ĐÁNH GIÁ BƯỚC ĐẦU KẾT QUẢ PHẪU THUẬT HỘI CHỨNG ỐNG CỔ TAY TẠI TRUNG TÂM Y TẾ HUYỆN XUÂN LỘC TỪ THÁNG 02/2018 ĐẾN THÁNG 09/2019

Abstract

Research objectives: To evaluate the effectiveness of surgery to resect the flexor tendon of the wrist to decompress the median nerve in carpal tunnel syndrome at Xuan Loc Medical Center from February 2018 to September 2019; To find out the limitations in surgery and treatment of carpal tunnel syndrome at the primary health care level. Methods: A retrospective cross-sectional study of all patients admitted to the Department of General Surgery, Xuan Loc District Medical Center from February 2018 to September 2019, with a diagnosis of carpal tunnel syndrome. Results: Among the 15 patients, 93.3% were aged 30-60 years, and 6.7% were under 30 years old. There were 11 female patients (73.3%) and 4 male patients (26.7%). The incidence of the disease was 40% in farmers, followed by 33.3% in workers, and 13.3% in traders and others. Of the 15 patients who received surgical intervention, simple flexor tendon fasciotomy accounted for 66.67% (10/15 cases), while flexor tendon fasciotomy with lateral nerve sheath resection accounted for 33.33% (5/15 cases). Postoperative response: The condition of “numbness upon waking up” was completely cured in 100% of cases. The conditions of “pain and paresthesia” and “swelling and heaviness of the hand” were completely cured in 14/15 cases, with 1/15 case showing partial reduction. The condition of “sensitivity to cold” was completely cured in 13/15 cases, with 2/15 cases showing partial reduction. Early postoperative complications were low, with wound edema occurring in 13.33% (2/15 cases) and joint swelling and stiffness in 6.67% (1/15 case). Among the 15 patients who underwent surgery, complete recovery was achieved in 93.3% (14/15 cases), partial improvement in 6.7% (1/15 case), and there were no cases of treatment failure. Conclusion: Flexor tendonectomy or median nerve sheath resection for the treatment of carpal tunnel syndrome at the Department of General Surgery, Xuan Loc District Medical Center was performed effectively. Performing surgery at the district level helps patients avoid transfers to higher-level hospitals, reduces costs due to lower hospital fees at the district level, and eliminates expensive travel costs. This approach also reduces the burden on higher-level hospitals, introduces new techniques to the local population, and enhances the reputation and quality of treatment at the medical center. Early diagnosis and treatment at the grassroots level contribute to reducing serious complications of the disease. Objective factors: Challenges in the surgery and treatment of carpal tunnel syndrome at the primary health care level include limited community knowledge about the disease due to the specific conditions of mountainous areas where farmers are the majority. Subjective disregard for early-stage symptoms also complicates treatment. Subjective factors: Limitations include a lack of microsurgical instruments, such as microscopes and pneumatic tourniquets, which may reduce the rate of complete cures. Additionally, a shortage of surgeons is a significant factor limiting the number of patients who can undergo surgery