Vasiliadis Haris S, Tokis Anastasios V, Andrikoula Sofia I, Kordalis Nikolaos V, Beris Alexandros E, Xenakis Theodoros, Georgoulis Anastasios D
Department of Orthopaedic Surgery, University of Ioannina Medical School, Ioannina, Greece.
Arthroscopy. 2006 Aug;22(8):807-12. doi: 10.1016/j.arthro.2006.03.021.
The goal of this descriptive study was to investigate the anatomy of the carpal tunnel with respect to the related neurovascular structures, because a detailed knowledge of the complex anatomy of this region is essential to perform endoscopic carpal tunnel release.
Sixteen fresh-frozen cadaveric hands were used for the study. Dissection of the palmar aspect of the hand was performed by use of magnifying loupes, an operative microscope, and microsurgical instruments. All anatomic components were photographed, and dimensions were recorded by use of a micrometer. The distance from the radial aspect of the os pisiformis and the proximal and distal portals to the main structures that may be injured was measured. Topography of the transverse ligament and possible adhesions to the tendons and median nerve were also recorded.
The mean distance from the radial aspect of the os pisiformis to the radial border of Guyon's canal and the ulnar edge of the palmaris longus tendon was 10.3 mm (range, 9 to 12 mm) and 16.1 mm (range, 12 to 22 mm), respectively. The mean distance from the distal portal to the superficial palmar arch and the ulnar artery was 10.4 mm (range, 5 to 15 mm) and 7.6 mm (range, 4.5 to 9 mm), respectively. The mean distance from the distal edge of the transverse ligament to the thenar branch of the median nerve was 2.7 mm (range, 0 to 4.1 mm). The mean length of the transverse ligament was 31 mm (range, 25 to 34.5 mm). In 14 hands we also identified the palmaris longus tendon. In 11 hands we found adhesions between the transverse ligament and the sheath of the flexor tendons.
The palmaris longus can be used as a guide for the placement of the proximal portal. Staying at the ulnar side of the palmaris longus keeps the superficial palmar branch of the median nerve at a safe distance from the instruments. The "fat drop sign" is also a useful guide for the placement of the distal margin of the transverse carpal ligament, keeping the distal portal away from the superficial palmar arch. Synovial adhesions can usually cover the inferior surface of the transverse ligament, and they need to be removed for clear endoscopic identification of the transverse fibers before the ligament is cut.
Detailed knowledge of the complex anatomy of the carpal tunnel is essential to perform endoscopic carpal tunnel release.
本描述性研究的目的是研究腕管相对于相关神经血管结构的解剖结构，因为详细了解该区域的复杂解剖结构对于进行内镜下腕管松解术至关重要。
本研究使用了16只新鲜冷冻的尸体手。使用放大放大镜、手术显微镜和显微外科器械对手掌面进行解剖。对所有解剖结构进行拍照，并使用千分尺记录尺寸。测量了从豌豆骨桡侧以及近端和远端入口到可能受损的主要结构的距离。还记录了横韧带的局部解剖以及与肌腱和正中神经可能的粘连情况。
从豌豆骨桡侧到Guyon管桡侧边界和掌长肌腱尺侧边缘的平均距离分别为10.3mm（范围9至12mm）和16.1mm（范围12至22mm）。从远端入口到掌浅弓和尺动脉的平均距离分别为10.4mm（范围5至15mm）和7.6mm（范围4.5至9mm）。从横韧带远端边缘到正中神经鱼际支的平均距离为2.7mm（范围0至4.1mm）。横韧带的平均长度为31mm（范围25至34.5mm）。在14只手中还识别出了掌长肌腱。在11只手中发现横韧带与屈肌腱腱鞘之间存在粘连。
掌长肌可作为近端入口放置的引导。保持在掌长肌尺侧可使正中神经掌浅支与器械保持安全距离。“脂肪滴征”也是确定腕横韧带远端边缘位置的有用引导，可使远端入口远离掌浅弓。滑膜粘连通常可覆盖横韧带的下表面，在切断韧带前需要将其清除以便在内镜下清晰识别横行纤维。
详细了解腕管的复杂解剖结构对于进行内镜下腕管松解术至关重要。
