遠位one portalによる鏡視下手根管開放術

Distal one portal technique for endoscopic carpal tunnel release

◆要旨：手根管症候群に対する遠位one portalによる鏡視下手根管開放術（endoscopic carpal tunnel release；以下，ECTR）の手術方法，短期成績について報告する．手術はwrist blockにて行い，約1.5cmの皮切をKaplanのcardinal lineと中指環指間の交差部に置き，溝付きガラス管を用いてECTRを施行した．本法を施行した21例22手（平均69.7歳）に合併症の発生はなく，遠位潜時は術前平均8.8msecから術後3か月時平均5.9msecと有意に改善した（p＜0.05）．本法は，浅掌動脈弓の表層で操作をすることで横手根靱帯を切離することができ，切離後に運動枝や指神経を直視下に確認できる．合併症予防としても有用な手術法であると考える．

The purpose of this study was to evaluate the short term results of endoscopic carpal tunnel release（ECTR） using a one portal technique from the distal side, and to report our surgical technique. All patients underwent wrist block anesthesia. A 1.5 cm incision was made in Kaplan's cardinal line across the middle and ring fingers. A glass tube was used for ECTR. Our surgical technique allows manipulation of the surface of the superficial palmar arterial arch, and allows the motor branch and digital nerve to be viewed under direct vision. A total of 22 procedures in 21 patients（mean age, 69.7 years） were included in the analysis. The follow-up duration was 3 months. There were no complications, the motor nerve conduction velocity improved significantly from 8.8 msec preoperatively to 5.9 msec postoperatively（p < 0.05）. These results suggest that our one-portal ECTR technique from the distal side is a safe treatment for carpal tunnel syndrome. Moreover, this technique is beneficial in terms of prevented complications.