Noszczyk Bartłomiej H, Zdybek Piotr
Medical Centre of Postgraduate Education, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2014 Sep;9(3):387-92. doi: 10.5114/wiitm.2014.44140. Epub 2014 Jul 19.
This retrospective report summarizes observations from eight operations where the endoscopically assisted approach was used to explore Guyon's canal syndromes of idiopathic aetiology.
To evaluate the feasibility and limitations of endoscopic Guyon's canal release performed from a distal forearm incision.
Eight charts and video records of eight ulnar tunnel syndrome patients presenting concomitant idiopathic Guyon's canal syndromes were retrospectively reviewed. In all cases endoscopically assisted explorations in Guyon's canals with simultaneous cubital tunnel releases were performed.
In all of the patients the multiple tight bands of the superficial volar carpal ligament forming the canal roof were divided. Some of these bands crossing the nerve in its direct vicinity could have been responsible for the constriction. We were also able to divide the proximal segment of the canal floor. We have observed, however, that the proximal to distal endoscopic dissection jeopardizes the motor branch of the ulnar nerve; therefore, it should not be used to release the pisohamate ligament, or the hypothenar fascia.
Although all of the patients showed improvement, we cannot recommend this method in its current form. We are of the opinion that safe endoscopic Guyon's canal operations may require a different approach.
本回顾性报告总结了8例采用内镜辅助入路探索特发性病因所致Guyon管综合征的手术观察结果。
评估经前臂远端切口进行内镜下Guyon管松解术的可行性和局限性。
回顾性分析8例伴有特发性Guyon管综合征的尺管综合征患者的病历和视频记录。所有病例均在内镜辅助下对Guyon管进行探查，并同时松解肘管。
所有患者均切断了构成管顶的掌侧腕横韧带的多条紧张束带。其中一些束带在神经附近交叉，可能是造成压迫的原因。我们还能够切断管底的近端部分。然而，我们观察到，从近端向远端进行内镜下解剖会危及尺神经运动支；因此，不应使用该方法松解豌豆钩骨韧带或小鱼际筋膜。
尽管所有患者均有改善，但我们目前不推荐这种方法。我们认为，安全的内镜下Guyon管手术可能需要采用不同的入路。
