Ricardo Nunes Carla, Marès Olivier, Martinel Vincent
Unidade do Punho e Mão, Hospital Cuf Tejo, Lisboa, Portugal.
Centre Hospitalier Régional Universitaire de Nîmes, Department of Orthopaedic Surgery, Nîmes, France.
Hand Surg Rehabil. 2025 May;44S:102091. doi: 10.1016/j.hansur.2025.102091. Epub 2025 Jan 21.
Compression of the median nerve in the carpal tunnel is a frequent pathology with severe functional impact. An ultrasound-guided technique was developed to preserve structures, diminish scar fibrosis and enable fast return to full activity. Its advantages are safety and low additional cost. Ultrasound-guided carpal tunnel release is indicated in moderate and severe carpal tunnel syndrome persisting after conservative treatment. A preoperative ultrasound scan is recommended to evaluate anatomy. Recurrent carpal tunnel syndrome, secondary carpal tunnel syndrome and anatomic variants compromising the safety of transverse carpal ligament division are contraindications. The procedure is performed under local anesthesia without tourniquet. The entry point is a short transverse incision proximal to the wrist crease. The transverse carpal ligament is divided anterogradely, using a dedicated blade under ultrasound control, making sure no nerves, tendons or blood vessels are injured. The final step is to check that the division is complete. Early return to use of the hand is permitted. Reports of similar techniques demonstrated early symptomatic relieve, favorable patient-reported outcome measures from within 1 week after surgery to 2 years' follow-up, with early return to normal daily activity and work. The complications rate is low: many series showed no complications. Comparative studies between ultrasound-guided carpal tunnel release and the mini-open technique reported similar or greater and quicker symptom relief, less scar pain and better strength. Final functional results tend to be similar.
腕管综合征是一种常见的疾病，对功能有严重影响。一种超声引导技术被开发出来，以保护组织结构，减少瘢痕纤维化，并能迅速恢复到完全活动状态。其优点是安全且额外成本低。超声引导下腕管松解术适用于保守治疗后持续存在的中重度腕管综合征。建议术前进行超声扫描以评估解剖结构。复发性腕管综合征、继发性腕管综合征以及影响腕横韧带切开安全性的解剖变异是禁忌证。该手术在局部麻醉下进行，不使用止血带。切口位于腕横纹近端的短横切口。在超声引导下，使用专用刀片顺行切开腕横韧带，确保不损伤神经、肌腱或血管。最后一步是检查切开是否完全。允许早期恢复手部使用。类似技术的报告显示，术后早期症状缓解，从术后1周内到2年随访期间患者报告的结果良好，能早期恢复正常日常活动和工作。并发症发生率低：许多系列研究显示无并发症。超声引导下腕管松解术与小切口开放技术的比较研究报告显示，症状缓解相似或更显著、更快，瘢痕疼痛更少，力量恢复更好。最终功能结果往往相似。
