[1]奥津一郎,Ikki Hamanaka,Aya Yoshida,等.什么是腕管综合征的真正内镜手术?--18年5 880例临床经验[J].中国微创外科杂志,2005,05(5):342-346.
　Ichiro Okutsu.What is true endoscopic surgery for carpal tunnel syndrome? - 5 880 clinical experiences in 18 years[J].Chinese Journal of Minimally Invasive Surgery,2005,05(5):342-346.
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什么是腕管综合征的真正内镜手术?--18年5 880例临床经验()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
05
期数:
2005年5期
页码:
342-346
栏目:
国外专稿
出版日期:
2005-05-31

文章信息/Info

Title:
What is true endoscopic surgery for carpal tunnel syndrome? - 5 880 clinical experiences in 18 years
作者:
奥津一郎; Ikki Hamanaka; Aya Yoshida; 史其林
Okutsu Minimally Invasive Orthopaedic Clinic,Tokyo 106-0047,Japan
Author(s):
Ichiro Okutsu
关键词:
腕管综合征;  内镜
分类号:
R686.5
文献标志码:
A
摘要:
腕管综合征是常见的卡压性周围神经病变,由正中神经在腕管内受到卡压引起.它的手术治疗方法在于从掌侧切开腕管,减压正中神经.术式有最初非开放的盲切手术、开放手术、以及利用内镜手术(主要分为单切口和双切口法两类)等.笔者在1986年首创了应用USE (universal subcutaneous endoscope)系统单切口法治疗腕管综合征,力求创伤最小、最安全的手术方式.USE系统由透明闭锁外套管和30°斜视内镜组成.这是真正意义上的内镜手术,与内镜辅助下的手术在视野、绝对禁忌证等多方面都不同.笔者术中在局麻下,透过透明外套管在内镜直视下在腕管内用钩刀或改良方法于腕管外用推刀彻底切断腕横韧带和DHFFR(distal holdfast fibers of the flexor retinaculum),达到腕管开放减压的目的,并可于术中通过透光实验及腕管压力测定等方法判断腕管是否完全开放以保证手术效果.另外,笔者还在腕管综合征的诊断方面,新创一种神经诱发体征,命名为Okutsu Test.它的阳性率高于Phalen Test,而且在正常人群中没有发现假阳性.然而最准确的腕管综合征诊断方法是腕管压力测定.通过正常对照,确定在腕管综合征术前休息位腕管内压力高于15 mm Hg,握拳位是腕管内压力高于135 mm Hg的诊断指标.采用腕管压力测定可以不仅可以用于诊断、还可以在术中测定判断腕管减压程度.笔者应用USE系统在18年中进行了5 880例腕管综合征的治疗,经过最少6月、平均2.4年的随访,近90%的患者在术后24周痛、触觉恢复正常,电生理检查和MRI检查结果也提示了良好的临床效果.并发症的发生率为0.34%,包括假性动脉瘤、局部血肿形成、暂时性尺神经麻痹等,无屈肌腱和神经损伤.本文介绍的应用USE系统取前臂切口内镜下治疗腕管综合征的方法是真正的内镜下微创手术,对健康组织损伤最小、并发症发生危险性最低,治疗效果满意可靠.

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备注/Memo

备注/Memo:
①（复旦大学附属华山医院骨科,上海,200040）
更新日期/Last Update: 2014-03-31