Tzaan Wen-Ching, Lui Tai-Ngar, Lee Shih-Tseng
Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan 204, ROC.
Chang Gung Med J. 2005 Feb;28(2):97-103.
Carpal tunnel syndrome is the most common entrapment neuropathy in humans today. For patients in whom conservative treatment fails, surgical decompression is indicated. Among the various surgical techniques currently in use, endoscopic techniques are becoming increasingly popular. Due to the rapid postoperative recovery shown after endoscopic operations, midpalmar accurate incision for carpal tunnel release is a comparative alternative.
From February 1998 through January 2003, 84 patients had undergone 96 midpalmar carpal tunnel releases with accurate skin incisions under regional block or general mask anesthesia. The postoperative evaluations were performed via subjective assessment with a standardized telephone interview over an average follow-up period of 22.4 months.
The average operation time was 16 minutes (range, 5 to 40 minutes). A total of 87 hands (91%) had excellent or good recovery in terms of symptom relief (improvement of 70% or greater). The incidence of postoperative sensory morbidity, i.e., pillar pain or scar tenderness, was 7% (7 hands). The motor functional morbidity of a persistent subjective decrease in grip strength was noted in 8% (8 hands), and the mean period for returning to work was 4.5 weeks. In addition, no operation-induced neurovascular or tendinous injury occurred in any patient.
The outcomes were similar to those of endoscopic carpal tunnel release. Based on these results, midpalmar carpal tunnel release with accurate location of skin incision is as effective as any other surgical procedures for carpal tunnel release. Furthermore, it is also a safe and simple procedure.
腕管综合征是当今人类最常见的卡压性神经病变。对于保守治疗失败的患者，需进行手术减压。在目前使用的各种手术技术中，内镜技术越来越受欢迎。由于内镜手术后恢复迅速，掌中部精准切口腕管松解术是一种可供比较的选择。
从1998年2月至2003年1月，84例患者在区域阻滞或全身面罩麻醉下接受了96次掌中部腕管精准皮肤切口松解术。术后评估通过标准化电话访谈进行主观评估，平均随访期为22.4个月。
平均手术时间为16分钟（范围5至40分钟）。就症状缓解而言（改善70%或更高），共有87只手（91%）恢复良好或极佳。术后感觉并发症的发生率，即柱状疼痛或瘢痕压痛，为7%（7只手）。握力持续主观下降的运动功能并发症发生率为8%（8只手），平均重返工作岗位时间为4.5周。此外，没有患者发生手术引起的神经血管或肌腱损伤。
结果与内镜腕管松解术相似。基于这些结果，掌中部腕管松解术且皮肤切口定位精准与其他任何腕管松解手术方法一样有效。此外，它也是一种安全且简单的手术。
