臨床整形外科51巻10号

2016年10月発行

臨床経験

手根管症候群電気生理学的重症度の治療法選択における役割

著者： 金谷貴子¹ 名倉一成¹ 鷲見正敏¹ 国分毅² 黒坂昌弘²

所属機関： ¹神戸労災病院整形外科 ²神戸大学大学院医学研究科整形外科学

ページ範囲：P.971 - P.975

背景：手根管症候群(CTS)における電気生理学的重症度の役割を調査した．

対象と方法：外来でCTSと診断された1,082手の重症度(Stage 1〜5)の分布状態と，各Stageでの手術/非手術選択率を検討した．

結果：最多はStage 4(34％)で，Stage 1→5と重症度に並行して手術選択率が増加し，Stage 5で有意に高かった(p＜0.0001)．

まとめ：電気生理学的重症度評価は治療法選択の目安になりうる．

参考文献

1) Aulisa L, Tamburrelli F, Padua R, et al. Carpal tunnel syndrome:Indication for surgical treatment based on electrophysiological study. J Hand Surg Am 1998;23:687-91.

2) Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000;23:1280-3.

3) Choi SJ, Ahn DS. Correlation of clinical history and electrodiagnostic abnormalities with outcome after surgery for carpal tunnel syndrome. Plastic Reconstr Surg 1998;102:2374-80.

4) 金谷貴子，藤岡宏幸，山崎京子・他．手根管症候群における短母指外転筋終末潜時と感覚神経伝導速度の関係について．末梢神経2006；17：280-2．

5) 金谷貴子，藤岡宏幸，黒坂昌弘・他．手根管開放術後における電気生理学的回復および臨床症状改善との関連について．臨整外2011；46：637-41．

6) Kanatani T, Fujioka H, Kurosaka M, et al. Delayed electrophysiological recovery after carpal tunnel release for advanced carpal tunnel syndrome:a two year follow-up study. J Clin Neurophysiol 2013;30:95-7.

7) Kanatani T, Nagura I, Kurosaka M, et al. Electrophysiological assessment of carpal tunnel syndrome in elderly patients:one year follow-up study. J Hand Surg Am 2014;39:2188-91.

8) Norlan WB III, Alkitis D, Grickel SZ, et al. Results of treatment of severe carpal tunnel syndrome. J Hand Surg Am 1992;17:1020-3.

9) Padua L, LoMonaco M, Aulisa L, et al. Surgical prognosis in carpal tunnel syndrome:usefulness of a preoperative neurophysiological assessment. Acta Neurol Scand 1996;94:343-6.

10) Fajardo M, Kim SH, Szabo RM. Incidence of carpal tunnel release:Trends and implications within the United States ambulatory. J Hand Surg Am 2012;37:1599-1605.

11) American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome:summary statement. Muscle Nerve 2002;25:918-22.

12) American Academy of Orthopedic Surgeons. Clinical Practice Guideline on the Treatment of Carpal Tunnel Syndrome. Rosemont, IL:American Academy of Orthopedic Surgeons;2008.

13) Maggard MA, Harness NG, Chang WT, et al. Indications for performing carpal tunnel surgery:Clinical quality measures. Plast Reconstr Surg 2010;126:169-79.

14) Bickel KD. Carpal tunnel syndrome. J Hand Surg Am 2010;35:147-52.

15) Lane LB, Strarecki M, Olson A, et al. Carpal tunnel syndrome diagnosis and treatment:A survey of members of the American Society For Surgery of the Hand. J Hand Surg Am 2014;39:2181-7.

16) Munns JJ, Awan HM. Trends in carpal tunnel surgery:An online survey of members of the American Society For Surgery of the hand. J Hand Surg Am 2015;40:767-71.

17) Bessete L, Keller RB, Liang MH, et al. Patients' preferences and their relationship with satisfaction following carpal tunnel release. J Hand Surg Am 1997;22:613-20.

18) Jerosch-Herold C, Mason R, Chojnowski AJ. A qualitative study of the experiences and expectations of surgery in patients with carpal tunnel syndrome. J Hand Ther 2008;21:54-62.

19) Hageman MGJS, Kinaci A, Ju K, et al. Carpal tunnel syndrome:Assesment of surgeon and patient preferences and priorities for decision-making. J Hand Surg Am 2014;39:1799-1804.

20) Baker NA, Livengood HM. Symptom severity and conservative treatment for carpal tunnel syndrome in association with eventual carpal tunnel release. J Hand Surg Am 2014;39:1792-8.

21) Bland JD. Do nerve conduction studies predict the outcome of carpal tunnel decompression? Muscle Nerve 2001;24:935-40.

22) Chan L, Turner JA, Comstock BA, et al. The relationship between electrodiagnostic findings and patient symptom and function in carpal tunnel syndrome. Arch Phys Med Rehabil 2007;88:19-24.

23) Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am 2008;90:2587-93.

24) English JHJ, Gwynne-Jones DP. Incidence of carpal tunnel syndrome requiring surgical decompression:A 10.5-Year review of 2039 patients. J Hand Surg Am 2015;40:2427-34.