Pensy Raymond A, Brunton Lance M, Parks Brent G, Higgins James P, Chhabra A Bobby
Curtis National Hand Center, Baltimore, MD, USA.
J Hand Surg Am. 2010 Feb;35(2):217-22. doi: 10.1016/j.jhsa.2009.11.011.
To determine whether a single-incision extensile approach to the distal radius used for open reduction internal fixation and a concomitant radial sided carpal tunnel (CT) release safely and effectively decompresses the carpal tunnel.
Five pairs of cadaveric forearms were mounted to a tabletop with a cable pulley system attached to the long finger. Each paired specimen was randomized to volar plating via either the flexor carpi radialis approach (control group) or the extensile volar exposure (combined flexor carpi radialis and radial-sided carpal tunnel release). Before and after the respective exposure and plating, increased CT pressures were created with 2.27, 4.54, and 6.81 kg of distraction. We used a paired t-test to compare the change in CT pressure at each level of distraction before and after intervention for the 2 groups, with significance set at p </= .05. A dissection of each exposure was performed with attention given to the radial aspect of the transverse carpal ligament (TCL) and any possible iatrogenic injuries.
Carpal tunnel pressure increased with increasing distraction. We noted a statistically significant reduction in CT pressure after the extensile exposure and plating with 4.54 (p = .023) and 6.81 (p < .001) kg of distraction, respectively. No significant reduction in mean CT pressure for the control group specimens occurred at any level of distraction force. The average length of the radial TCL was 22 mm (range, 18-31 mm); the average distance between the recurrent motor branch and distal TCL was 11 mm (range, 8-15 mm). No iatrogenic tendon or nerve injury occurred with the extensile volar exposure.
Carpal tunnel pressure is safely reduced and the distal radius is adequately exposed for fixation with the extensile volar approach.
确定用于桡骨远端切开复位内固定的单切口扩展入路以及同时进行的桡侧腕管（CT）松解术能否安全有效地减压腕管。
将五对尸体前臂固定在桌面上，通过电缆滑轮系统连接到示指。每对标本随机分为经桡侧腕屈肌入路进行掌侧钢板固定（对照组）或扩展掌侧显露（联合桡侧腕屈肌和桡侧腕管松解）。在各自的显露和钢板固定前后，分别施加2.27、4.54和6.81千克的牵张力以增加腕管压力。我们使用配对t检验比较两组在干预前后每个牵张力水平下腕管压力的变化，显著性设定为p≤0.05。对每种显露方式进行解剖，注意腕横韧带（TCL）的桡侧以及任何可能的医源性损伤。
腕管压力随牵张力增加而升高。我们注意到，在扩展显露和钢板固定后，分别施加4.54（p = 0.023）和6.81（p < 0.001）千克牵张力时，腕管压力有统计学意义的降低。对照组标本在任何牵张力水平下平均腕管压力均无显著降低。桡侧TCL的平均长度为22毫米（范围为18 - 31毫米）；运动返支与TCL远端的平均距离为11毫米（范围为8 - 15毫米）。扩展掌侧显露未发生医源性肌腱或神经损伤。
扩展掌侧入路可安全降低腕管压力，并能充分显露桡骨远端以便进行固定。
