CAJ | 학술논문

目的：探讨内镜下采用透明外导管双入口 Chow 法施行腕横韧带松解术治疗腕管综合征的疗效及安全性。方法选取2008年7月至2013年3月在北京大学第一医院以透明外导管行双入口 Chow 法治疗腕管综合征的27例患者38个腕关节。其中男4例，女23例；年龄25~66岁，平均52.81岁；右腕12例，左腕4例，双腕11例。根据术前症状按滨田分类法分级，Ⅰ级9腕，Ⅱ级6腕，Ⅲ级23腕。手术采用局麻、止血带，腕部小切口引入透明导管，在透明外导管内可分辨出肌腱、韧带、神经的情况下切开腕横韧带，松解正中神经。结果术后随访2~47个月，平均17.67个月。失访6例，共随访32个腕关节。单腕平均手术时间15 min，出血0 mL。术后1例出现疼痛、麻木加重，无正中神经、血管、肌腱损伤及神经黏连等并发症，无二次手术者。无皮肤深浅感觉障碍、无切口瘢痕疼痛者。握力及捏力均不同程度改善。术后 Kelly 分级评定，优18腕，良9腕，一般4腕，差1腕，优良率为84.3%。分级为一般及差的5例均出现在术前滨田分类Ⅲ级的患者中。结论关节镜下用可视的透明外套管行“双孔道”Chow 法腕横韧带松解术结合了 Chow 法与 Okutsu 法的优点，皮肤切口小，组织创伤轻，手术时间短，术后不需石膏外固定，不残留大的手术瘢痕。此方法是一种有效且操作安全性高的微创术式。
목적：탐토내경하채용투명외도관쌍입구 Chow 법시행완횡인대송해술치료완관종합정적료효급안전성。방법선취2008년7월지2013년3월재북경대학제일의원이투명외도관행쌍입구 Chow 법치료완관종합정적27례환자38개완관절。기중남4례，녀23례；년령25~66세，평균52.81세；우완12례，좌완4례，쌍완11례。근거술전증상안빈전분류법분급，Ⅰ급9완，Ⅱ급6완，Ⅲ급23완。수술채용국마、지혈대，완부소절구인입투명도관，재투명외도관내가분변출기건、인대、신경적정황하절개완횡인대，송해정중신경。결과술후수방2~47개월，평균17.67개월。실방6례，공수방32개완관절。단완평균수술시간15 min，출혈0 mL。술후1례출현동통、마목가중，무정중신경、혈관、기건손상급신경점련등병발증，무이차수술자。무피부심천감각장애、무절구반흔동통자。악력급날력균불동정도개선。술후 Kelly 분급평정，우18완，량9완，일반4완，차1완，우량솔위84.3%。분급위일반급차적5례균출현재술전빈전분류Ⅲ급적환자중。결론관절경하용가시적투명외투관행“쌍공도”Chow 법완횡인대송해술결합료 Chow 법여 Okutsu 법적우점，피부절구소，조직창상경，수술시간단，술후불수석고외고정，불잔류대적수술반흔。차방법시일충유효차조작안전성고적미창술식。
Objective To evaluate the effect and safety of the Chow′s endoscopic procedures in the treatment of CTS with a clear cannula. Methods 27 patients(38 wrists,23 females and 4 males,15 left and 23 right,25 ~ 66 years old with an av-erage age of 52. 81y)with CTS had a Chow′s technique ECTR with a clear cannula in Orthopedic Department of 1st hospital of Peking University. There were 9 cases of grade Ⅰ,6 cases of grade Ⅱ,23 cases of grade Ⅲ according to Hamada′s classifica-tion. Double small incision was made in the wrist and palm and an endoscope was used to observe the carpal ligament which was cut with a small hook blade under direct visualization. The mean follow-up was 17. 67 months(2 ~ 47 months). Results The Kelly score was excellent in 18 wrists,good in 9 wrists,fair in 4 wrists and poor in 1 case among the 32 cases at the end point of the follow-up and the excellent and good rate was 84. 3% . No complications such as median nerve injury and adhe-sion,skin sensory dysfunction,scar pain occurred and no one got a second operation. The average surgery time was 15 min of each wrist and blood loss of 0 mL. The 5 fair/ poor cases according to Kelly criteria were in the grade Ⅲ group. Conclusion Double-entry Chow endoscopic technique with a clear cannula for treatment of CTS,as a minimal invasive technique has the advantages of both Chow and Okutsu procedure . With smaller incisions and mild injury to normal tissue,it has the advantage of recovery,less pain,earlier return to work and activities.