Histopathologic Evaluation of Flexor Tenosynovium in Recurrent Carpal Tunnel Syndrome
Histopathologic Evaluation of Flexor Tenosynovium in Recurrent Carpal Tunnel Syndrome
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复发性腕管综合征屈肌腱鞘的组织病理学评估
DOI：
10.1097/prs.0000000000005090
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发表时间：
2019
影响因子：
3.6
通讯作者：
K. Renfree
中科院分区：
文献类型：
--
作者：
K. Scott;C. Conley;K. Renfree
背景资料：作者的目的是评价真实的特发性复发性腕管综合征中屈肌肌腱滑膜的组织病理学，以确定是否存在异常炎症或病理学发现，这些异常炎症或病理学发现可能解释因果关系或与先前描述的原发性特发性腕管综合征不同。研究方法：35名患者（19名女性和16名男性;平均年龄72岁）在初次腕管松解后平均13年（范围0.5 - 30年）接受开放性腕管松解翻修术。复发通过复发症状、阳性激发试验和电诊断试验证实。所有患者均接受肌腱滑膜活检，包括淀粉样蛋白的刚果红染色。结果如下：组织学检查结果显示35例患者中有31例（89%）为非炎性纤维结缔组织; 35例患者中有4例（11%）为轻度慢性炎症（无肉芽肿）。35例患者中有9例（26%）淀粉样蛋白阳性，男性（p = 0.03）和高龄（p = 0.02）的发病率在统计学上更高。在9份淀粉样蛋白阳性标本中的8份中进行了亚型分型，确认了7例甲状腺素运载蛋白型淀粉样蛋白典型见于局部（老年）淀粉样变性，1例轻链淀粉样蛋白见于随后诊断为骨髓瘤的患者。结论：复发性腕管综合征患者的屈肌腱鞘在组织学上似乎与先前描述的原发性特发性腕管综合征患者没有实质性差异，尽管在该组（尤其是老年男性）中观察到淀粉样蛋白的患病率略高。没有患者发生系统性淀粉样变性。对于特发性、复发性腕管综合征患者，不需要进行常规腱鞘活检。
Background: The authors’ purpose was to evaluate the histopathology of flexor tenosynovium in true, idiopathic recurrent carpal tunnel syndrome for the presence of abnormal inflammatory or pathologic findings that might explain causation or that differ from those previously described for primary, idiopathic carpal tunnel syndrome. Methods: Thirty-five patients (19 women and 16 men; mean age, 72 years) underwent open revision carpal tunnel release a mean 13 years (range, 0.5 to 30 years) after primary carpal tunnel release. Recurrence was confirmed by recurrent symptoms, positive provocative tests, and electrodiagnostic testing. All patients underwent tenosynovial biopsy, including Congo red staining for amyloid. Results: Histopathologic findings demonstrated noninflammatory, fibrous connective tissue in 31 of 35 patients (89 percent); and mild, chronic inflammation (without granulomas) in four of 35 patients (11 percent). Nine of 35 patients (26 percent) had positive results for amyloid, with a statistically higher incidence in men (p = 0.03) and advanced age (p = 0.02). Subtyping performed in eight of nine amyloid-positive specimens confirmed seven cases of transthyretin-type amyloid typically seen in localized (senile) amyloidosis and one case of light-chain amyloid in a patient who was subsequently diagnosed with myeloma. Conclusions: Flexor tenosynovium in patients with recurrent carpal tunnel syndrome does not appear to be substantially different histologically from that previously described in primary idiopathic carpal tunnel syndrome, although a slightly higher prevalence of amyloid was seen in this group (especially older men). No patients have developed systemic amyloidosis. Routine biopsy of tenosynovium in idiopathic, recurrent carpal tunnel syndrome is unnecessary.