透明外导管行Chow法内镜治疗腕管综合征  

Endoscopic Treatment of Carpal Tunnel Syndrome Following Chow's Technique with a Clear Cannula

作　　者：刘恒[1] 王瑞[1] 曹永平[1] 张道俭[1] 杨昕[1] 文立成[1] 

机构地区：[1]北京大学第一医院骨科,北京100034

出　　处：《实用骨科杂志》2014年第5期409-413,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨内镜下采用透明外导管双入口Chow法施行腕横韧带松解术治疗腕管综合征的疗效及安全性。方法选取2008年7月至2013年3月在北京大学第一医院以透明外导管行双入口Chow法治疗腕管综合征的27例患者38个腕关节。其中男4例,女23例;年龄25～66岁,平均52.81岁;右腕12例,左腕4例,双腕11例。根据术前症状按滨田分类法分级,Ⅰ级9腕,Ⅱ级6腕,Ⅲ级23腕。手术采用局麻、止血带,腕部小切口引入透明导管,在透明外导管内可分辨出肌腱、韧带、神经的情况下切开腕横韧带,松解正中神经。结果术后随访2～47个月,平均17.67个月。失访6例,共随访32个腕关节。单腕平均手术时间15 min,出血0 mL。术后1例出现疼痛、麻木加重,无正中神经、血管、肌腱损伤及神经黏连等并发症,无二次手术者。无皮肤深浅感觉障碍、无切口瘢痕疼痛者。握力及捏力均不同程度改善。术后Kelly分级评定,优18腕,良9腕,一般4腕,差1腕,优良率为84.3%。分级为一般及差的5例均出现在术前滨田分类Ⅲ级的患者中。结论关节镜下用可视的透明外套管行＂双孔道＂Chow法腕横韧带松解术结合了Chow法与Okutsu法的优点,皮肤切口小,组织创伤轻,手术时间短,术后不需石膏外固定,不残留大的手术瘢痕。此方法是一种有效且操作安全性高的微创术式。Objective To evaluate the effect and safety of the Chow＇s endoscopic procedures in the treatment of CTS with a clear cannula. Methods 27 patients（ 38 wrists,23 females and 4 males,15 left and 23 right,25 ～ 66 years old with an average age of 52. 81y） with CTS had a Chow＇s technique ECTR with a clear cannula in Orthopedic Department of 1st hospital of Peking University. There were 9 cases of grade Ⅰ,6 cases of grade Ⅱ,23 cases of grade Ⅲ according to Hamada＇s classification. Double small incision was made in the wrist and palm and an endoscope was used to observe the carpal ligament which was cut with a small hook blade under direct visualization. The mean follow-up was 17. 67 months（ 2 ～ 47 months）. Results The Kelly score was excellent in 18 wrists,good in 9 wrists,fair in 4 wrists and poor in 1 case among the 32 cases at the end point of the follow-up and the excellent and good rate was 84. 3%. No complications such as median nerve injury and adhesion,skin sensory dysfunction,scar pain occurred and no one got a second operation. The average surgery time was 15 min of each wrist and blood loss of 0 mL. The 5 fair / poor cases according to Kelly criteria were in the grade Ⅲ group. Conclusion Double-entry Chow endoscopic technique with a clear cannula for treatment of CTS,as a minimal invasive technique has the advantages of both Chow and Okutsu procedure. With smaller incisions and mild injury to normal tissue,it has the advantage of recovery,less pain,earlier return to work and activities.

关 键 词：内镜 腕管松解术 腕管综合征 

分 类 号：R651.3[医药卫生—外科学]