Comparison of the Therapeutic Effect of the Mini-Open Incision and Conventional Open Neurolysis of the Median Nerve for Carpal Tunnel Syndrome

Abstract

Objective: The aim of this study was to compare the therapeutic effects of the mini-open incision and conventional open surgery for carpal tunnel syndrome (CTS).

Methods: The clinical data of 52 patients with CTS treated at the First Affiliated Hospital of the University of Science and Technology of China from October 2020 to February 2022 were retrospectively analyzed. The patients were divided into the conventional open surgery group (28 cases) and the mini-open incision group (24 cases) according to different surgical incisions applied. The incision length, operation time, time until postoperative return to work, and complications were observed in the two groups. The Visual Analog Scale (VAS) for pain at one day, one month, and three months after surgery and the Boston Carpal Tunnel Questionnaire scores before, at one month, and at three months after surgery were compared between the two groups.

Results: The incision length, operation time, and time until return to work in the mini-open incision group were all shorter than those in the conventional open surgery group (2.58 ± 0.35 vs. 7.32 ± 0.61 cm, 18.67 ± 2.62 vs. 29.46 ± 3.42 min, and 5.33 ± 1.40 vs. 13.86 ± 2.70 d, respectively), and differences were statistically significant (P < 0.05 in all). The VAS scores in the mini-open incision group were lower than those in the conventional open surgery group at one day and one month after surgery, while the difference in the VAS scores at three months after surgery was not statistically significant between the two groups. There was no statistically significant difference in neurological recovery between the two groups at postoperative follow-ups (P > 0.05). The incidences of postoperative scar hyperplasia and scar pain were higher in the conventional open surgery group than those in the mini-open incision group, and differences were statistically significant (P < 0.05 in both).

Conclusion: Mini-open incision surgery for CTS was a safe and reliable procedure with a precise therapeutic effect, minimal surgical trauma, and high postoperative comfort for patients and could achieve enhanced recovery. Trial Registration. This trial is registered with ChiCTR2200064631.

Figure 1

An “S”-shaped incision was made across the wrist of a length of approximately 6–8 cm (the dotted line is a Kaplan cardinal line and the solid line is an incisional site). (a) The incised skin was retracted, subcutaneous tissue and palmar aponeurosis were bluntly dissected using vascular forceps, and the transverse carpal ligament was exposed. (b) The ligament was cut with a surgical blade. (c) Exploration of the recurrent branch of the median nerve (d).

Figure 2

A longitudinal incision placed in the radial border of the ring finger line, which begins about 1 cm to the distal flexor wrist crease (dotted lines are the Kaplan cardinal line and radial side ring finger and the solid line is an incisional site). (a) The incised skin was retracted with the help of a miniretractor, subcutaneous fat tissue was dissected, and the ligament was cut with a surgical blade. (b) The wrist joint was flexed palm forward, and the ligament was released to the level of the distal flexor wrist crease. (c) The wrist joint was extended dorsally, and the branch of the median nerve could be released under direct vision (d).