Limited Open Carpal Tunnel Release through a Small Palmar Incision-Experience in the Usage of a New Instrument-The Indiana Carpal Tunnel Tome

局限性腕隧道開放性切開術－Indiana腕隧道切開刀的臨床使用經驗

戴念梓(Niann-Tzyy Dai) ； 陳天牧(Tim-Mo Chen) ； 鄭天宇(Tian-Yeu Cheng) ； 陳錫根(Shyi-Gen Chen) ； 周聰鐸(Trong-Duo Chou) ； 王先震(Hsian-Jenn Wang) ； 陳紹良(Shao-Liang Chen)

《中華民國重建整形外科醫學會雜誌》 8卷2期 (1999/06) Pp. 97-106

https://doi.org/10.7096/JPRSA.199906.0005

摘要

自從西元1966年，在學者Phalen對於腕隧道症候群的診斷及治療，提出了詳細的研究報告之後，腕隧道切開手術就成爲了手外科領域裏一項常見的手術。然而，對於所採用的手術方法，到底是直接剖開腕隧道較好呢，或是以內視鏡手術來切開腕隧道較好呢？則各有其支持者及反對者。爲了集合此兩種方法的優點，以達到手術簡單、安全的目標，而又不會造成正中神經等組織的傷害及術後造成手部功能的影響，許多不同的改良手術，應運而生。Indiana腕隧道切開刀是由Indiana手外科中心的James W. Strickland醫師所設計，利用此工具，可以僅靠手掌上2公分長的切口，即可將腕橫韌帶切開，達到腕隧道鬆解的目的。
三軍總醫院，自西元1998年4月至8月，利用此手術方法，由不同的醫師主刀，總共爲7位病患進行了8個腕隧道切開手術。病患年齡由21歲至75歲，平均54.71歲。腕隧道病狀發生期間，由2個月至10年，平均21.38個月。平均術後追蹤期爲8週。手術的效果如何，是以病患手術部位的疼痛程度、拇指捏力及手部握力的恢複程度及病患對病狀改善的滿意度，來加以評估。在我們的手術病例裏，50%的病例，其術後6到8週時的握力比術前增加，而75%的病例，術後6到8週時的捏力比術前增加。經由問卷調查，覺得術後腕隧道症狀完全改善或僅存些微症狀者，佔75%。此外，病患手術部位的疼痛率也很低，與Andrew Lee等學者的報告相近。在我們的手術病例裏沒有任何並發症發生。
根據我們的臨床經驗，利用腕隧道切開刀的手術方法，確實表現了腕隧道切開手術的簡單、快速、易學及安全性，值得推廣。

並列摘要

Surgical release of the carpal tunnel for carpal tunnel syndrome has become one of the most commonly performed procedures in hand surgery since the report by Phalen et al. Both the open carpal tunnel release and the endoscopic carpal tunnel release methods has its supporters and its adversaries. To be able to combine the simplicity and safety of both methods, and to reduce its hazard towards tissue trauma and postoperative morbidity, variable operation methods were developed. The Indiana carpal tunnel tome was designed by James W. Strickland, MD, in the Indiana Hand Center 12 This device divides the transverse carpal ligament through a small palmar incision. From April 1998 to August 1998, 8 carpal tunnel releases (CTR) were performed in 7 patients using the Indiana tome by multiple surgeons. The patients' ages ranged from 21 to 75 years (mean: 54.71 years). The duration of preoperative symptoms ranged from 2 months to 10 years (mean: 21.38 months). The mean follow-up period was 8 weeks. The efficacy of carpal tunnel release was determined by postoperative tenderness, recovery of postoperative strength, and satisfaction. In our series, four patients (4 CTR-50%) increased postoperative grip strength within 6-8 weeks, and six patients (6 CTR-75%) increased postoperative pinch strength. Seventy-five percent of the patients had either complete resolution or only minimum amount of residual symptoms. Furthermore, the tenderness at incision site, radial and ulnar pillar pain were relatively low. In our clinical experience, the technique of carpal tunnel release through a limited palmar incision with the Indiana tome really represents the advantages of simple, quick, easy learning and safety.

並列關鍵字

limited open carpal tunnel release ； Indiana tome