摘要
目的介绍内窥镜视下结合CO_2注气法皮下气腔行尺神经松解前置术的临床应用。方法对8例9侧肘管综合征患者,根据Dellon分型:轻度者3例3侧,中度者4例4侧,重度者1例2侧。在上臂内侧、肘上10.0 cm处作1.0～1.5cm长横切口为腔镜入口,在外侧或肘内后侧处作0.5～1.0cm长横切口为操作入口。利用腹腔镜系统,通过气腹机注入CO_2气体形成皮下气腔,内窥镜视下游离松解尺神经至肘上8.0～10.0 cm和肘下5.0～6.0 cm,并将尺神经前置于肘前皮下。结果8例患者均在内窥镜视下顺利完成手术,手术时间平均每侧约45～60min。术中内窥镜视下全段观察尺神经元损伤,臂部无皮下积气、血肿。术后随访时间为8～15个月,所有患者尺神经症状均有改善,未见神经滑脱现象。手功能恢复优5例5侧,良3例4侧。结论内窥镜下结合CO_2皮下气腔行尺神经松解前置术,不仅能达到常规开放手术的同等疗效,而且手术更微创、美观。
Objective To introduce the method of endoscopic decompression and anterior transposition of the ulnar nerve in carbon dioxide generated cavity for treatment cubital tunnel syndrome. Methods The operations were performed in 9 elbows of 8 cubital tunnel syndrome cases. According to Dellon＇ s criteria, three elbows were categorized preoperatively as grade Ⅰ , four as grade Ⅱ , and two elbows of one case as grade Ⅲ. Along the course of ulnar nerve in the upper arm a 1.0- 1.5 cm transverse incision was made 10 cm above elbow for endoscope approach. Another 0.5 - 1.0 cm transverse incision was made lateral to the ulnar nerve or posteromedial to the elbow for operation approach. CO2 was pumped using laparoscopic system to generate a space for maneuvering. The ulnar nerve was released and transposed anteriorly in the cavity which was maintained with CO2 inflation. Results All of the 8 cases were operated successfully. The average operation time was 45 to 60 minutes. No ulnar nerve injury was found under the endoscope. There was no subcutaneous pneumatosis and hematoma. The patients were followed for 8 to 15 months. All patients had improvement of their symptoms. No subluxation of the ulnar nerve was noted. Clinical results were evaluated as excellent for 5 cases and good for 4. Conclusion Endoscopic decompression and anterior transposition of the ulnar nerve in CO2 generated cavity is as effective as traditional open operation. It has the advantage of being less invasive and more aesthetic.
出处
《中华手外科杂志》
CSCD
北大核心
2007年第2期79-81,共3页
Chinese Journal of Hand Surgery
关键词
外科手术
内窥镜
肘管综合征
神经松解术
Surgical procedures, endoseopes
Cubital tunnel syndrome
Neurolysis
