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目的 探讨腕管内、外松解治疗腕部正中神经双卡征的疗效.方法 2011年4月-2014年5月,收治31例腕部正中神经双卡征患者.男8例,女23例;年龄33～69岁,平均56.4岁.手掌桡侧3个半指皮肤两点辨别觉7～14mm,平均9.5 mm;其中4～10 mm 24例,＞10 mm 7例.腕管正中神经Tinel征(+),正中神经返支手掌体表投影点处按压大鱼际肌有乏力、酸胀不适感.神经电生理检查:正中神经末梢运动潜伏期4.5 ～ 10 ms 22例,＞10 ms 9例;出现纤颤电位和正相电位6例;所有患者正中神经感觉传导速度减慢,运动传导速度减慢;运动神经波幅5～ 10 mV 19例,＜5 mV 12例.病程3～8个月,平均5.5个月.行腕管内正中神经及腕管外正中神经返支手术探查,尤其对正中神经返支存在的多种易卡压因素如拇短屈肌起点增厚腱弓、拇短屈肌浅头尺侧缘腱纤维束、掌腱膜深层纤维膜及变异的拇短屈肌浅头起点等给予彻底松解,解除卡压因素.结果 术后患者伤口均Ⅰ期愈合,未出现伤口瘢痕痛.31例患者均获随访,随访时间24～ 59个月,平均33个月.所有患者夜间麻痛症状消失,正中神经返支穿人大鱼际处酸胀感消失.28例手掌桡侧3个半指皮肤感觉恢复至S4,3例示、中指指尖感觉恢复至S3+;正中神经支配区皮肤两点辨别觉4～6mm,平均4.8 mm.拇指对掌功能恢复正常29例,轻度受限2例;31例握力均恢复,其中1例有明显增加.术前大鱼际肌萎缩者,术后肌力恢复至S54例,S42例.术后2年根据顾玉东推荐的腕管综合征功能评定标准评价,优29例,良2例,优良率100％.结论 腕管内、外松解治疗腕部正中神经双卡征时,正中神经返支存在较多易卡因素,应彻底松解,可提高临床疗效.“,”Objective To investigate the effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist.Methods Thirty-one patients of median nerve double entrapment at wrist were treated between April 2011 and May 2014.There were 8 males and 23 females with an age of 33-69 years (mean,56.4 years).In palm lateral three and a half finger,the two-point discrimination was 7-14 mm (mean,9.5 mm),in which 24 cases were 4-10 mm and 7 cases were more than 10 mm.Carpal tunnel median nerve Tinel sign was positive;there was weak and acid swollen felling when press big thenar muscle on median nerve return branch palm surface projection points.Electromyography examination showed that median nerve endings movement incubation period was 4.5-10 ms in 22 cases,more than 10 ms in 9 cases;fibrillation potentials and positive phase voltage happened in 6 cases;the median nerve sensory conduction velocity of all patients was slow,and the motor conduction velocity also slowed down;the motor amplitude was 5-10 mV in 19 cases,less than 5 mV in 12 cases.The disease duration was 3-8 months (mean,5.5 months).Surgical exploration of wrist median nerve in carpal tunnel and median nerve return branch outside carpal tunnel were performed in patients,especially completely released the variety entrapment factors such as thickening bow at starting point of short hallux flexor tendon,fiber bundles at ulnar side of short hallux flexor tendon,deep layer fiber of the palmar aponeurosis,and variant shallow head of short hallux flexor.Results All the wounds healed by first intention without wound scar pain.The patients were followed up 24-59 months (mean,33 months).Night numbness and pain disappeared,and weak and acid swollen feeling in big thenar muscle on median nerve return branch points also disappeared.The sensation recovered to S,in 28 patients in palm lateral three and a half finger,the index and middle fingertip sensation recovered to S3+ in 3 cases.In the median nerve innervation area,the two points discrimination was 4-6 mm (mean,4.8 mm).The thumb opposition function returned to normal in 29 cases and mild confinement in 2 cases.The grip strength of all the 31 cases recovered,and 1 of them increased significantly.In preoperative big thenar muscle atrophy cases,muscle strength recovered to S5 in 4 cases,S,in 2 cases.At 2 years after operation,according to the functional assessment of carpal tunnel syndrome recommend by GU Yudong,the results were excellent in 29 cases and good in 2 cases,with an excellent and good rate of 100％.Conclusion When treating the nerve double entrapment in wrist using wrist tube inside and outside releasing method,the variety entrapment factors of return branch of median nerve should be completely released,so the effectiveness can be improved.