Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, Catholic University of Korea, Wonmi-gu, Korea.
Arch Orthop Trauma Surg. 2010 Jul;130(7):829-34. doi: 10.1007/s00402-010-1053-z. Epub 2010 Jan 22.
Thenar muscle atrophy is a common finding in long-standing severe carpal tunnel syndrome (CTS). Combination of carpal tunnel release and Camitz opponensplasty has been used to treat severe CTS with thenar muscle atrophy. Camitz opponensplasty is beneficial for abduction, but provides little benefit to thumb flexion and pronation. This problem could be overcome by the use of a pulley.
Twelve cases of long-standing CTS with severe thenar muscle atrophy in 11 patients were investigated. They were treated with the modified Camitz opponensplasty using a pulley at the ulnar side remnant of the flexor retinaculum at the time of carpal tunnel release. Outcome was assessed by clinical grade of thenar muscle atrophy, degree of thumb opposition and the patient's satisfaction.
The average grade of thenar muscle atrophy improved from grade 3 pre-operatively to grade 0.83 at the last follow-up. Mean maximal palmar abduction improved from 3.6 to 6.8 cm, and spatial rotation improved from 54 degrees to 83 degrees . Kapandji tip opposition changed from 65 to 85% symmetry at the last follow-up. All 11 patients were 'very satisfied' or 'satisfied' with the outcome.
Modified Camitz opponensplasty is a simple procedure that provides immediate improvement of thenar function. Palmar flexion and pronation can be further improved by addition of a pulley.
大鱼际肌萎缩是慢性严重腕管综合征（CTS）的常见表现。腕管松解联合 Camitz 对掌成形术已用于治疗伴有大鱼际肌萎缩的严重 CTS。Camitz 对掌成形术有利于外展，但对拇指屈曲和旋前作用有限。这一问题可以通过使用滑轮来克服。
对 11 例 12 例慢性 CTS 伴严重大鱼际肌萎缩患者进行研究。在施行腕管松解的同时，于屈肌支持带尺侧残端使用滑轮进行改良的 Camitz 对掌成形术。通过大鱼际肌萎缩的临床分级、拇指对掌程度和患者满意度评估结果。
大鱼际肌萎缩的平均分级从术前的 3 级改善至末次随访时的 0.83 级。最大掌侧外展平均从 3.6cm 改善至 6.8cm，空间旋转从 54 度改善至 83 度。Kapandji 尖端对掌从末次随访时的 65%对称改善至 85%对称。所有 11 例患者对结果非常满意或满意。
改良的 Camitz 对掌成形术是一种简单的术式，可即刻改善大鱼际功能。通过增加滑轮，可进一步改善掌屈和旋前。
