Condamine J L, Marcucci L, Rosas M H, Fourquet M, Pichereau D
Département d'Orthopédie, CHU, Caen.
Rev Chir Orthop Reparatrice Appar Mot. 1998 Jul;84(4):323-9.
This study analyzes 18 revision procedures for carpal tunnel release failure.
This series did not present any difference in terms of age compare to the population suffering from median nerve entrapment: mean age 56 years, 17 female and 1 male, 1 monolateral syndrome and 8 bilateral. Two third of the patients were seen between 2 and 9 months after initial surgical treatment. Most of the first surgical procedures were performed by an orthopedic surgeon (12/18). The approach was open (14/18) with 5 short incisions, and 4 endoscopic releases. Clinical symptoms were worse or unchanged compare to prior to surgery. All the patients had EMG study and 15 had worse electric signs than before. Open surgical approach was always palmar using optic magnification for median nerve neurolysis.
16 times an incomplete section of the anterior retinaculum and 2 median nerve lacerations were found. All patients were seen with a follow up of more than 2 months. Results concerning pain and sensibility were good for 16 of them; regarding motor impairment, only 13 of them had a good result. Grasp was not improved for 50 per cent of them. Two patients had a result considered as bad (one NAD sequela and one median total laceration).
In our series as well as in literature, failures of carpal tunnel release are due to incomplete section of the anterior retinaculum and sometimes to median nerve laceration. The second look has to be performed when there is no improvement or when the situation is worse after initial surgery.
Incomplete section of the anterior retinaculum is the most frequent reason for carpal tunnel release failure. An EMG seems necessary to confirm diagnosis before revision surgical procedure.
本研究分析了18例腕管松解术失败后的翻修手术。
与正中神经卡压患者群体相比，该系列患者在年龄方面无差异：平均年龄56岁，女性17例，男性1例，1例单侧综合征，8例双侧综合征。三分之二的患者在初次手术治疗后2至9个月就诊。大多数初次手术由骨科医生进行（12/18）。手术入路为开放手术（14/18），有5个短切口，4例为内镜松解。与手术前相比，临床症状加重或未改善。所有患者均进行了肌电图检查，15例患者的电生理指标比术前更差。开放手术入路均为掌侧，使用光学放大进行正中神经松解。
发现16例腕横韧带切开不完全，2例正中神经撕裂。所有患者均接受了超过2个月的随访。其中16例患者的疼痛和感觉结果良好；关于运动功能障碍，只有13例结果良好。50%的患者抓握功能未改善。2例患者结果较差（1例无恢复后遗症，1例正中神经完全撕裂）。
在我们的系列研究以及文献中，腕管松解术失败的原因是腕横韧带切开不完全，有时是正中神经撕裂。初次手术后无改善或情况恶化时，必须进行二次探查。
腕横韧带切开不完全是腕管松解术失败最常见的原因。在翻修手术前，似乎有必要进行肌电图检查以确诊。
