Krishnan Kartik G, Pinzer Thomas, Schackert Gabriele
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
Neurosurgery. 2006 Jul;59(1 Suppl 1):ONS89-100; discussion ONS89-100. doi: 10.1227/01.NEU.0000219979.23067.5C.
To describe a simple retractor integrated endoscopic technique for treating idiopathic solitary compression neuropathies with special attention to the anterior transposition of the ulnar nerve and tarsal tunnel release, and to present the clinical results.
Eleven patients with ulnar sulcus syndrome, eight with tarsal tunnel syndrome, and one with meralgia paraesthetica (seven females and 13 males; age range, 12-64 yr) were treated with endoscopic anterior ulnar nerve transposition and in situ decompression of the tibial (eight patients) and lateral femoral cutaneous nerves (one patient), respectively. The selection criteria were: classical nerve compression symptoms, failed conservative treatment, abnormal electrophysiology, and a nonviolated anatomic region. The degree of nerve compression (after Dellon) was rated as moderate in five out of 20 patients and as severe in 15 out of 20 patients. Electrophysiological studies were conducted independently by physicians specializing in these techniques. Postoperative recovery was evaluated according to the nine-point Bishop rating system.
Of the 11 patients with anterior ulnar nerve transposition, seven scored excellent, three scored good, and one scored fair (mean follow-up, 15.5 mo; range, 6-27 mo). Five patients with tarsal tunnel release scored excellent and three scored good (mean follow-up, 10.1 mo; range, 3-24 mo). The patient with meralgia paraesthetica showed an excellent score at 28 months after surgery. There were no technical or postoperative complications. None of the operations had to be converted to open surgery.
We describe a new endoscopic technique for transposing the ulnar nerve and decompressing the tibial nerve. This technique could be extrapolated to release other single nerve entrapments. The simplicity of the technique, and our preliminary clinical results, may encourage other groups to adapt this method.
描述一种简单的牵开器辅助内镜技术，用于治疗特发性单发性压迫性神经病变，尤其关注尺神经前置和跗管松解，并展示临床结果。
11例尺神经沟综合征患者、8例跗管综合征患者和1例股外侧皮神经感觉异常患者（7例女性和13例男性；年龄范围12 - 64岁）分别接受了内镜下尺神经前置以及胫神经（8例患者）和股外侧皮神经（1例患者）的原位减压治疗。选择标准为：典型的神经压迫症状、保守治疗失败、电生理异常以及解剖区域未受侵犯。20例患者中，5例神经压迫程度（根据Dellon法）为中度，15例为重度。电生理研究由专门从事这些技术的医生独立进行。术后恢复情况根据九点Bishop评分系统进行评估。
11例尺神经前置患者中，7例评分优秀，3例评分良好，1例评分中等（平均随访15.5个月；范围6 - 27个月）。5例跗管松解患者评分优秀，3例评分良好（平均随访10.1个月；范围3 - 24个月）。股外侧皮神经感觉异常患者术后28个月时评分优秀。未出现技术或术后并发症。所有手术均未转为开放手术。
我们描述了一种用于尺神经前置和胫神经减压的新内镜技术。该技术可推广用于松解其他单神经卡压。该技术的简单性以及我们的初步临床结果，可能会促使其他团队采用这种方法。
