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采用KnifeLight技术进行腕管松解术:内镜手术的替代方法?

Carpal tunnel release using the KnifeLight technique: An alternative to endoscopic approach?

作者信息

Fadili Omar, Khodja Mohammed, Azarpira Mohammad Reza

机构信息

Service de Chirurgie Orthopédique et Traumatologique, CHI Meulan, Les Mureaux, France; Service de Traumatologie-Orthopédie et Chirurgie Réparatrice Aile 4, CHU Ibn Rochd de Casablanca, Morocco; Faculté de Medecine et de Pharmacie de Casablanca, Université Hassan 2, Morocco.

Service de Chirurgie Orthopédique et Traumatologique, CHI Meulan, Les Mureaux, France.

出版信息

Int J Surg Case Rep. 2024 Dec;125:110609. doi: 10.1016/j.ijscr.2024.110609. Epub 2024 Nov 15.

DOI:10.1016/j.ijscr.2024.110609
PMID:39550812
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11615583/
Abstract

INTRODUCTION AND IMPORTANCE

Carpal tunnel syndrome (CTS) is caused by compression of the median nerve, leading to both sensory and motor dysfunction in the hand. Traditional open carpal tunnel release (CTR) is a proven treatment but often results in longer recovery times, visible scarring, and postoperative issues like pillar pain. Endoscopic techniques, while reducing recovery time and limiting incision size, present risks such as incomplete ligament release and possible nerve injury. This underscores the need for a surgical approach that combines the advantages of both methods while minimizing their downsides.

SURGICAL TECHNIQUE AND CASE PRESENTATION

This article introduces a minimally invasive surgical technique for CTR using the KnifeLight instrument. The procedure involves a small incision and integrates a light source for improved visualization. This setup enables precise division of the transverse carpal ligament, reducing the risk of damage to surrounding structures. Each step of the procedure is detailed, highlighting its advantages over both traditional open and endoscopic CTR.

CLINICAL DISCUSSION

The KnifeLight technique enables more controlled and accurate ligament release, resulting in reduced scarring and quicker recovery. Initial data indicate that patients experience less postoperative discomfort and shorter rehabilitation compared to traditional CTR. This method's precision also reduces the risk of complications, such as nerve damage or incomplete ligament release. The KnifeLight procedure represents a promising middle ground between open and endoscopic CTR. It combines the visual clarity and precision of open surgery with the benefits of a smaller incision and quicker recovery typical of endoscopic methods. The built-in light source enhances visualization, ensuring both patient safety and effective ligament release. However, further comparative studies are needed to fully assess its long-term outcomes and potential complications.

CONCLUSION

The KnifeLight technique for carpal tunnel release offers a strong alternative to both open and endoscopic CTR methods. It minimizes scarring, shortens recovery time, and improves overall patient outcomes, making it a potential future standard for treating CTS. Further research and broader clinical adoption are necessary to confirm its long-term efficacy and safety.

摘要

引言与重要性

腕管综合征(CTS)是由正中神经受压引起的,导致手部感觉和运动功能障碍。传统的开放性腕管松解术(CTR)是一种经过验证的治疗方法,但通常会导致恢复时间延长、明显的疤痕以及术后诸如支柱疼痛等问题。内窥镜技术虽然减少了恢复时间并缩小了切口尺寸,但存在诸如韧带松解不完全和可能的神经损伤等风险。这凸显了需要一种结合两种方法的优点同时将其缺点降至最低的手术方法。

手术技术与病例展示

本文介绍了一种使用KnifeLight器械进行CTR的微创外科技术。该手术涉及一个小切口,并集成了一个光源以改善可视化。这种设置能够精确地切断腕横韧带,降低对周围结构造成损伤的风险。该手术的每一步都进行了详细描述,突出了其相对于传统开放性和内窥镜CTR的优势。

临床讨论

KnifeLight技术能够实现更可控、更精确的韧带松解,从而减少疤痕形成并加快恢复。初步数据表明,与传统CTR相比,患者术后不适更少,康复时间更短。这种方法的精确性还降低了诸如神经损伤或韧带松解不完全等并发症的风险。KnifeLight手术代表了开放性和内窥镜CTR之间一个有前景的中间方案。它将开放手术的视觉清晰度和精确性与内窥镜方法典型的较小切口和更快恢复的优点相结合。内置光源增强了可视化,确保了患者安全和有效的韧带松解。然而,需要进一步的对比研究来全面评估其长期结果和潜在并发症。

结论

KnifeLight腕管松解技术为开放性和内窥镜CTR方法提供了一个有力的替代方案。它最大限度地减少了疤痕形成,缩短了恢复时间,并改善了患者的总体预后,使其成为未来治疗CTS的潜在标准方法。需要进一步的研究和更广泛的临床应用来确认其长期疗效和安全性。

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本文引用的文献

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Endoscopic Versus Open Carpal Tunnel Release: An Umbrella Review and a Meta-analysis.内镜与开放式腕管松解术:伞式评价与荟萃分析。
Ann Plast Surg. 2024 Jun 1;92(6):677-687. doi: 10.1097/SAP.0000000000004005.
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Endoscopic Carpal Tunnel Release Past, Present, and Future Directions.内镜腕管松解术的过去、现在和未来方向。
Bull Hosp Jt Dis (2013). 2024 Mar;82(1):21-25.
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The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines.SCARE 2023 指南:更新共识外科病例报告(SCARE)指南。
Int J Surg. 2023 May 1;109(5):1136-1140. doi: 10.1097/JS9.0000000000000373.
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Minimally invasive carpal tunnel decompression using the KnifeLight: How I Do It.
Acta Neurochir (Wien). 2021 Jul;163(7):2089-2091. doi: 10.1007/s00701-020-04649-3. Epub 2020 Nov 25.
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Endoscopic release for carpal tunnel syndrome.腕管综合征的内镜下松解术
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Mini open carpal tunnel release using Knifelight: evaluation of the safety and effectiveness of using a single wrist incision (cadaveric study).使用Knifelight进行微型开放式腕管松解术:对采用单一切口的安全性和有效性的评估(尸体研究)
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Comparison of the results of open carpal tunnel release and KnifeLight carpal tunnel release.开放性腕管松解术与KnifeLight腕管松解术结果的比较。
Singapore Med J. 2007 Dec;48(12):1131-5.
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Minimally invasive carpal tunnel decompression using the KnifeLight.使用KnifeLight进行微创腕管减压术。
Neurosurgery. 2007 Feb;60(2 Suppl 1):ONS162-8; discussion ONS168-9. doi: 10.1227/01.NEU.0000249249.33052.7E.
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A randomized controlled trial of knifelight and open carpal tunnel release.刀光与开放性腕管松解术的随机对照试验
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