アブストラクト
| Title | 手根管症候群の直視下手術 |
|---|---|
| Subtitle | 特集 : 手根管症候群の治療トピックス |
| Authors | 織田崇* |
| Authors (kana) | |
| Organization | *済生会小樽病院整形外科, 診療部長 |
| Journal | MB Orthopaedics |
| Volume | 33 |
| Number | 4 |
| Page | 53-59 |
| Year/Month | 2020 / 4 |
| Article | 報告 |
| Publisher | 全日本病院出版会 |
| Abstract | [Abstract] 手根管症候群に対する直視下手術は簡便で標準的な術式である. 治療成績は良好で, おおむね3か月以内に自覚的な症状や機能の改善が始まる. 手掌内皮切による手術では手首皮線部の創瘢痕や遷延治癒を回避できるが, 良好な結果を得るためには横手根靱帯の遠位部と前腕筋膜を確実に切開することが肝要である. 手首皮線を越えて近位まで展開する従来法はあらゆる病態による手根管症候群に適用でき, 術中に明らかとなった種々の病態にも同時に対応が可能となる. エピネフリン含有リドカインを使用したwide awake local anesthesia no tourniquet technique (WALANT法)により, 止血帯による諸問題を回避できる. WALANT法による直視下手術は医療費の軽減に役立つだけでなく, 満足度が高く患者視点からも好まれる手術術式である. |
| Practice | 臨床医学：外科系 |
| Keywords | 手根管症候群 (carpal tunnel syndrome), 手根管開放術 (carpal tunnel release), 局所麻酔 (local anesthesia), 止血帯 (tourniquet) |
- 全文ダウンロード： 従量制、基本料金制の方共に968円(税込) です。
参考文献
- 1) Amadio PC : The first carpal tunnel release? J Hand Surg. 20B : 40-41, 1995.
- 2) Munns JJ, Awan HM : Trends in carpal tunnel surgery : an online survey of members of the American Society for Surgery of the Hand. J Hand Surg. 40A : 767-771, 2015.
- 3) Louie DL, Earp BE, Collins JE, et al : Outcomes of open carpal tunnel release at a minimum of ten years. J Bone Joint Surg. 95A : 1067-1073, 2013.
- 4) Rivlin M, Kachooei AR, Wang ML, et al : Elec-trodiagnostic grade and carpal tunnel release outcomes : a prospective analysis. J Hand Surg. 43A : 425-431, 2018.
- 5) Zhang D, Blazar P, Earp BE : Rates of Compli-cations and Secondary Surgeries of Mini-Open Carpal Tunnel Release. Hand(N Y). 14 : 471-476, 2019.
残りの18件を表示する
- 6) Werner BC, Teran VA, Deal DN : Patient-Related Risk Factors for Infection Following Open Carpal Tunnel Release : An Analysis of Over 450,000 Medicare Patients. J Hand Surg. 43A : 214-219, 2018.
- 7) Citron ND, Bendall SP : Local symptoms after open carpal tunnel release. A randomized pro-spective trial of two incisions. J Hand Surg. 22B : 317-321, 1997.
- 8) Osei DA, Calfee RP, Stepan JG, et al : Simulta-neous Bilateral or Unilateral Carpal Tunnel Release? A Prospective Cohort Study of Early Outcomes and Limitations. J Bone Joint Surg. 96A : 889-896, 2014.
- 9) Park KW, Boyer MI, Gelberman RH, et al : Simultaneous Bilateral Versus Staged Bilateral Carpal Tunnel Release : A Cost-effectiveness Analysis. J Am Acad Orthop Surg. 24 : 796-804, 2016.
- 10) Gil JA, Bokshan S, Genovese T, et al : Medical malpractice following carpal tunnel surgery. Orthopedics. 41 : e569-e571, 2018.
- 11) Lanz U : Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg. 2A : 44-53, 1977.
- 12) Henry BM, Zwinczewska H, Roy J, et al : The prevalence of anatomical variations of the median nerve in the carpal tunnel : a system-atic review and meta-analysis. PLoS One. 10 : e0136477, 2015.
- 13) Stutz N, Gohritz A, van Schoonhoven J, et al : Revision surgery after carpal tunnel release--analysis of the pathology in 200 cases during a 2 year period. J Hand Surg. 31B : 68-71, 2006.
- 14) Madhav TJ, To P, Stern PJ : The palmar fat pad is a reliable intraoperative landmark dur-ing carpal tunnel release. J Hand Surg. 34A : 1204-1209, 2009.
- 15) Zhang D, Earp BE, Blazar P : Evaluation and Management of Unsuccessful Carpal Tunnel Release. J Hand Surg. 44A : 779-786, 2019.
- 16) Lalonde D, Martin A : Epinephrine in local anesthesia in finger and hand surgery : the case for wide-awake anesthesia. J Am Acad Orthop Surg. 21A : 443-447, 2013.
- 17) 和田卓郎, 織田 崇, 高嶋和磨 : Wide awake surgery手技の実際. 整・災外. 60 : 171-175, 2017.
- 18) Vossinakis IC, Stavroulaki P, Paleochorlidis I, et al : Reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. J Hand Surg. 29B : 399-401, 2004.
- 19) Prasetyono TO, Saputra DK, Astriana W : One-per-mil tumescent technique for bone and joint surgery in hand. Hand(N Y). 10 : 123-127, 2015.
- 20) Nodwell T, Lalonde D : How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective, randomized, blinded study : The Dalhousie project experimental phase. Can J Plast Surg. 11 : 187-190, 2003.
- 21) 高嶋和磨, 織田 崇, 和田卓郎 : 手根管症候群に対するWide-awake hand surgeryの有用性の検討-患者主観による評価-. 日手会誌. 33 : 878-880, 2017.
- 22) Tulipan JE, Kim N, Abboudi J, et al : Open Carpal Tunnel Release Outcomes : Performed Wide Awake versus with Sedation. Hand Microsurg. 9 : 74-79, 2017.
- 23) Nikkhah D, Ruston J, Pearl R, et al : 'WALANT carpal tunnel release : Technical considerations and pain outcomes'. J Plast Reconstr Aesthet Surg. 72 : 1576-1606, 2019.
