tailieunhanh - Tissue Surgery - part 6

Hình 6-14. a) Speculum chèn vào để xem ban đầu của đường hầm xa cubital. b) trụ thần kinh đi vào đường hầm cubital dưới dây chằng của Osborne (cubital retinaculum). c) xem Speculum kéo để cắt dây chằng Osborne và | 78 Tissue Surgery elbow a new compression site by kinking and perineural fibrosis These are only a few examples of potential complications of anterior transposition. A surgeon seeking advice from Green s operative Hand Surgery will be told that the indications for in situ decompression are mild or intermittent symptoms in a nonsubluxating ulnar nerve when there is normal osseous anatomy absence of pain around the medial epicondyle and findings are consistent with compression under the fibrous arcade. The surgeon will then be advised to do a limited in situ decompression extending down to 5 cm distal from the medial epicondyle. Alternatively a subcutaneous anterior transposition will be recommended for patients with bony deformity or subluxation or dislocation of the nerve or for severe cases with motor involvement. The recommended technique involves a 15-cm skin incision and extensive dissection up to 8 cm proximally and at least 7 cm distally. How these recommendations fit with the overall statement that any technique will give good results must be very confusing for the reader. We believe that there are true elements in both procedures. Open in situ decompression is safe but it may not be extensive enough in all cases. The extensive dissection and decompression necessary for a nerve transposition are effective but they are also laden with many risks and dangers. The endoscopic approach is not new. Tsu-Min Tsai et used an endoscopic technique for cubital tunnel syndrome as early as 1992. They concluded that their results were no better than those of other standard techniques. The description of their technique has some analogy to the techniques used for endoscopic surgery for carpal tunnel syndrome. They describe the extensive division of the forearm fascia only. Our endoscopic operation for cubital tunnel syndrome is a long-distance in situ decompression. We combine the advantages of both procedures and minimize the risks. We apply the same general .