Episode Transcript
Dr. Miller: 你的主治医生建议你去找专科医生治疗腕管. We're going to talk about that next on Scope Radio.
Announcer: 向大发娱乐的专家大发娱乐提供有关您今天面临的最大健康问题的深入信息, The Specialists, with Dr. Tom Miller, is on The Scope.
Dr. Miller: Hi, I'm here today with Dr. Doug Hutchinson. Doug, 告诉大发娱乐当你收到腕管综合症的转诊时会发生什么我给你一个我认为患有腕管综合症的病人. What are the next steps?
Dr. Hutchinson: Well, of course, you're always right, 这样我就不用担心任何诊断情况了.
Dr. Miller: That's what my wife always tells me.
Dr. Hutchinson: Yes. 通常情况下，病人会来找大发娱乐说，“我麻木了，医生. Miller: thinks I have carpal tunnel syndrome,“大发娱乐会愉快地和他们交谈，因为他们告诉大发娱乐发生在他们身上的事情比任何事情都重要. Their history is the most important thing. 大发娱乐会做一些身体检查来证实大发娱乐的怀疑.
如果他们是一个典型的病人，他们抱怨麻木而不是疼痛，他们是40或50岁，而不是20岁, 然后大发娱乐就可以在办公室里诊断为腕管综合症而不需要进一步的研究, 不需要电学研究或者其他常规的方法.
Dr. Miller: Which patients might need electro-diagnostic studies?
Dr. Hutchinson: In my opinion, those that need it are those that things don't fit, 神经在手上的分布好像不太对, they don't wake up at night with numbness, a splint doesn't help them, they think it's work related. 像这样的事情和正常情况有点不同大发娱乐可能需要更多的信息来确保大发娱乐没有遗漏其他的东西.
一个颈部疼痛和腕管综合症并存的病人很容易在其他地方压迫神经, like in the neck, 知道这是来自颈部还是来自手腕显然是明智的因为手腕手术不会解决颈部问题.
Dr. Miller: Let's say you agree with the diagnosis of carpal tunnel. 使用夹板和其他治疗的保守疗法效果如何?
Dr. Hutchinson: It's very effective, actually, 夹板是大发娱乐治疗的主要方法如果一个人晚上能睡，醒来时手指不会麻木, they're going to feel a lot better, they're going to do better during the day, 他们的手不会受伤，也不会像白天那样躺着睡觉.
他们需要好几年的时间才能接受这种治疗, despite splinting, 他们仍然感到麻木，这时他们可能应该谈论手术.
Dr. Miller: Are there any other conservative measures aside from splinting? Are there any exercises?
Dr. Hutchinson: 在大多数情况下，在我看来，没有很多练习可以大发娱乐. 服用复合维生素B对任何神经问题都有大发娱乐，这可能对一些人有益, it's probably going to delay things. 如果症状有所缓解，可能会延迟一年或两年.
The other main thing we use is an injection of cortisone. An injection of cortisone, most of us feel, 不能治愈腕管综合症但它可以持续一年无症状, 所以我经常用这个方法让人们去他们想去的地方做手术.
For example, if they're a big skier, they want to wait until ski season's over, that's a reasonably good thing to do. 如果他们要去度假，他们不想每天晚上醒来时双手麻木, that helps them do that.
另一个主要的影响因素是怀孕的女性，她最终不会怀孕. 因此，如果大发娱乐能让她们的症状在妊娠晚期减轻，那么当她们分娩时，她们的手通常会变好，她们就不需要手术了. 有些人怀疑10年后他们是否需要做手术, 但他们现在不需要，反正不是他们想要的时候.
Dr. Miller: 当保守方法无效时，手术的效果如何?
Dr. Hutchinson: 腕管综合症的手术，在我看来，可能是世界上最好的手术.
Dr. Miller: No doubt.
Dr. Hutchinson: 它使更多的人快乐，很少的人不快乐. 每次手术都有风险每次手术都有失败的时候. This surgery is simple, fast, easy to get over, and many, 99% or so, of the patients are not just happy, they're ecstatic. 他们认为从外科的角度来看，这是他们做过的最简单、最伟大的事情, 他们想知道为什么他们在最后一个月或最后一年或者他们生命中的任何时候都要用夹板等待. 他们觉得他们应该提前做这件事.
Dr. Miller: Is there any new special technique that you use surgically now?
Dr. Hutchinson: There really isn't much new there for the last 20 years, we've been doing an endoscopic carpal tunnel release, which is decreasing the size of the scar. 事实是，当我在训练的时候，伤疤的大小是现在的四倍. So we've learned to get smaller scars, not spend much time; it takes about nine minutes to do a carpal tunnel release. The patient can be completely awake during that time.
We do most of our carpal tunnels with them, more or less, in a procedure room, 甚至不在手术室里因为他们可以避免麻醉后遗症, they can avoid changing clothes, getting an IV. 他们甚至可以避免前一天晚上不吃东西. 我的一些病人会在早上端着一杯咖啡进来, get their carpal tunnel done, and pick up their coffee and go back to work.
Dr. Miller: So is that surgery effective long-term? Does it recur?
Dr. Hutchinson: It's really effective mostly long-term and, on a rare situation, 有人需要再做一次腕管松解手术.
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