Assmus H, Staub F
Neurochirurgische Gemeinschaftspraxis, Dossenheim.
Handchir Mikrochir Plast Chir. 2006 Oct;38(5):331-3. doi: 10.1055/s-2006-923780.
An inadequate indication for a carpal tunnel revision procedure may be followed by disastrous sequelae for the patient. So it may be justified to talk of iatrogenic CTS. A patient suffering from bilateral CTS is presented who had been operated on six times in all. The following techniques had been used by an orthopedic surgeon, a neurologist, a neurosurgeon and a hand surgeon: microsurgical neurolysis, epineurectomy, neuroma resection, tenosynovectomy and finally a hypothenar fat flap. Initial cause for this fatal series was scar tenderness following lesion of the muscular and palmar branches of the median nerve in the first or second operation. Since sensory nerve conduction was normal after decompression had been performed, there would have been no indication for further surgery of the median nerve. Resection of the neuromas of the two injured branches was not followed by any relief for the patient nor did wrapping the nerve in a fat flap help. Such courses may lead to high costs in health care and occupational disability. They can be avoided by competent neurological and electrophysiological examination, correct interpretation of findings as well as critical consideration of the indication for revision procedures.
腕管修复手术指征不充分可能会给患者带来灾难性后果。因此，医源性腕管综合征的说法是合理的。本文介绍了一位双侧腕管综合征患者，总共接受了六次手术。一名骨科医生、一名神经科医生、一名神经外科医生和一名手外科医生采用了以下技术：显微神经松解术、神经外膜切除术、神经瘤切除术、腱鞘切除术，最后采用小鱼际脂肪瓣术。这一系列致命手术的最初原因是第一次或第二次手术中正中神经肌肉支和掌支损伤后的瘢痕压痛。由于减压术后感觉神经传导正常，因此没有进一步对正中神经进行手术的指征。切除两根受损神经分支的神经瘤并没有使患者病情缓解，用脂肪瓣包裹神经也没有效果。这样的治疗过程可能会导致高昂的医疗费用和职业残疾。通过专业的神经学和电生理检查、对检查结果的正确解读以及对修复手术指征的审慎考虑，可以避免这些情况的发生。
