手掌侧单孔入路微创治疗腕管综合征的解剖学研究

Anatomic study of the volar single-aperture approach of endoscopic carpal tunnel release

目的报道手掌侧单孔入路微创治疗腕管综合征的解剖入路及手术方法,为手掌侧入路微创治疗腕管综合征手术提供解剖学基础。方法选取16例新鲜成人上肢标本,解剖观测腕管及手掌的相关解剖结构。选取6例新鲜成人上肢标本进行模拟手术,镜视下切开屈肌支持带并进行神经外膜松解。结果手术入路点为拇指呈最大外展位,沿掌指关节尺侧取一平行线,与中、环指间的长轴线交叉点处向尺侧1cm处,操作层面为浅筋膜层与掌腱膜间的腔隙。结论手掌侧单孔入路微创治疗腕管综合征是安全可行的,在镜视下可彻底切开屈肌支持带并进行神经外膜松解,有利于术者进行操作及减轻术中损伤。

Objective To report the palmar approach and surgical method for the view to provide anatomical data for the volar single-aperture approach of endoscopic carpal tunnel release（ECTR）. Methods 16 specimens of fresh adult upper limb were used to observe and measure the anatomical structures in the carpal tunnel and palm. 6 specimens of fresh adult upper limb were used randomly to simulate the operation that divided the flexor retinaculum and released the median nerve of ECTR by one-point technique in palm. Results The best entrance point in palm of ECTR： Draw a parallel line along the thumb in the maximal abduction position to the ulnar side, and draw a axis between the middle finger and the ring finger; Mark the intersection of the lines, and then take an incision in the ulnar aspect about lcm away from the intersection. Surgical plane was the lacunar space between the superficial fascia and palmar aponeursis. Conclusion Our study confirms that ECTR by one-point technique in palm is safe and feasible. It＇ s practical for surgeons to adopt the surgical approach of ECTR and avoid damage during severance offlexor retinaculum and relief of the median nerve under endoscope.