Agee J M, McCarroll H R, North E R
Hand Biomechanics Lab, Inc., Sacramento, California.
Hand Clin. 1994 Nov;10(4):647-59.
The goal of the single incision endoscopic technique is to avoid an incision on the palmar surface of the hand. As compared with open release and the two-portal endoscopic technique for release of the carpal tunnel, this single incision technique permits the patient to return earlier to work and activities of daily living as a result of less tenderness and earlier return of strength. Safe performance of the technique requires that the surgeon have both a thorough knowledge of the anatomy of the hand and a commitment to master the technical details of the surgical approach. Because the technique is of value strictly to view and divide the TCL, patient selection requires careful preoperative evaluation to exclude those carpal tunnels with pathology that requires direct inspection or surgical treatment. In a prospective study with the redesigned point of entry blade assembly that allows a view of the blade's entry into the ligament, no device-related complications occurred. In considering a surgical approach for endoscopic carpal tunnel release, the authors feel that it is important to recognize the value of an "open" proximal surgical incision designed to directly view the plane between the finger flexor synovium and the deep surface of the TCL. Stab wound "portals" that are widely used in arthroscopic surgery are inadequate for endoscopic carpal tunnel releases. The device and the procedure are designed to obtain an unobstructed view of the underside of the TCL and divide it completely. Additional long-term prospective studies are needed to define the comparative recurrence rates of open versus single incision endoscopic carpal tunnel release surgeries.
单切口内镜技术的目标是避免在手的掌面做切口。与开放性腕管松解术和双切口内镜腕管松解术相比，这种单切口技术能使患者因疼痛减轻和力量恢复较早而更早重返工作岗位和进行日常生活活动。该技术的安全实施要求外科医生对手部解剖结构有全面的了解，并致力于掌握手术入路的技术细节。由于该技术的价值严格体现在观察和切断腕横韧带（TCL）上，患者选择需要进行仔细的术前评估，以排除那些需要直接检查或手术治疗的有病变的腕管。在一项对重新设计的进针刀片组件的前瞻性研究中，该组件能看到刀片进入韧带的情况，未发生与器械相关的并发症。在考虑内镜下腕管松解术的手术入路时，作者认为认识到一个“开放”的近端手术切口的价值很重要，该切口旨在直接观察指屈肌腱滑膜与腕横韧带深层表面之间的平面。关节镜手术中广泛使用的小切口“入口”对于内镜下腕管松解术是不够的。该器械和手术方法旨在获得腕横韧带下方的无阻碍视野并将其完全切断。需要更多长期前瞻性研究来确定开放性与单切口内镜腕管松解术的比较复发率。
