一种新的手掌侧单孔入路微创治疗腕管综合征的解剖与临床研究  

Anatomic and clinical study of a new surgical procedure with volar single-portal approach for minimally invasive treatment of carpal tunnel syndrome

作　　者：庄永青 刘靖波[2] 魏瑞鸿[1] 姜浩力[1] 熊洪涛[1] 方锡池[1] 温桂芬[1] 蔡妙霞[1] 刘兆康[1] 劳杰[2] Zhuang Yongqing Liu Jingbo Wei Ruihong Jiang Haoli Xiong Hongtao Fang Xichi Wen Guifen Cai Miaoxia Liu Zhaokang Lao Jie(Department of Hand Microsurgery, Shenzhen People＇s Hospital Affiliated to the Second Clinical College of Jinan University, Guangdong 518020, China)

机构地区：[1]深圳市人民医院暨南大学第二临床医学院手显微血管外科,广东518020 [2]复旦大学附属华山医院手外科,上海

出　　处：《中华手外科杂志》2017年第4期289-292,共4页Chinese Journal of Hand Surgery

基　　金：深圳市科研项目（JCYJ20140416122811970）;深圳市卫生科技项目（201506006）

摘　　要：目的研究一种新的手掌侧单孔入路微创治疗腕管综合征的解剖学基础及临床治疗效果。方法在8具16侧新鲜成人上肢标本上，对腕管及手掌结构进行解剖学观察及测量，确定手掌侧单孔入路微创治疗腕管综合征手术入路点、手术操作标志线及操作层面。依据解剖研究结果，采用该术式治疗中重度腕管综合征患者68例，术后随访患者恢复隋况，与同期行传统开放手术的75例患者进行对比。结果解剖研究表明该术式较佳的手术入路点：拇指呈最大外展位，掌指关节沿尺侧取一平行线，与中环指间的长轴线交叉点处向尺侧1cm，呈45°。手术操作标志线：掌长肌腱与远侧腕横纹的交点，手术入路点与该交点用直线连接。手术操作层面：手掌浅筋膜层与掌腱膜间的腔隙。所有患者术后随访时间为6-12个月，平均9．5个月，按顾玉东的腕管综合征术后功能评定标准评定，该微创治疗术式效果满意，术后患手麻痛症状、感觉检查、肌肉萎缩、对掌功能、捏力、握力等得到明显改善，瘢痕痛极少，较传统手术具有明显优点。结论可手掌侧单孔入路微创治疗腕管综合征有临床解剖基础，能有效达到切开屈肌支持带，解除正中神经受压的手术目的，是一种有效的治疗腕管综合征的微创方法。Objective To investigate the anatomical basis and clinical effects of a new surgical procedure with volar single-portal approach for minimally invasive treatment of carpal tunnel syndrome. Methods On 8 fresh adult upper limb specimens （16 sides）, anatomical observation and measurement of carpal tunnel and palm structures were performed to determine the entry point, guide line and operative level of a new surgical procedure with volar single-portal approach for minimally invasive treatment of carpal tunnel syndrome. According to the anatomical findings, the new operation was performed on 68 patients with moderate to severe carpal tunnel syndrome. Postoperative recovery of the patients was followed up and compared with that of 75 patients who received conventional open carpal tunnel release at the corresponding period. Results According to the results of anatomical study, the best entry point of the surgical procedure was determined as following. A line parallel and ulnar to the metaearpophalangeal joint was drawn when the thumb was at maximum radial abduction. Another line was drawn along the long axis between the index and middle fingers. A 1-cm long vertical incision was made at 45° and 1-cm ulnar to the intersection of these two lines. The surgical projection line was the line connecting the surgical incision and the intersection point between palmaris longus tendon and distal wrist crease. The dissection plane was the space between the superficial palmar fascia and the palmar aponeurosis. The 68 minimally invasive surgery treated cases were follow-up for 6 to 12 months, the average follow-up being 9.5 months. Based on the carpal tunnel syndrome postoperative functional assessment criteria proposed by Gu, the results were satisfactory. Postoperative pain symptoms, sensory examination, muscle atrophy, thumb opposition, pinching and grip strength were all significantly improved. There was very little postoperative sear pain. Compared with the conventional surgery the minimally invasive procedure has obvious

关 键 词：腕管综合征 外科手术 微创性 解剖学 临床研究 

分 类 号：R688[医药卫生—骨科学]