人工腔隙技术在内镜辅助周围神经手术中的应用

Application of the artificial cavity techniques in endoscopic peripheral nerve surgery

目的:介绍3种人工腔隙技术在内镜辅助治疗周围神经卡压综合征松解手术和腓肠神经切取手术中的临床应用。方法:自2003年1月至2008年12月,分别应用3种人工腔隙技术行内镜下周围神经松解手术和腓肠神经切取手术共41例。其中应用CO2皮下充气法内镜辅助下切取腓肠神经移植手术9例,尺神经松解前置手术治疗肘管综合征8例,腓总神经松解手术治疗腓管综合征7例;应用皮肤提拉装置形成皮下腔隙镜下行腕管外腕横韧带切断术治疗腕管综合征15例;用自制的环型组织撑开器内镜辅助下行腋神经松解术治疗四边孔综合征2例。结果:41例患者均获得充分的腔镜视野,在镜下顺利完成手术操作,无神经、血管损伤并发症,切口1～3 cm,比开放性手术缩短3～10 cm。37例患者获得随访1～5年。周围神经松解手术30例,感觉功能在术后1～3个月内恢复,达S4级,29例患者运动功能在术后6～12个月内恢复至IV～V级,未见复发;1例腓总神经卡压患者随访24个月,伸踝、趾肌力恢复至II级停止,二期行肌腱转位术。镜下腓肠神经切取移植手术随访7例,受区神经功能恢复良好。结论:人工腔隙技术使内镜辅助周围神经手术具有更好的腔镜视野和操作空间,是内镜手术成功的关键。

Objective： To introduce the clinic application of three artificial cavity techniques in endoscopic decompression in the peripheral nerve entrapment syndrome and endoscopic harvesting of the sural nerve.Methods： This study included 41 patients.The endoscopic harvesting of the sural nerve in CO2 generated cavity was performed in 9 cases.The ulnar nerves were released and anterior transposed under endoscope in 8 cases.The common peroneal nerves were released under endoscope in 7 peroneal tunnel syndrome cases.The transverse carpal ligaments were released under endoscope by skin traction technique in 15 cases.The axillary nerves were released under endoscope by self-made distraction device in 2 quadrilateral space syndrome cases.Results： All of the 41 cases were operated smoothly and successfully.There were no complications of nerve and vessel injured in all cases.The incision was 1 to 3 cm,shorter 3 to 10cm than it be in the open decompression operation.Thirty-seven cases were followed up ranged from 1 to 5 years.Improvement of symptoms occurred in all patients.The sensation function completely recovered in 1 to 3 months,the motor function recovered in 6 to 12 months.No recrudescent cases were found.Only one of the peroneal tunnel syndrome case was poor,and the muscle transfer was operated in the second stage.Conclusion： Artificial cavity technique can provide better visual field and operation space for endo-scopic peripheral nerve surgery,which is the key point to the success of endoscopic surgery.