Treatment for Carpal Tunnel Syndrome by Coronal Z-type Lengthening of the Transverse Carpal Ligament

Objective: To compare the effects of coronal Z-type lengthening of transverse carpal ligament with conventional open approach for carpal tunnel syndrome. Methods: A double-blinded study was conducted from January 2005 to August 2008 on 68 patients with a mean age of 41 years (range 27~55 years) diagnosed as severe carpal tunnel syndrome. They were randomized into two groups(A and B). Patients in group A underwent coronal Z-type lengthening of transverse carpal ligament, and patients in group B had conventional open approach surgery. Postoperative evaluation was scheduled at 1, 3, 6 and 12 months after the surgery and incidence rate of bowstring of the flexor tendons, improvement of grip strength and ADL activities of daily living) score were recorded. Results: Fifty-eight patients had been followed up successfully, 30 and 28 for group A and B respectively. The Scar Tissue Formation of the flexor tendons in group B was observed more than that in group A at 6 and 12 month after operation. Improvement of grip strength were observed in two groups, which was statistically different between 6 and 12 months after operation and no significant difference was seen between 1 and 3 months after operation. According to ADL, the satisfaction rates documented on form for patients were statistically different in the two groups at 6 and 12 months after operation and no difference was noted at 1 and 3 months after operation. Conclusion: Excellent improvement of function and satisfaction were achieved by Coronal Z-type reconstruction of the flexor retinaculum for severe carpal tunnel syndrome. Our method offers a more effective alternative method for conventional carpal tunnel open decompression surgery.