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内窥镜下松解腕管综合征的神经并发症
引用本文:顾玉东,史其林,孙贵新.内窥镜下松解腕管综合征的神经并发症[J].中华手外科杂志,2003,19(3):151-152.
作者姓名:顾玉东  史其林  孙贵新
作者单位:200040,上海,复旦大学华山医院手外科
摘    要: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。

关 键 词:内窥镜  松解术  腕管综合征  并发症  神经损伤  原因
修稿时间:2003年6月26日

Nerve complication produced by endoscopic releasing of carpal tunnel
GU Yu-dong,SHI Qi-lin,SUN Gui-xin.Nerve complication produced by endoscopic releasing of carpal tunnel[J].Chinses Journal of Hand Surgery,2003,19(3):151-152.
Authors:GU Yu-dong  SHI Qi-lin  SUN Gui-xin
Institution:GU Yu-dong,SHI Qi-lin,SUN Gui-xin. Department of Hand Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China
Abstract:Objective To report the cause of nerve injury and evaluate the reason after technique of endoscopic carpal tunnel release (ECTR) .Methods A total of 136 patients were performed by the technique of ECTR from the year 1997 to 2003. Two cases were considered failure or had complication after operation. They were performed again under open procedure to investigate the indication and characteristics of nerve injury under direct observation. Results One case showed that the median nerve adhered to the transverse carpal ligament in the carpal tunnel. The epineurium and perineurium were injured when the transverse carpal ligament was cut under endoscope. The other case showed the median nerve palmar cutaneous branch hand anatomical variety at the wrist and was injuried in the proximal small incision. Both cases were alleviated after nerve releasing. Conclusion This study suggests that ECTR for carpal tunnel syndrome is a safe and reliable procedure with a high success rate at the most time.However, nerve injury is liable to occur when there are anatomic variety or operative difficult during the ECTR procedure. The symptoms will be alleviated after nerve releasing under direct observation.
Keywords:Carpal tunnel syndrome  Endoscopes  Postoperative complications
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