Implantation Of Ramus Palmaris Superficialis Arteriae Radialis Into Median Nerve With Neurolysis Of Epineurium For Treatment Of Carpal Tunnel Sydrome

Objective: According to much clinical observation and animal experiment, it is discovered that grafted nerve implanted vascula can accelerate vascularization of nerve and it is easy to clear disintegrating axonal degeneration and myelin that can provides favorable conditions for nerve and axonal regeneration,grafted nerve implanted vascula is same to neural transplantation with vascula.neurolysis with vascula can protect blood supply of nerve and is helpful to improve the microcirculation and blood oxygen tension,it also obtained better clinical effects. Decompression of nerve with vascula implanted can early recover blood supply of nerve damaged by compression and neurolysis,so it can accelerate vascularization of nerve and regeneration of nerve . We observe and summarize clinical effect of implanting ramus palmaris superficialis arteriae radialis into median nerve with neurolysis of epineurium for treatment of carpal tunnel sydrome to provide clinical evidence for implantation of artery into nerve for nerve entrapment.Methods: From January 2009 to January 2010, 42 cases of carpal tunnel syndrome were treated by the method of decompression of median nerve.There were 10 males and 32 females with an average of 46 years (24-67years).The disease course was 1 month to 2 years (mean 6.5 months). The disease happened to left carpal tunnel :17 cases and right carpal tunnel :25 cases. 42 patients were divided into three groups (mild ,moderate , and severe) according to electromyogramic results: mild group 10 cases,moderate group 20 cases and severe 12 cases and every group was divided into experimental group and control group according to random pair. The way of operation of experimental group is implantation of ramus palmaris superficialis arteriae radialis into median nerve with neurolysis of epineurium and the way of operation of control group is neurolysis of epineurium.42 cases were tested by electromyogram again after 6 months and sensory nerve conduction velocity of the median nerve from thumb finger to wrist and were latency of CMAP in the median nerve were compared with preoperative.Result: All wounds healed by first intention and no operative complications and recurrences occurred.To compare preoperative with postoperative electromyogramic results, There was statistically significant difference in sensory nerve conduction velocity of the median nerve in 3 groups and in the latency of CMAP in the median nerve in severe group and moderate group except for mild group(P<0.05).To compare preoperative electromyogramic results of experimental group with control group in each group, There was not statistically significant difference in sensory nerve conduction velocity of the median nerve and in the latency of CMAP in the median nerve in 3 groups. To compare postoperative electromyogramic results of experimental group with control group in each group, There was statistically significant difference in sensory nerve conduction velocity of the median nerve and in the latency of CMAP in the median nerve in severe group except for mild group and moderate group (P<0.01) .Conclusions: 1 Implantation of ramus palmaris superficialis arteriae radialis into median nerve with neurolysis of median nerve is useful for the early recovery of median nerve and accelerating recovery of median nerve.2 The relation of the nerve's regeneration and the blood circulation and nourishment of the nerve is close,To restore the blood supply of nerves by neurolysis can make regeneration of nerves.Vascular bundle implantaion into compressed nerve can reconstruct blood supply early and accelerate regeneration and recovery of function.3 The ramus palmaris superficialis arteriae radialis implanted into median nerve is stronger enough to regenerate the vascula of perineurium and epineuiun, the advantages of implantaion are reconstruction of blood supply fast and the course of implantaion doesn't need suturing vascula and cutting off the ramus palmaris superficialis arteriae radialis doesn't affect the blood supply of hand.4 Epineurium of median nerve was incised with implanted ramus palmaris superficialis arteriae radialis,It is a good way to decompress nerve and remain continuity of epineurirm and blood supply maxmatily and it provide clinical evidence to treat peripheral entrapment neuropathies by implante vascula.