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1.
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  相似文献   

2.
麻醉手术期间应用电话传送心电监测793例观察   总被引:2,自引:0,他引:2  
麻醉手术期间应用电话传送心电监测793例观察王亚轩董振明佟飞本文应用电话传送心电监测系统(Transtele-phonicElectrocardiographicMonitoringSystem,TTEM),对麻醉手术期间的患者进行了观察。资料与方法...  相似文献   

3.
SMAS与面部支持韧带在除皱术中的意义王晓君,陈宗基近年来对除皱术解剖学基础研究的一个新进展是有关面部表浅肌肉腱膜系统(Superficial-musculoaponeuroticsystem简称SMAS)的研究和面部支持韧带(RetaingLiga...  相似文献   

4.
自从James1854年首次描述正中神经在腕管内的慢性压迫及其症状以来,已经有很多论文报告了。1913年Marie和Foix报告了一例双侧鱼际萎缩病人的解剖情况,观察到腕管内正中神经肿胀及狭窄。1930年Richard首次进行了一次特殊的手术——横断腕横韧带,使腕管内正中神经松解,达到减压的目的。  相似文献   

5.
局限性前列腺癌的治疗对生活质量的影响   总被引:1,自引:0,他引:1  
随访 1993~ 1998年前列腺癌患者84 2例 ,分析前列腺癌与生活质量的关系 ,对其中 1995年以后的 14 6例患者进行前瞻性研究 ,生活质量用医疗结果研究健康状况观察表 (MedicalOutcomesStudyShort Form 36HealthStatusSur vey)、癌症康复评估系统表格 (CancerRehabilitationEvaluationSystemShortForm)和加利福尼亚洛杉矶大学前列腺癌指数 (UniversityofCaliforniaLosAn gelesProstateCancerIn…  相似文献   

6.
内窥镜下松解腕管综合征的神经并发症   总被引:8,自引:7,他引:1  
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。  相似文献   

7.
电视辅助胸腔内视镜手术的临床应用现状周清华综述杨振华审校胸腔镜外科手术由于利用电视屏幕协助完成胸腔外科手术,故称为电视辅助胸腔内视镜手术(Video-assistedthoracicSurgery,VATS).VATS的应用已引起外科医师和病人的广泛...  相似文献   

8.
经后路椎管内椎间盘镜与微创小切口手术的比较   总被引:5,自引:0,他引:5  
我们于 1999年 2月至 8月采用经后路椎管内椎间盘镜施行腰椎间盘手术(microendoscopicdiscectomysystem ,MED组 ) 12 2例 ,与同期采用微创小切口腰椎间盘手术 (microtraumadiscecto my ,MTD组 ) 10 5例进行了比较观察。临床资料 MED组中男 74例 ,女48例 ,年龄 14~ 82岁 ,平均 35 2岁 ;病程 3d~ 15年 ;腰椎间盘突出 70例 (侧后方型 44例 ,中央型 2 6例 ) ,脱出或游离14例 ,腰椎间盘膨出并局限性突出 38例 ;42例伴有侧隐窝狭窄、小关节突增生、黄韧带肥厚、纤维环或后纵韧…  相似文献   

9.
普外科技英语PANCREATICPSEUDOCYSTSItisbecomingincreasinglyclearthatpancreaticpseudocystsaremorecommonthanwaspreviouslyappreciated[1]...  相似文献   

10.
近十余年来,医学三维影像技术与计算机科学技术迅猛发展并相互交叉渗透,产生了计算机辅助立体定向导航系统(ComputerAsistedStereotacticSystem,CASS)、计算机辅助手术设计模拟系统(ComputerAsistedDesig...  相似文献   

11.
急性腕管综合征的手术治疗   总被引:1,自引:0,他引:1  
王晓腾  陈昌伟 《中国骨伤》2006,19(7):428-429
目的:探讨急性腕管综合征的手术治疗方法和效果。方法:对14例急性腕管综合征患者的手术方法进行分析总结,手术主要是切开腕横韧带,清除积血和炎性渗出物及致压物,解除粘连,彻底松解正中神经和血管受压。结果:切口均Ⅰ期愈合,手部肿胀于1周内消退,神经症状逐渐恢复,完全恢复正常时间2~45 d,平均15 d。随访6个月~1年,无一例复发,患手功能良好。结论:对急性腕管综合征患者,经短时间观察和保守治疗无效,早期手术可获得满意疗效。  相似文献   

12.
OBJECT: Recently developed novel MR protocols called MR neurography, which feature conspicuity for nerve, have been shown to demonstrate signal change and altered median nerve configuration in patients with median nerve compression. The postoperative course following median nerve decompression can be problematic, with persistent symptoms and abnormal results on electrophysiological studies for some months, despite successful surgical decompression. The authors undertook a prospective study in patients with carpal tunnel syndrome, correlating the clinical, electrophysiological, and MR neurography findings before and 3 months after surgery. METHODS: Thirty patients and eight control volunteers were recruited to the study. The MR neurography consisted of axial and sagittal images (TR = 2000 msec, TE = 60 msec) obtained using a temporomandibular surface coil, fat saturation, and flow suppression. Maximum intensity projection images were used to follow the median nerve through the carpal tunnel in the sagittal plane. Magnetic resonance neurography in patients with carpal tunnel syndrome demonstrated proximal swelling (p < 0.001) and high signal change in the nerve, together with increased flattening ratios (p < 0.001) and loss of nerve signal in the distal carpal tunnel (p < 0.05). Sagittal images were very effective in precisely demonstrating the site and severity of nerve compression. After surgery, division of the flexor retinaculum could be demonstrated in all cases. Changes in nerve configuration, including increased cross-sectional area, and reduced flattening ratios (p < 0.001) were seen in all patients. In many cases restoration of the T. signal intensity toward that of controls was seen in the median nerve in the distal carpal tunnel. Sagittal images were excellent in demonstrating expansion of the nerve at the site of surgical decompression. CONCLUSIONS: In this study the authors suggest that MR neurography is an effective means of both confirming compression of the median nerve and its successful surgical decompression in patients with carpal tunnel syndrome. This modality may prove useful in the assessment of unconfirmed or complex cases of carpal tunnel syndrome both before and after surgery.  相似文献   

13.
Nine patients were clinically diagnosed as having a pronator syndrome, i.e., high median nerve compression. The main symptom was pain at the proximal volar aspect of the forearm increasing for several hours after exercise. All patients showed local tenderness over the median nerve 4-5 cm distal to the elbow and pain on active forearm pronation against resistance. Two patients had been previously operated upon for carpal tunnel syndrome. Preoperative routine neurographic-electromyographic studies were normal. In the differential diagnosis, the exclusion of carpal tunnel syndrome and anterior interosseous nerve entrapment is most important. On active isometric forearm pronation, interference with median nerve motor conduction occurred in three patients preoperation. This phenomenon had disappeared following median nerve decompression at the level of the pronator muscle. Fibrous bands from the pronator muscle, encircling the nerve, seemed to be an etiological factor. Eight of nine patients were either improved or recovered completely by surgical treatment.  相似文献   

14.
目的 探讨应用内镜技术辅助松解术治疗周围神经卡压综合征的临床效果.方法 2003年3月至2006年3月,收治44例周围神经卡压综合征患者,男19例,女25例;年龄24~67岁,平均37.6岁.对27例32腕腕管综合征患者中的7例8腕行Okutsu法手术,15例18腕行Chow法手术,5例6腕行皮肤牵引法腕管外镜下腕横韧带切断术;8例9肘肘管综合征和7例腓总神经卡压患者通过CO2 充气皮下气腔法内镜下行肘部尺神经松解前置术和腓总神经松解术;2例四边孔综合征患者用自制的组织撑开器内镜辅助下行腋神经松解术.术后进行疗效观察.结果 44例患者均在镜下顺利完成手术,无一例发生神经、血管损伤等并发症,切口1~3 cm,随访时间6~36个月,平均18.5个月.感觉功能在1~3个月内恢复,达S4级.43例患者运动功能在6~12个月内恢复至4~5级,未见复发病例;1例腓总神经卡压患者随访至24个月时,因伸踝、趾肌力恢复至2级停止而二期行肌腱转位术.除1例腓总神经卡压患者外,43例患者均于术后12个月复查肌电图,结果 显示神经传导速度正常,神经所支配肌肉重收缩呈单纯一混合相或混合相.结论 内镜辅助治疗部分周围神经卡压综合征安全实用,不仅能达到与常规开放手术相同的疗效,而且更微创、美观,但由于其手术适应证的局限性,开放手术仍是目前治疗周围神经卡压的常规方法 .  相似文献   

15.
目的 比较腕管综合征术前和正中神经松解术后 (术中 )两者感觉神经动作电位 (sensorynerveactionpotential ,SNAP)与复合肌肉动作电位 (compoundmuscleactionpotential,CMAP)检测结果的差异。方法 对 2 0例腕管综合征患者 ,术中在切开屈肌支持带及正中神经松解术后 ,分别测定 (1)拇短展肌的CMAP ;(2 )刺激示、中指 ,于腕部记录正中神经的SNAP ;(3 )刺激环指 ,于腕部分别记录正中神经和尺神经的SNAP。将三者结果与术前的相应数据行统计学分析。结果  (1)术前拇短展肌CMAP的潜伏期小于4 3ms ,术后其潜伏期、波幅与术前相比差异无统计学意义 (P >0 0 5 )。 (2 )术后 2~ 4指SNAP的潜伏期比术前平均缩短 5 %、波幅增加 13 %左右 ,两者相比差异均有统计学意义 (P <0 0 1)。结论 腕管综合征手术中 ,在正中神经松解术后行SNAP检测较CMAP检测的结果更为敏感和准确。  相似文献   

16.
Abstract

This report presents the case of a 44-year-old man who presented with elective bilateral carpal tunnel decompression. At the operation, he was found to have bilateral palmaris profundus tendons within the carpal tunnel, impinging on the median nerve. In releasing both carpal tunnels, the patient's symptoms were alleviated and there was regain of full function. There have been very few documented cases of these anomalous tendons implicated in carpal tunnel syndrome and this case highlights how such anatomical variations are important in the surgical approach to carpal tunnel decompression.  相似文献   

17.
Odumala O  Ayekoloye C  Packer G 《Injury》2001,32(7):577-579
Our objective was to evaluate the role of carpal tunnel decompression in preventing median nerve dysfunction after buttress plating of the distal radius. We studied 69 consecutive patients with distal radial fractures managed by volar plating over a 4-year period. (1995-1998). Patients' clinical notes were assessed for symptoms of median nerve dysfunction and all the patients were followed up for a minimum period of 6 months. Twenty-four patients had prophylactic carpal tunnel decompression and 45 patients did not. Forty-two patients (61%) were women and 27 patients (39%) men. The average age of the patients was 56 years, (range 24-81 years). Overall 17 patients (25%) developed median nerve dysfunction post-operatively of which nine patients had and eight patients did not have formal prophylactic tunnel decompression, respectively; this was not statistically significant (P=0.08). In addition prophylactic decompressed patients had more than twice the relative odds=2.7 (confidence interval: CI=0.94-4.76) of developing median nerve dysfunction. All cases resolved spontaneously except for three cases that required carpal tunnel decompression. We conclude that prophylactic median nerve decompression does not alter the course of median nerve dysfunction and may increase post-operative morbidity.  相似文献   

18.
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。  相似文献   

19.
BACKGROUND: It was hypothesized that preserving a layer of gliding tissue, the parietal layer of the ulnar bursa, between the contents of the carpal tunnel and the soft tissues incised during carpal tunnel surgery might reduce scar pain and improve grip strength and function following open carpal tunnel decompression. METHODS: Patients consented to randomization to treatment with either preservation of the parietal layer of the ulnar bursa beneath the flexor retinaculum at the time of open carpal tunnel decompression (fifty-seven patients) or division of this gliding layer as part of a standard open carpal tunnel decompression (sixty-one patients). Grip strength was measured, scar pain was rated, and the validated Patient Evaluation Measure questionnaire was used to assess symptoms and disability preoperatively and at eight to nine weeks following the surgery in seventy-seven women and thirty-four men; the remaining seven patients were lost to follow-up. RESULTS: There was no difference between the groups with respect to age, sex, hand dominance, or side of surgery. Grip strength, scar pain, and the Patient Evaluation Measure score were not significantly different between the two groups, although there was a trend toward a poorer subjective outcome as demonstrated by the questionnaire in the group in which the ulnar bursa within the carpal tunnel had been preserved. Preserving the ulnar bursa within the carpal tunnel did, however, result in a lower prevalence of suspected wound infection or inflammation (p = 0.04). CONCLUSIONS: In this group of patients, preservation of the ulnar bursa around the median nerve during open carpal tunnel release produced no significant difference in grip strength or self-rated symptoms. We recommend incision of the ulnar bursa during open carpal tunnel decompression to allow complete visualization of the median nerve and carpal tunnel contents.  相似文献   

20.
Carpal tunnel syndrome is the most common peripheral neuropathy. Conventional carpal tunnel surgery has been performed as a primary procedure for the decompression of the median nerve at the wrist in patients who have idiopathic carpal tunnel syndrome. While the results have been excellent, this surgical procedure has been reported to be related to high postoperative morbidity and extended length of recovery time. Over the past decade, endoscopic release of the transverse carpal ligament has been developed as a new, alternative method to the open procedures. Endoscopic carpal tunnel release has been reported to ensure less postoperative morbidity, more rapid recovery of strength, with earlier return to work, reduced disability time and a better cosmetic result. The authors present a surgical series of 200 hands in 164 patients (36 bilaterals) with idiopathic carpal tunnel syndrome, who underwent a single-portal endoscopic carpal tunnel release (Agee technique), with regards to the clinical outcome and complications occurred after 4-months follow-up.  相似文献   

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