腕管综合征内镜诊治新方法——改良奥津法(附11例报告)

Endoscopic management of carpal tunnel syndrome——the reformed Okutsu methods (with report of 11 cases)

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。

Objective: To introduce a new technique——Endoscopic carpal tunnel released by the reformedOkutsu's technique——which has been introduced into from abroad and has been a common surgery for carpaltunnel syndrome. Methods; A 1cm skin incision is made under brachial plexus anaesthesia. The procedure is conducted with USE system (Universal Subcutaneous Endoscope System). According to the preoperative and postoperative electromyogramic results, not only the flexor retinaculum(FR) but also the distal holdfast fibers of the flexor retinaculum (DHFFR) should be cut off. After the DHFFR is released, the latency of CMAP in the median nerve decreased 1ms postoperatively. Results; 11 cases of CTS were treated with this method. Functional assessment has been made in each patient, using Kelly's methods after operation. Follow-up was conducted in the first, third month after the operation. 9 cases are excellent; 2 cases are good; no one is fair or poor. The average time of the operation is fifteen minutes. There is less blood losing in the procedure. Conclusions:Compared with open procedure, the minimal invasion has advantage of smaller incision less tissue damage, shorter operation time, less skin scar and no post-operation plastic splint. We should pay much attention to the complete decompression. The results of this approach are as efficient as routine procedure.