内镜辅助治疗周围神经卡压综合征

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 .

Endoscopic decompression for the treatment of peripheral nerve entrapment syndrome

Objective To introduce the clinical application of endoscopic decompression in the peripheral nerve entrapment syndrome.Methods From March 2003 to March 2006,endoscopic decompression operations were performed in 44 patients.There were 19 males,25 females,with an average age of 37.6 years (range,24-67 years).The transverse carpal ligaments were released under endoscope in 27 carpal tunnel syndrome cases (32 wrists).The ulnar nerves were released and anterior transposed under endoscope in 8 cubital tunnel syndrome cases (9 elbows).The axillary nerves were released under endoscope in 2 quadrilateral space syndrome cases.The common peroneal nerves were released under endoscope in 7 peroneal tunnel syndrome cases.The treatment outcomes had been observed.Results All of the 44 cases were operated smoothly and successfully.There was no complications of nerve and vessel injured in all cases.The length of incision was 1 to 3 cm.All patients were followed up 6 to 36 months,with the average of i 8.5 months.Improvement of symptoms occurred in all patients.The sensation function completely recovered to S4 grade within 1 to 3 months.The motor function recovered to 4-5 grade within 6 to 12 months in 43 patients.No recrodescent cases were found.Only one of the peroneal tunnel syndrome case was poor,and the muscle transfer was performed in the second stage after 24 months after first operation.Conclusion The endoscopic assisted decompression of the peripheral nerve is safe and useful method.It can obtain the same treatment outcomes compared with the traditional opening operation.More advantages such as less invasive and atraumatic,good aesthetic results are obviously.