Erfahrungen mit der endoskopischen Operation zur Behandlung des Karpaltunnelsyndroms

Abstract

Endoscopic carpal tunnel release is a new technique for treatment of carpal tunnel syndrome. The benefits of this procedure are a small skin wound with less local pain, the fact that the hand can quickly be used again, and earlier return to work or other activities. We present the preliminary results of the 3-month follow-up of 88 patients out of a prospective study of 100 patients. All patients were operated on using the one-port technique. Six additional decompressions had to be abandoned and open release was performed. Of the patients with pain, 73.6% (68/88) were completely pain-free and in 13.2% (9/68) pain improved in more than 50%. Subjective symptoms like paresthesia and numbness of the hand disappeared completely in 77.2% (64/83). Sensory deficits disappeared in 50% (33/66). Ten of 17 patients with preoperative paresis of the abductor pollicis brevis muscle and 11/14 with paresis of the opponens pollicis muscle had normal motor function 3 months after the operation. The complication rate concerning nerve lesions was 2.3%. The return to work time was 21 days (range 3-49 days). According to clinical symptoms, our preliminary results do not seem to have any benefits compared to the conventional open technique, and the costs for the endoscopic procedure are markedly higher. The complication rate after the learning curve period is approximately the same as open carpal tunnel release.

Reoperation bei Karpaltunnelsyndrom

“…Die of fe ne Spal tung er folg te in 21 Fäl len über einen kur z en Schnitt, mit ma xi mal 3 cm Län ge, 8 Ope ra tio nen er folg ten über einen lan gen Schnitt, 6 Schnitt füh run gen konn ten we der der einen noch der an deren Tech nik zu ge ord net wer den, da bei guter Nar ben hei lung die Schnitt län ge nach 2 Jah ren nicht mehr si cher be ur teilt werden kann. Die en do sko pi schen Ope ra tionen wur den alle nach der Tech nik von Chow [2], also der Zwei por tal tech nik, durch ge führt. Ei nem Zwei tein griff un terzo gen sich 34 Pa ti en ten, bei 2 Pa ti en ten war eine drit te Ope ra ti on er for der lich.…”

“…Eine in kom plet te Spal tung des Re tinacu lum fle x orum wur de 26-mal be ob ach tet, hier zeig ten sich be sonders häu fig die dis ta len Fa sern nicht ge spalten. Von die sen 26 Ope ra tio nen wa ren 24 in of fe ner Tech nik (16 Kurz schnitt ver fahren, 4 Lang schnitt ver fah ren, 4 nicht zu zuord nen) und 2 in en do sko pi scher Tech nik nach Chow [2] durch ge führt wor den. Eine Früh fi bro se trat in 8 Fäl len (5 Kurz schnittver fah ren, ein en do sko pi sches Ver fah ren, ein Lang schnitt ver fah ren, ei nes nicht zu zuord nen) auf, die se war durch ex tre me Vernar bung des Hüll ge we bes und der Um gebung ge kenn zeich net.…”

“…Aller dings steht den Vor tei len die ser mi nimal-in va si ven Ope ra ti ons ver fah ren aufgrund der in tra ope ra tiv ein ge schränk-ten Sicht ver hält nis se ein er höh tes Ri si ko schwe rer in tra ope ra ti ver Kom pli ka tio nen ge gen über. Ins be son de re wur de über eine er höh te Ver let zungs ge fahr neu ro vas ku lä-rer Struk tu ren be rich tet [2,8]. Ge fähr det sind so wohl der N. me dia nus als auch der N. ul na ris und der ober fläch li che Hohlhand bo gen [12].…”

Uniportal Endoscopic Surgery of Carpal Tunnel Syndrome: Technique and Clinical Results

“…The endoscopic carpal tunnel release has gained in significance during the last decade within the scope of minimal invasive neurosurgery. The reasons for this development are the supposed advantages of the endoscopic technique [3]: small and inconspiciuous scars in the wrist line; minor local pain after surgery; preservation of the stabilizing structures of the palmar, especially of the palmar aponeurosis; faster usability of the hand and therefore shorter disablement. However, this turn to the endoscopic procedure will only lasting, if the proof for this advantage will be furnished and if the results of endoscopic surgery turn out at least as favourable as those of the conventional open carpal tunnel release.…”

“…The very good result of open carpal tunnel surgery, which means the lack of subjective and objective symptoms after decompression of median nerve, varies between 46 and 91 % [3,39].…”