Seiler J G, Barnes K, Gelberman R H, Chalidapong P
Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston 02114.
J Hand Surg Am. 1992 Nov;17(6):996-1002. doi: 10.1016/s0363-5023(09)91045-0.
To determine the relationship of neurovascular structures to the sites of portal placement and transverse carpal ligament division during two-portal endoscopic carpal tunnel release, a study of 20 fresh cadaver specimens was carried out. Open dissection of the carpal tunnel after endoscopic surgery showed complete ligamentous release in 18 hands (90%). In 10 specimens, the procedure was performed as described by Chow. There was one partial transection of the superficial palmar arch (5%), and five specimens (50%) had complete divisions of the superficial palmar fascia with considerable pressure placed on the ulnar nerve at the wrist. A modified technique was used in 10 specimens in which the proximal incision was made in a more distal location and a distally based ligamentous flap was created. The superficial palmar arch and the distal edge of the transverse carpal ligament were visualized directly before passage of the trocar. No complications were noted with this method.
为确定在双切口内镜下腕管松解术中神经血管结构与切口位置及腕横韧带切开部位之间的关系，我们对20个新鲜尸体标本进行了研究。内镜手术后对腕管进行开放解剖显示，18只手（90%）实现了韧带完全松解。在10个标本中，手术按照Chow所描述的方法进行。有1例掌浅弓部分横断（5%），5个标本（50%）的掌浅筋膜完全切开，且腕部尺神经受到相当大的压迫。在10个标本中采用了改良技术，近端切口在更靠远端的位置进行，并制作了一个以远端为基底的韧带瓣。在套管针穿刺前可直接看到掌浅弓和腕横韧带的远端边缘。该方法未发现并发症。
