切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (06) : 503 -506. doi: 10.3877/cma.j.issn.1673-9450.2024.06.009

论著

内窥镜辅助下改良Okutsu 法治疗腕管综合征的临床疗效
齐伟亚1, 方杰1, 左志诚2, 刘桂谦1, 裴广楠1, 刘波3,()   
  1. 1.221004 徐州仁慈医院手外科
    2.215004 苏州医科大学附属第二医院手足外科2
    3.100035 首都医科大学附属北京积水潭医院手外科
  • 收稿日期:2024-05-14 出版日期:2024-12-01
  • 通信作者: 刘波

Clinical efficacy of endoscopic assisted modified Okutsu method in the treatment of carpal tunnel syndrome

Weiya Qi1, Jie1 Fang1, Zhicheng Zuo2, Guiqian1 Liu1, Guangnan Pei1, Bo Liu3,()   

  1. 1.Department of Hand Surgery,Xuzhou Renci Hospital, Xuzhou 221004, China
    2.Department of Hand and Foot Surgery,Second Affiliated Hospital of Soochow University, Suzhou 215004, China
    3.Department of Hand Surgery,Bejing Jishuitan Hospital,Capital Medical University,Bejing 100035,China
  • Received:2024-05-14 Published:2024-12-01
  • Corresponding author: Bo Liu
引用本文:

齐伟亚, 方杰, 左志诚, 刘桂谦, 裴广楠, 刘波. 内窥镜辅助下改良Okutsu 法治疗腕管综合征的临床疗效[J]. 中华损伤与修复杂志(电子版), 2024, 19(06): 503-506.

Weiya Qi, Jie1 Fang, Zhicheng Zuo, Guiqian1 Liu, Guangnan Pei, Bo Liu. Clinical efficacy of endoscopic assisted modified Okutsu method in the treatment of carpal tunnel syndrome[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(06): 503-506.

目的

探讨内窥镜辅助下于腕管外切开腕横韧带治疗腕管综合征的临床疗效,评估内窥镜单入路对术后掌根痛及手功能感觉恢复的临床效果。

方法

回顾性分析自2021 年6 月至2023年6 月徐州仁慈医院手外科24 例腕管综合征患者,采用远端腕横纹处单一横切口,腕管外简易扩张,内窥镜辅助下切开腕横韧带,术后观察掌根痛以及正中神经支配区皮肤麻木恢复程度和拇指运动功能。 应用顾玉东推荐的腕管综合征功能评定标准评价手功能及感觉。

结果

24 例患者均获得随访,术后1 d 麻木症状缓解,切口无感染,掌根无柱状痛。 术后6 个月根据腕管综合征功能评定标准优19例,良3 例,可2 例,优良率为91.67%。

结论

内窥镜辅助下改良Okutsu 法是治疗腕管综合征的一种安全有效的微创手术,其疗效可靠,康复时间短,是值得推荐的治疗方法。

Objective

Explore the clinical efficacy of endoscopic assisted incision of the transverse carpal ligament outside the carpal tunnel for the treatment of carpal tunnel syndrome, and evaluate the clinical effect of endoscopic single approach on postoperative palmar root pain and hand functional sensation recovery.

Methods

A retrospective analysis was conducted on 24 patients with carpal tunnel syndrome in Department of Hand Surgery of Xuzhou Renci Hospital from June 2021 to June 2023.A single transverse incision was made at the distal wrist crease, with simple expansion outside the carpal tunnel.The transverse ligament of the wrist was incised with endoscopic assistance, and postoperative palmar root pain, recovery of skin numbness in the median nerve innervation area, and thumb motor function were observed.The carpal tunnel syndrome assessment criteria recommended by Gu Yudong were applied to assess hand function and sensation.

Results

All 24 patients were followed up and their numbness symptoms improved one day after surgery.There was no infection in the incision and no columnar pain in the palm root.6 months after surgery,according to criteria of carpal tunnel syndrome, 19 cases were rated as excellent, 3 cases as good, and 2 cases as fair, with excellent and good rate of 91.67%.

Conclusion

The modified Okutsu method assisted by endoscopy is a safe and effective minimally invasive surgery for the treatment of carpal tunnel syndrome as a recommendable method, with reliable efficacy and short recovery time.

表1 腕管综合征的功能评定标准
图1 患者女,52 岁,长期从事家务劳动,右侧腕管综合征。 A 示术前大鱼际肌无萎缩;B 示中注射器透明通道扩张;C 示镜下剪开腕管;D 示术后小切口1.0 cm;E 示术后14 个月复诊手部疤痕照片;F~H 示术后对掌、屈拇、外展功能恢复
[1]
Graham B, Peljovich AE,Afra R,et al.The American academy of orthopaedic surgeons evidence-based clinical practice guideline on: management of carpal tunnel syndrome[J].J Bone Joint Surg Am,2016,98(20):1750-1754.
[2]
Ibrahim I, Khan WS, Goddard N,et al.Carpal tunnel syndrome: a review of the recent literature[J].Open Orthop J,2012,6:69-76.
[3]
Okutsu I,Hamanaka I,Chiyokura Y,et al.Intraneural median nerve pressure in carpal tunnel syndrome[J].J Hand Surg Br,2001,26(2):155-156.
[4]
Pomphrey MM Jr.Endoscopic carpal tunnel release: its time has come[J].Mo Med,1998,95(12):670-671.
[5]
Okutsu I,Ninomiya S,Natsuyama M,et al.Subcutaneous operation and examination under the universal endoscope [ J].Nihon Seikeigeka Gakkai Zasshi,1987,61(5):491-498.
[6]
顾玉东.腕管综合征与肘管综合征功能评定标准的现状与建议[J].中华创伤骨科杂志,2011,13(1):6-7.
[7]
陈曦,曹瑾瑾,芮晶,等.腕管综合征发病危险因素的病例对照研究[J].中华手外科杂志,2023,39(4):331-335.
[8]
顾玉东.腕管综合征与肘管综合征诊治中的有关问题[J].中华手外科杂志,2010,26(6):321-323.
[9]
Badger SA,O'Donnell ME,Sherigar JM,et al.Open carpal tunnel release--still a safe and effective operation[J].Ulster Med J,2008,77(1):22-24.
[10]
钱月楼,王秋桂,万敬枝,等.正中神经掌皮支的应用解剖[J].中华手外科杂志,2002,18(1):289-292.
[11]
童劲松,董震.周围神经卡压的诊疗进展[J].中华手外科杂志,2021,37(3):219-222.
[12]
史其林,薛峰,王金武,等.腕管综合征在内窥镜视下手术与常规手术的疗效比较[J].中华手外科杂志,2000,16(3):152.
[13]
孟国成,陈立科,陈四华,等.三种手术方式治疗腕管综合征的临床优劣分析[J].中华手外科杂志,2011,27(4):246-247.
[14]
茅天,谢仁国,汤锦波.腕管综合征术后柱状痛的临床研究[J].中华手外科杂志,2010,26(6):369-371.
[15]
顾玉东,史其林,孙贵新.内窥镜下松解腕管综合征的神经并发症[J].中华手外科杂志,2003,19(3):151-152.
[16]
Chow JC.Endoscopic release of the carpal ligament for carpal tunnel syndrome: 22-month clinical result[J].Arthroscopy,1990,6(4):288-296.
[17]
庄永青,刘靖波,魏瑞鸿,等.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[J].中华手外科杂志,2017,33(4):289-292.
[18]
孙贵新,史其林,郑宪友,等.Okutsu 法与Chow 法内窥镜下治疗腕管综合征的手术方法与疗效分析[J].中国内镜杂志,2004,10(11):28-31.
[19]
赵睿,鲜航,史林,等.使用单一腕上横切口对改善腕管综合征术后疼痛的效果评估[J].中华手外科杂志,2021,37(6):406-409.
[20]
Bo Liu,Feiran Wu.Initial outcomes of a novel high-visibility endoscopic carpal tunnel release technique[J].J Wrist Surg,2021,10(1):64-69.
[1] 权赫磊, 罗渝昆, 王月香, 朱亚琼, 姜波. 高频超声在腕管综合征病因学评价中的应用[J]. 中华医学超声杂志(电子版), 2022, 19(05): 454-458.
[2] 李芸, 明佳. 腋窝单孔腔镜辅助下乳房切除术加一期乳房重建研究进展[J]. 中华乳腺病杂志(电子版), 2022, 16(05): 315-318.
[3] 蔡茗, 俞亚红. 胆总管结石术后复发危险因素的研究进展[J]. 中华普通外科学文献(电子版), 2022, 16(06): 438-442.
[4] 陈燕. LCBDE和ERCP+EST治疗胆囊结石合并胆总管结石的疗效观察[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 385-388.
[5] 鲁鑫, 杨琴, 许佳怡. 不同术式治疗恶性梗阻性黄疸疗效及对免疫功能的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 180-183.
[6] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[7] 宋奇锋, 高良辉, 林师佈, 李永强, 曾维乾. 三种不同预切法在ERCP困难插管中的临床效果分析[J]. 中华普外科手术学杂志(电子版), 2022, 16(05): 526-529.
[8] 朱俊杰, 王斌, 刘覃, 蔡志杰. LC联合LCBDE对急性结石性胆囊炎合并胆总管结石的临床疗效[J]. 中华普外科手术学杂志(电子版), 2022, 16(04): 458-461.
[9] 葛蓓蕾, 孙静. vNOTES入路建立与缝合技术关键点[J]. 中华腔镜外科杂志(电子版), 2024, 17(01): 4-8.
[10] 黄金鑫, 陈佳骏, 王旋, 曲岩, 张晞文, 李甫. ERCP在胆胰合流异常患者诊治中的应用[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 699-704.
[11] 张天献, 吕云福, 郑进方. LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石效果Meta分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 45-50.
[12] 范清泉, 宋晓玲, 翁明哲, 顾钧. 消化道重建术后ERCP安全性和疗效分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 331-335.
[13] 郭世龙, 杨潇, 胡欢欢, 杨梁, 周文富, 丛魁武, 张雨胜, 李英锋. ERCP在胆胰疾病微创治疗中的有效性及安全性[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 216-220.
[14] 郝杰, 李宇, 陈晨, 杨雪, 陶杰, 王铮, 董鼎辉, 仵正, 孙昊. 十二指肠侧视镜引导下ERCP在消化道重建术后胆胰疾病治疗中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 221-226.
[15] 郑慧媛, 马新春, 张英, 张玉梅. 克拉霉素联合鼻窦内窥镜手术对慢性鼻窦炎鼻息肉患者炎症反应和免疫功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(01): 63-67.
阅读次数
全文


摘要