Centro di Chirurgia Sant'Anna.
Department of Orthopedic Surgery, General Hospital, Merano.
Tech Hand Up Extrem Surg. 2021 May 3;26(1):12-17. doi: 10.1097/BTH.0000000000000351.
Established endoscopic carpal tunnel release (ECTR) techniques carry a not entirely eludible risk of iatrogenic complications, mainly because of incomplete view of the cutting blade and intraoperative pressure increase inside the carpal tunnel (CT). We describe a novel single-portal ECTR method, conceived to reduce these risks, by optimizing visual control and avoiding dilatation of the CT. After incising the well exposed proximal third of the transverse carpal ligament (TCL), transection of the remainder is completed using a pediatric urethrotome. This small caliber instrument is moved in the plane of the TCL, without invading the tunnel, and provides detailed view of the TCL and any crossing anatomical structures at any given moment. We present the technique and the results of a retrospective case series of 33 patients with CT syndrome who underwent the procedure, after failing to respond to conservative treatment. Because of improved view and the avoidance of intraoperative pressure trauma to structures passing through the CT, the described approach may contribute to prevent iatrogenic complications and represent a valid improvement over conventional ECTR procedures.
已确立的内镜腕管松解术（ECTR）技术存在不可完全避免的医源性并发症风险，主要是因为无法完全观察到切割刀片和腕管内的术中压力增加。我们描述了一种新的单门户 ECTR 方法，旨在通过优化视觉控制和避免腕管扩张来降低这些风险。在切开充分暴露的近端三分之一的腕横韧带（TCL）后，使用小儿尿道探子完成其余部分的横断。该小口径器械在 TCL 的平面上移动，不侵犯隧道，并在任何给定时刻提供 TCL 和任何交叉解剖结构的详细视图。我们介绍了该技术，并对 33 例 CT 综合征患者的回顾性病例系列进行了研究，这些患者在保守治疗失败后接受了该手术。由于改善了视野，并避免了术中通过腕管的结构的压力损伤，所描述的方法可能有助于预防医源性并发症，并代表了对传统 ECTR 手术的有效改进。
