Proubasta Ignacio R, Lluch Alberto, Lamas Claudia G, Oller Barbara T, Itarte Joan P
Hand Surgery Unit, Orthopaedic Department, Hospital Sant Pau, Barcelona, Spain.
Neurosurgery. 2007 Oct;61(4):810-3; discussion 813-4. doi: 10.1227/01.NEU.0000298910.01754.13.
The release of the transverse carpal ligament (TCL) for relief of carpal tunnel syndrome has been a standard operative procedure since the early 1950s. Although complications are not common after the open surgical technique, a small but significant group of patients will have similar symptoms after surgery or will experience new symptoms in the postoperative period. Incomplete section of the TCL is the major cause of these complications. The authors have described two signs that confirm a complete release of the TCL, called the "fat pad" and "little finger pulp" signs.
Between 2000 and 2003, we treated 643 hands in 611 patients (45 men and 566 women; age range, 32-76 yr; mean age, 58.2 yr). All patients were examined 6 months after the procedure, with special attention given to the persistence or recurrence of symptoms. The presence of palmar scar pain, residual numbness, patient satisfaction, and time to return to work were also evaluated. A longitudinal incision (2 cm) at the base of the palm was used to release the TCL. A good indicator that the distal TCL has been released is the visualization of a fatty tissue ("fat pad" sign). This fatty tissue is always present underneath the most distal fibers of the TCL, covering the sensory digital branches of the median nerve. To confirm the complete release of the proximal fibers of the TCL, we should be able to introduce the little finger pulp in a proximal direction underneath the distal flexion crease of the wrist ("little finger pulp" sign). When both signs are confirmed, we can be certain that the TCL is completely released.
Night pain disappeared immediately after surgery in all patients except three. There were seven complications (1%) not related to the palmar scar and 10 complications (1.5%) related to it. However, all of these complications disappeared an average of 3 months postoperatively. Patient satisfaction was 100%, and the mean time to return to work and full activity was 22 days (range, 14-36 d).
Two surgical observations that are reliable to confirm a complete release of the TCL were described. The first, called the "fat pad" sign, is useful to determine whether or not the distal end of the TCL has been adequately released, whereas the "little finger pulp" sign indicates whether or not the proximal end of the TCL has been fully divided.
自20世纪50年代初以来，横腕韧带（TCL）松解术一直是缓解腕管综合征的标准手术方法。尽管开放手术技术后并发症并不常见，但仍有一小部分但数量可观的患者术后会出现类似症状或在术后出现新症状。TCL切断不完全是这些并发症的主要原因。作者描述了两种可确认TCL完全松解的体征，即“脂肪垫”和“小指指腹”体征。
2000年至2003年，我们治疗了611例患者的643只手（45例男性和566例女性；年龄范围32 - 76岁；平均年龄58.2岁）。所有患者在手术后6个月接受检查，特别关注症状的持续或复发情况。还评估了手掌瘢痕疼痛、残留麻木、患者满意度以及恢复工作的时间。在手掌根部做一个纵向切口（2厘米）来松解TCL。一个表明远端TCL已被松解的良好指标是可见脂肪组织（“脂肪垫”体征）。该脂肪组织总是存在于TCL最远端纤维下方，覆盖正中神经的感觉指支。为确认TCL近端纤维已完全松解，我们应能够将小指指腹沿近端方向插入腕部远端屈褶下方（“小指指腹”体征）。当两种体征都得到证实时，我们就可以确定TCL已完全松解。
除3例患者外，所有患者术后夜间疼痛立即消失。有7例（1%）并发症与手掌瘢痕无关，10例（1.5%）并发症与手掌瘢痕有关。然而，所有这些并发症平均在术后3个月消失。患者满意度为100%，恢复工作和完全活动的平均时间为22天（范围14 - 36天）。
描述了两种可靠的手术观察方法以确认TCL完全松解。第一种称为“脂肪垫”体征，有助于确定TCL远端是否已充分松解，而“小指指腹”体征则表明TCL近端是否已完全切断。
