Hozack Bryan A, Campbell Benjamin R, Kistler Justin M, Matzon Jonas L, Jones Christopher M, Rivlin Michael
Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
J Hand Surg Am. 2025 Feb;50(2):237.e1-237.e6. doi: 10.1016/j.jhsa.2023.06.019. Epub 2023 Aug 3.
To evaluate the proximity of the ulnar neurovascular structures to the endoscopic blade during endoscopic carpal tunnel release (CTR).
Ten fresh-frozen cadaver hands were used to perform endoscopic CTR using devices from two manufacturers. The skin was excised from the palm, and the endoscopic carpal tunnel blade was deployed at the distal edge of the transverse carpal ligament (TCL). The blade's proximity to the ulnar neurovascular bundle, deep ulnar motor branch, superficial palmar arch, and median nerve was recorded. Following release of the TCL, the device was turned ulnar to the maximal extent to determine if direct injury to the ulnar neurovascular bundle was possible.
The average longitudinal distance from the end of the TCL to the superficial palmar arch was 13.3 mm (range, 8.4-20.9) and to the ulnar motor branch was 10.8 mm (range, 4.0-15.0). The average transverse distance from the end of the TCL to the ulnar neurovascular bundle was 5.9 mm (range, 3.1-7.8) and to the median nerve was 3.3 mm (range, 0-6.5). In two of our specimens, the median nerve subluxated volarly over the cutting device. When placing the blade at the distal edge of the TCL, injury to the deep motor branch of the ulnar nerve, ulnar neurovascular bundle, or superficial palmar arch was not possible in any specimens using the tested devices, even when turning the blade directly toward these structures.
There is a low likelihood of direct injury to the ulnar neurovascular bundle during endoscopic CTR.
These results suggest that injury to the ulnar neurovascular bundle is unlikely during endoscopic CTR if the distal aspect of the transverse carpal ligament can be clearly identified prior to release. Control of the median nerve is also important to prevent subluxation over the cutting device.
评估在内镜下腕管松解术（CTR）过程中尺神经血管结构与内镜刀片的接近程度。
使用来自两个制造商的设备，对10只新鲜冷冻尸体手进行内镜下CTR。从手掌切除皮肤，将内镜腕管刀片置于腕横韧带（TCL）的远端边缘。记录刀片与尺神经血管束、尺神经深运动支、掌浅弓和正中神经的接近程度。在松解TCL后，将设备最大限度地转向尺侧，以确定是否可能直接损伤尺神经血管束。
从TCL末端到掌浅弓的平均纵向距离为13.3毫米（范围8.4 - 20.9毫米），到尺神经运动支的平均纵向距离为10.8毫米（范围4.0 - 15.0毫米）。从TCL末端到尺神经血管束的平均横向距离为5.9毫米（范围3.1 - 7.8毫米），到正中神经的平均横向距离为3.3毫米（范围0 - 6.5毫米）。在我们的两个标本中，正中神经向掌侧半脱位越过切割设备。当将刀片置于TCL远端边缘时，使用测试设备的任何标本中，即使将刀片直接转向这些结构，也不会损伤尺神经深运动支、尺神经血管束或掌浅弓。
在内镜下CTR过程中，直接损伤尺神经血管束的可能性较低。
这些结果表明，如果在松解之前能够清楚识别腕横韧带的远端，在内镜下CTR过程中不太可能损伤尺神经血管束。控制正中神经对于防止其在切割设备上半脱位也很重要。
