Jenny-Hagen K, Sennwald G
Chirurgie St. Leonhard, St. Gallen.
Helv Chir Acta. 1990 Jun;57(1):125-8.
The carpal tunnel syndrome (CTS) is a common disease, and the decompression of the median nerve is one of the most often performed procedures in surgery. Within our patients from the 1. 12. 1987 to the 1. 12. 1988 we found 16 cases of recurrent CTS. Intraoperatively in more than 60% of the cases we could detect some sort of subluxation or even luxation of the median nerve and severe scarring involving the median nerve and the regenerated transverse carpal ligament in all cases. Considering the anatomy of the transverse carpal ligament, to guide the median nerve and the flexor tendon within the carpal tunnel, as well as serving as origin for the thenar musculature, especially for the opposition, one concludes that the simple dissection of the carpal ligament should be avoided. For the past 4 years we therefore have been performing a widening Z-plasty and reconstruction of the transverse carpal ligament, for the primary CTS as well as for revisions. The favorable postoperative results seem to confirm our theory. We discuss our operative technique as well as the results in CTS revision cases.
腕管综合征（CTS）是一种常见疾病，正中神经减压术是外科手术中最常开展的手术之一。在我们1987年12月1日至1988年12月1日期间的患者中，我们发现了16例复发性腕管综合征。术中，超过60%的病例中我们能检测到正中神经的某种半脱位甚至脱位，并且所有病例中均存在累及正中神经和再生腕横韧带的严重瘢痕形成。考虑到腕横韧带的解剖结构，其在腕管内引导正中神经和屈肌腱，同时作为鱼际肌特别是对掌肌的起点，人们得出结论应避免单纯切开腕横韧带。因此，在过去4年里，我们一直对原发性腕管综合征以及翻修手术实施Z形皮瓣加宽和腕横韧带重建术。良好的术后效果似乎证实了我们的理论。我们讨论了我们的手术技术以及腕管综合征翻修病例的结果。
