Zitoun Y, Abid F, Ben Ghozlen H, Masmoudi L, Ayadi F, Hamdi M-F, Sassi N
Service d'Orthopédie, Hôpital Tahar Sfar, 5100 Mahdia, Tunisie.
Rev Chir Orthop Reparatrice Appar Mot. 2003 Dec;89(8):730-2.
Acute carpal tunnel syndrome resulting from acute metacarpal osteomyelitis is an exceptional etiopathogenic entity. A 6-year-old boy developed an acute carpal tunnel syndrome on the left four days after trauma. The carpal tunnel was opened in an emergency setting and exploration revealed a pale median nerve with infiltration of neighboring tissue. After release, pus issued from the depth of the tunnel. A posterior approach disclosed the collection and a total loss of the 4th metacarpal periosteum, leading to the diagnosis of acute osteomyelitis. Edema and pain regressed rapidly with antibiotic therapy. A pathologic fracture of the 4th metacarpal discovered three months later was treated conservatively. At 10 months, the child has a very good functional result despite persistence of a short 4th metacarpal after healing. There was no motor or sensitive neurological deficit and thumb opposition was complete. We have been unable to find any other report of acute metacarpal osteomyelitis leading to acute carpal tunnel syndrome. Emergency treatment is crucial. Opening the annular ligament is the only way to achieve complete nerve recovery.
急性掌骨骨髓炎导致的急性腕管综合征是一种罕见的致病实体。一名6岁男孩在创伤后4天出现左侧急性腕管综合征。在紧急情况下切开腕管，探查发现正中神经苍白，周围组织有浸润。松解后，有脓液从腕管深处流出。后路手术发现了脓肿，第四掌骨骨膜完全缺失，从而诊断为急性骨髓炎。抗生素治疗后水肿和疼痛迅速消退。三个月后发现的第四掌骨病理性骨折采用保守治疗。10个月时，尽管愈合后第四掌骨仍短，但患儿功能恢复良好。没有运动或感觉神经功能缺损，拇指对掌功能完全。我们未能找到其他急性掌骨骨髓炎导致急性腕管综合征的报告。紧急治疗至关重要。切开环状韧带是实现神经完全恢复的唯一方法。
