微创内镜下治疗腕管综合征——附69例报告

目的探讨应用微创内镜下Okutsu技术治疗腕管综合征(ECTR).解除其对正中神经压迫的手术技巧及疗效. 方法局部麻醉,不使用驱血带,皮肤1cm切口,应用USE SYSTEM (Universal Subcutaneous Endoscopic System)电视光源录像系统,在内镜下切断腕管横韧带,据Kelly标准评定术后疗效.术后1、3、12月进行随访. 结果临床应用126例149腕,手术时间平均10分钟,出血少,术后随访69例78腕,优54例;良19例;一般3例;差2例,其中1例发生术后正中神经粘连,行2次手术. 结论与常规手术相比,皮肤切口小,组织创伤轻,手术时间短,术后不需石膏外固定,不残留手术瘢痕.在微创伤条件下,能与常规手术取得相同的疗效.     

微创内镜下治疗腕管综合征——附69例报告

目的 探讨应用微创内镜下Okutsu技术治疗腕管综合征(ECTR)。解除其对正中神经压迫的手术技巧及疗效。方法 局部麻醉,不使用驱血带,皮肤lcm切口,应用USE SYSTEM(Universal Subcutaneous Endoscopic System)电视光源录像系统,在内镜下切断腕管横韧带,据Kelly标准评定术后疗效。术后l、3、12月进行随访。结果 临床应用126例：149腕,手术时间平均l0分钟,出血少,术后随访69例78腕,优54例;良19例;一般3例;差2例,其中l例发生术后正中神经粘连,行2次手术。结论 与常规手术相比,皮肤切口小,组织创伤轻,手术时间短,术后不需石膏外固定,不残留手术瘢痕。在微创伤条件下,能与常规手术取得相同的疗效。     

腕管综合征内镜诊治新方法——改良奥津法(附11例报告)

目的:介绍应用改良内镜技术治疗腕管综合征,术前和术后应用肌电图检测,从腕管内直接切断腕管横韧带和屈肌支持带远侧纤维束,解除其对正中神经压迫的手术方法及技巧。方法:臂丛麻醉,不使用驱血带,皮肤1cm切口,应用USE系列,在内镜下切断腕管横韧带和屈肌支持带远侧纤维束,经肌电图验证,术后正中神经末端CMAP平均潜伏期较术前加快1ms。结果:临床应用11例腕管综合征病人,于术后第1,第3个月随访,结果据Kelly疗效评定标准,优9例;良2例;一般或差无。结论:与常规手术相比,皮肤切口小,组织创伤轻,手术时间短,术后不需石膏外固定,不残留手术瘢痕。术中注意减压彻底,在微创伤条件下,能与常规手术取得相同的疗效。     

腕管综合征的内窥镜诊治——Okutsu（奥津）法

目的：介绍利用引进国外内窥镜新技术，从腕管内直接切断腕管横韧带，解除其对正中神经压迫的手术方法。方法：局部麻醉，不使用驱血带，皮肤１ｃｍ切口，应用ＵＳＥ ＳＹＳＴＥＭ（ｕｎｉｖｅｒｓａｌ ｓｕｂｃｕｔａｎｅｏｕｓ ｅｎｄｏｓｃｏｐｉｃ ｓｙｓｔｅｍ）电视光源录象系统，在内窥镜下切断腕管横韧带。结果：临床应用１００例１１８腕，疗效满意。手术时间平均８分钟，出血少，所有病例未见并发症。结论：与常规手术     

内窥镜下松解腕管综合征的神经并发症

目的 报道内窥镜治疗腕管综合征时引起神经损伤的原因。方法 1997年至2003年，应用内窥镜治疗腕管综合征136例。对其中2例在内窥镜术后发生并发症的患者，在直视下再次进行手术探查，以明确神经损伤的部位及性质，并探讨引起神经损伤的原因。结果 1例正中神经在腕管内与腕横韧带粘连，在切断腕横韧带时同时损伤相连的正中神经外膜与部分束膜。经神经外膜松解后症状缓解。另1例正中神经掌皮支起始部发生变异，在内窥镜插入腕上切口处，直接损伤该皮支；经神经松解后症状缓解。结论 内窥镜治疗腕管综合征，通常是安全有效的。但在解剖变异及内窥镜下手术有困难时，易发生神经损伤，再次进行手术松解，症状缓解。     

内镜下切断屈肌支持带远侧纤维束治疗腕管综合征

目的探讨内镜下腕管切开减压术（endoscopic carpal tunnel release，ECTR）中切断屈肌支持带远侧纤维束（distal holdfast fibers of the flexor retinaculum，DHFFR）的必要性。方法观察组16例，臂丛神经阻滞麻醉，不使用止血带，皮肤1cm切口，内镜下应用USE系列切断腕管横韧带和DHFFR，与对照组16例单纯切断腕管横韧带进行疗效比较。结果术后6个月功能随访，按照Kelly疗效评定标准，观察组优13例，良3例；对照组优8例，良5例，可3例，2组浜田Ⅱ、Ⅲ级疗效差异有显著性（，=6．278，P=0．043）。2组均无严重并发症及术后复发。结论对浜田Ⅱ、Ⅲ级腕管综合征者术中注意腕横韧带切断不是唯一的目标，同时切断DHFFR才能彻底减压。     

两点法内镜下治疗腕管综合征

腕管综合征常规手术是将皮肤与腕管横韧带之间的组织完全切断,直视下切开腕横韧带,然后行神经松解。开放性手术的缺点是手术创伤较大,术后手部功能恢复期较长,手的握力和捏力明显下降;手掌部的皮肤切开易损伤正中神经的掌皮支,形成神经瘤而产生疼痛;切口持续性疼痛,活动时加重;易发生弓弦状屈肌腱、神经与皮肤和肌腱粘连、外形不够美观等并发症。尽管开放手术的手术切口不断改良,但最终难免在手掌部残留有痛性或肥厚性瘢痕。日本Okutsu1986年首先应用内镜治疗腕管综合征,通过前臂1cm     

小双切口治疗腕管综合征15例体会

目的 介绍应用小双切口作腕管切开治疗腕管综合征的方法及临床效果。方法 在掌长肌腱尺侧，平行远侧腕横纹作1．5cm长的横切口，腕横纹以远2．5cm为中心沿鱼际肌纹作1cm长的纵切口，分别显露腕横韧带远近缘及指屈肌腱及正中神经，直视下将腕横韧带完全切开，正中神经外膜松解3例，鱼际肌支松解1例。结果 术后2周，15例症状完全消失，拇、示、中3指指腹两点辨别觉恢复正常。术后1年随访，术前大鱼际肌萎缩5例，肌萎缩明显改善，拇指对掌功能恢复正常。全部病例无1例产生腕掌部瘢痕疼痛及尺神经、掌浅弓损伤等并发症。结论 小双切口行腕管松解术，可操作窄间大，并发症少，术后美观。是治疗腕管综合征的有效方法。     

显微技术在治疗腕管综合征中的应用

目的探讨显微技术在治疗腕管综合征中的应用价值。方法随机将62例腕管综合征患者分为A、B两组，A组在腕横韧带切开的基础上，应用手术显微镜行正中神经内松解术；B组单纯行腕横韧带切开减压术。比较两组术前、术后在症状、体征、肌电图方面的改变。结果随访8～18个月，平均12个月。按自拟疗效评估标准判定，A组优良率92．5％，B组优良率70．97％。结论在腕横韧带切开的基础上，采用显微技术行正中神经内减压治疗腕管综合征可显著提高手术效果。     

内窥镜治疗腕管综合征的疗效观察

目的：观察内窥镜治疗腕管综合征的临床疗效。方法2009年至今,利用内窥镜单切口入路,通过切开腕管、松解正中神经,治疗腕管综合征18例（30侧）。术前及术后3个月进行神经电生理测试,测定正中神经掌腕段感觉及运动传导速度。结果本组患者术后随访6个月,术后3个月正中神经感觉、运动神经传导速度明显较术前加快（P〈0.05）,患者肢体感觉基本恢复正常,未见复发。结论内窥镜治疗腕管综合征疗效确切,术后正中神经功能恢复明显。     

腕管综合征在内窥镜视下手术与常规手术的疗效比较

目的 对腕管综合征在内窥镜视下手术与常规手术的疗效进行比较。方法 内窥镜组４０例４４腕,常规手术组４０例４４腕。术前按滨田分类方法分为３类。两组分别在术后１个月、３个月、１２个月进行随访。根据Ｋｅｌｌｙ功能评定标准对各型进行功能评价。结果内窥镜组各型患者术后１个月时,功能恢复速度稍慢于常规手术组,３个月两后两组功能则完全相同。结论 两组的手术入路不同,但术后３个月时的疗效却相同。但内窥镜组具有皮     

感觉过敏型腕管综合征的治疗

目的 报道7例感觉过敏型腕管综合征的诊治特点.方法 收集与分析2002年3月至2005年3月间128例腕管综合征中感觉过敏型7例的病情及治疗特点.其中女性4例、男性3例.4例应用内镜治疗,3例切开治疗,经1～4年随访,平均随访时间1.5年.结果 内镜治疗中2例疗效差,均在术中插入扩张导管时出现异常疼痛,另外2例基本满意.3例切开治疗中,2例疗效差,1例基本满意.3例基本满意中,2例内镜插入导管时均未出现疼痛,另1例为单纯切断腕横韧带,并在神经外膜下注射激素.结论 感觉过敏型腕管综合征是一组特殊病例,保护神经外膜是治疗关键.     

Does the severity of bilateral carpal tunnel syndrome influence the timing of staged bilateral release?

A retrospective chart analysis was performed of 66 patients with bilateral carpal tunnel syndrome (CTS) who underwent either single endoscopic carpal tunnel release (ECTR) or staged bilateral ECTR to determine the frequency and timing of contralateral surgery. Bilateral CTS patients with contralateral severe CTS underwent bilateral staged ECTR 86% of the time and the second operation was performed 6 ± 5 weeks after the initial ECTR. Patients with contralateral moderate CTS underwent bilateral staged ECTR 74% of the time with a mean of 11 ± 3 months between operations. Patients with contralateral mild CTS underwent bilateral staged ECTR 20% of the time and averaged 7 ± 3 years between procedures. For patients with bilateral CTS, the severity of CTS on the contralateral side to the initial release affects both the frequency and timing of the contralateral surgery. This information may be used to establish guidelines for treatment with bilateral simultaneous CTR.     

Surgical outcome of endoscopic carpal tunnel release in 100 patients with carpal tunnel syndrome.

The purpose of this study is to present the surgical outcome of endoscopic carpal tunnel release (ECTR) for the treatment of carpal tunnel syndrome (CTS). One hundred and thirty-one procedures (36 right hands, 33 left hands and 31 bilateral hands) of single portal ECTR were performed upon 100 patients (age range: 36-77 years, mean age: 52.9 years; 98 women and 2 men) with electrodiagnostically proven CTS for 2.5 years from 2001. Preoperative clinical severity and results of electrodiagnostic studies were compared with surgical outcomes at the minimal 3-month postoperative period. Among 131 cases 125 (95.4 %) with complete or significant relief of symptoms were satisfied and 6 (4.6 %) with partial or no relief of symptoms were dissatisfied. There were 2 cases of major complications (one with ulnar nerve injury and the other with ulnar artery injury) that developed in our early experience of ECTR and 1 case of recurrence. The grade of electrodiagnostic abnormalities was associated with surgical outcome but there was no statistical significance between them. The severity of clinical findings, age at onset and symptom duration were not correlated with surgical outcome. In conclusion, ECTR surgery was effective in relieving the symptoms of CTS with a low complication rate after the learning curve period. Thus, ECTR can be an alternative to the traditional open surgery and can be the first procedure for CTS with several advantages over open methods.     

小切口治疗腕管综合征14例报告

Objective　To introduce the technique of carpal tunnel release by small incision,and evaluate its outcome in the treatment of carpal tunnel syndrome.Methods　This method was applied in the operations of 14 cases of carpal tunnel syndrome.An incision 1.5 cm in length was made at the level of the proximal transverse wrist crease ulnar to the palmaris longus tendon.The proximal margin of the transverse carpal ligament was visualized and the ligament was cut subcutaneously under direct vision.The flexor digitorum tendons were retracted and the edematous synovium excised.Results　Follow - up of the patients 2 weeks postoperatively showed that the symptoms of numbess and pain disappeared in all 14 cases.Normal 2 - PD in the pulp of the thumb,index finger and long finger was ＜ 4 mm.One year after the operation,muscle atrophy in 5 patients who sustained preoperative thenar muscle atrophy was greatly improved with recovery of normal opponens function of the thumb.No pillar pain and injury of the ulnar nerve and superficial palmar arch was found.Conclusion　Carpal tunnel release under direct vision through a small incision is a new and effective surgical procedure.     

经手掌近侧小切口的腕管切开松解减压术

目的 报告使用手掌近侧小切口的腕管切开松解减压术的疗效。方法 自大、小鱼际纹交界处向远侧腕横纹做纵行切口，长2～2．5cm，直视下切开屈肌支持带，解除正中神经卡压。术后随访并与同期采用传统长切口的病例比较，观察小切口的疗效。结果 随访病例19例30腕，其中小切口6例11腕，长切口13例19腕，它们在手指麻木、腕痛、握力及两点辨别觉改善等方面无明显差异，在切口长度、手术时间、恢复正常生活与工作时间以及术后瘢痕触痛、墩柱部疼痛等方面，前者优于后者。结论 经手掌近侧小切口实施腕管切开松解减压术，较传统方法有更多优点，是一种安全、有效的治疗方法。     

Carpal tunnel syndrome grading system in rheumatoid arthritis

The grading system of Hashizume and Hirooka for carpal tunnel syndrome (CTS) was modified to refine the system for surgical treatment selection for specific subsets of CTS in patients with rheumatoid arthritis (RA). The grading system uses clinical signs and symptoms of CTS, including pain indications, to identify surgical subsets of patients to facilitate treatment selection. Retrospective analysis of the system included radiographic and electromyographic findings. Twenty-nine hands of 21 adult patients with CTS in RA were graded in the current study. Eight hands with mild synovitis received conservative treatment only. Endoscopic carpal tunnel release (ECTR), using Okutsu's universal subcutaneous endoscopic system with a clear cannula, was performed in 11 hands with moderate synovitis. Open carpal tunnel release (OCTR) combined with flexor tenosynovectomy was performed in 9 hands with severe synovitis. One more hand required OCTR after ECTR when malignant RA was diagnosed. Clinical results, evaluated using Kelly's criteria, were: excellent in 19 hands, good in 5, fair in 4, and poor in the 1 patient with malignant RA. Clinical symptoms of CTS improved in all but the latter patient. Although the sample size in the current study is small, the results appear to warrant further study to determine the clinical utility of the grading system. Received: April 2, 2001 / Accepted: November 1, 2001     

Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation

The current concepts of carpal tunnel syndrome (CTS) with respect to its pathophysiology, treatment, and evaluation are discussed. With regard to the pathophysiology of idiopathic CTS, biomechanical studies to determine the kinematics of the flexor tendon, and the median nerve inside the carpal tunnel may provide valuable insights. Different degrees of excursion between the flexor tendons and the median nerve could cause strain and microdamage to the synovial tissue; this has been microscopically observed. A biomechanical approach for elucidating the events that trigger the development of CTS seems interesting; however, there are limitations to its applications. Endoscopic carpal tunnel release (ECTR) is a useful technique for achieving median nerve decompression. However, it is not considered superior to conventional open carpal tunnel release in terms of fast recovery of hand function. Unless the effect of inserting a cannula into the diseased carpal tunnel on the median nerve function is quantitatively elucidated, ECTR will not be regarded as a standard procedure for relieving the median nerve from chronic compression. The treatment of CTS should be evaluated on the basis of patient-oriented questionnaires as well as conventional instruments because these questionnaires have been validated and found to be highly responsive to the treatment. It should be noted that nerve conduction studies exclusively evaluate the function of the median nerve, whereas patient-oriented questionnaires take into account not only the symptoms of CTS but other accompanying pathologies as well, such as flexor tenosynovitis. In Japan, the number of CTS patients is expected to rise; this may be attributed to a general increase in the life-span of the Japanese and increase in the number of diabetic patients. Thus, more efforts should be directed toward elucidating the pathophysiology of so-called idiopathic CTS, so that new treatment strategies can be established for CTS of different pathologies.