Burnham Robert, Playfair Larry, Loh Eldon, Roberts Shannon, Agur Anne
From the Central Alberta Pain and Rehabilitation Institute, Lacombe (RB, LP); Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton (RB), Alberta; Department of Physical Medicine and Rehabilitation, Parkwood Institute, Western University, London (EL); and Division of Anatomy, Department of Surgery (SR, AA), and Division of Physical Medicine and Rehabilitation (AA), University of Toronto, Toronto, Ontario, Canada.
Am J Phys Med Rehabil. 2017 Jul;96(7):457-463. doi: 10.1097/PHM.0000000000000652.
The looped thread carpal tunnel release (TCTR) procedure is a minimally invasive percutaneous technique performed under ultrasound (US) to transect the transverse carpal ligament in patients with carpal tunnel syndrome. Study objectives were to evaluate the accuracy of identifying key US landmarks, safety, effectiveness, and technical difficulty of TCTR.
Fourteen lightly embalmed cadaveric distal forearm-hand specimens were subject to US identification of key landmarks, TCTR procedure, and post-TCTR dissection. Outcome measures of interest were (1) correspondence between key landmarks (median nerve and 4 bony pillars of transverse carpal ligament) identified on US and anatomical structures exposed by dissection, (2) percentage of the transverse carpal ligament transected and location of the transection, (3) frequency of damage to adjacent structures, (4) time to complete procedure, and (5) operator assessment of technical difficulty of each TCTR procedure (0 = extremely easy, 10 = extremely difficult).
(1) Skin markings delineating the position of US-visualized landmarks corresponded almost perfectly to anatomical dissection. (2) Nine (64.2%) of 14 specimens had complete division of the transverse carpal ligament. In the remaining 5 specimens, an average of 68.8% of the ligament was transected. (3) No adjacent structures were damaged. (4) Time to complete the procedure was on average 9.9 ± 4.6 minutes. (5) Average procedural difficulty was 4.3/10.
Thread carpal tunnel release is potentially a safe, quick, and effective procedure to transect the transverse carpal ligament. Future clinical investigation is recommended.
环形丝线腕管松解术（TCTR）是一种在超声引导下进行的微创经皮技术，用于切断腕管综合征患者的腕横韧带。研究目的是评估TCTR识别关键超声标志的准确性、安全性、有效性和技术难度。
对14个轻度防腐的尸体远端前臂-手部标本进行超声识别关键标志、TCTR操作及TCTR术后解剖。感兴趣的结果指标包括：（1）超声识别的关键标志（正中神经和腕横韧带的4个骨支柱）与解剖暴露结构之间的对应关系；（2）腕横韧带切断的百分比及切断位置；（3）相邻结构损伤的频率；（4）完成手术的时间；（5）术者对每个TCTR操作技术难度的评估（0=极其容易，10=极其困难）。
（1）描绘超声可见标志位置的皮肤标记与解剖解剖几乎完全对应。（2）14个标本中有9个（64.2%）腕横韧带完全切断。其余5个标本中，韧带平均切断68.8%。（3）无相邻结构受损。（4）完成手术的平均时间为9.9±4.6分钟。（5）平均手术难度为4.3/10。
丝线腕管松解术可能是一种安全、快速且有效的切断腕横韧带的手术。建议未来进行临床研究。
