Bhashyam Abhiram R, Kao Dennis S
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA.
Division of Plastic Surgery, University of Washington, Seattle, WA.
J Hand Surg Glob Online. 2022 Jan 13;4(3):166-171. doi: 10.1016/j.jhsg.2021.11.007. eCollection 2022 May.
Multiple prior studies have assessed the results of open approaches for concurrent carpal tunnel release with distal radius fracture fixation; however, less is known regarding the feasibility of endoscopic techniques, especially in the setting of high-energy trauma. In this study, we assessed the feasibility and results of concurrent endoscopic carpal tunnel release and distal radius fracture fixation using the flexor carpi radialis approach after high- and low-energy trauma.
We performed a retrospective, single-surgeon study of 17 consecutive adult patients (aged >18 years) who underwent open reduction internal fixation of an acute distal radius fracture with concurrent endoscopic carpal tunnel release at a level 1 trauma center between April 2017 and October 2020. Recovery from median nerve dysfunction was assessed from patient charts at routinely scheduled postoperative follow-up visits (at 2 weeks, 4 weeks, 6 weeks, and 12 weeks).
The transverse carpal ligament could be visualized and released in all patients. All patients had a return of light touch sensibility with or without intermittent paresthesia by 12 weeks after surgery (the median time from surgery to recovery was 19 days [range, 12-82 days]). There were no patient reports or clinical examination evidence of palmar cutaneous branch, recurrent motor branch, or the third common digital nerve injury. Time to recovery was significantly different in the setting of high- versus low-energy trauma (26 days vs 18 days, respectively; = .02).
In this study, we demonstrated that concurrent endoscopic carpal tunnel release using the flexor carpi radialis approach for distal radius fracture fixation in the settings of high- and low-energy trauma is safe from major complications and effective at releasing the transverse carpal ligament.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
此前已有多项研究评估了开放性手术同期行腕管松解术与桡骨远端骨折内固定术的效果；然而，关于内镜技术的可行性，尤其是在高能量创伤情况下的可行性，人们了解较少。在本研究中，我们评估了在高能量和低能量创伤后，采用桡侧腕屈肌入路同期行内镜下腕管松解术与桡骨远端骨折内固定术的可行性及效果。
我们对17例连续的成年患者（年龄>18岁）进行了一项单术者回顾性研究，这些患者于2017年4月至2020年10月期间在一家一级创伤中心接受了急性桡骨远端骨折切开复位内固定术并同期行内镜下腕管松解术。通过术后常规安排的随访（术后2周、4周、6周和12周）时的患者病历评估正中神经功能障碍的恢复情况。
所有患者均能清晰看到并松解腕横韧带。所有患者在术后12周时均恢复了轻触觉，无论有无间歇性感觉异常（从手术到恢复的中位时间为19天[范围，12 - 82天]）。没有患者报告或临床检查证据表明掌皮支、返支运动神经或第三指总神经损伤。高能量创伤与低能量创伤情况下的恢复时间有显著差异（分别为26天和18天；P = 0.02）。
在本研究中，我们证明了在高能量和低能量创伤情况下，采用桡侧腕屈肌入路同期行内镜下腕管松解术与桡骨远端骨折内固定术可避免主要并发症，且能有效松解腕横韧带。
研究类型/证据水平：治疗性IV级。
