results suggest that compared with the mini-open release, the endoscopic release contributes to shorter hospitalization time and postoperative recovery time, better symptom relief and lower risk of complications. But large-sample and high-quality randomized controlled trials are needed to provide more reliable evidence for these findings. Subject headings: Carpal Tunnel Syndrome; Depression, Surgical; Tissue EngineeringCite this article: Bai J, Xu YB, Xia L, Zhou HZ. The clinical efficacy and safety of endoscopic release versus mini-open release for carpal tunnel syndrome. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(33):5009-5016.0 引言 Introduction腕管综合征是最常见的周围神经卡压性疾病，是指正中神经在腕管内受到压迫所引起的一组临床症状和体征[1]。
腕管综合征主要临床表现为正中神经分布区域指麻木、疼痛，感觉异常等，夜间症状尤甚。
腕管综合征的发病率为88-125/10万，尤以中年女性多见[2]。
近年来，随着电脑办公等生活方式的改变，发病率有升高的趋势。
轻中度腕管综合征的治疗方式主要以保守为主，包括休息、支具固定、封闭注射、非类固醇类抗炎药、超声疗法等；而对于严重以及保守治疗无效的患者，主张采用手术治疗[3]。
腕管综合征手术目的主要是将腕横韧带切断，增加腕部容积，减轻正中神经卡压症状[4]。
目前腕管综合征主要的手术方式包括腕管切开减压(open carpal tunnel release ，OCTR)和内镜下腕管松解减压(endoscopic carpal tunnel release ，ECTR)，其中腕管切开减压又分为传统腕管切开松解术 (traditional open carpal tunnel release ，TOCTR)和改良小切口管切开松解术(mini-open carpal tunnelrelease ，MOCTR)。