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Re: Невропатия срединного нерва в результате сдавления сухожильным ганглием
послал SAGo 08 Март 2012, 18:10
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"Не вижу никакого смысла выполнять теносиновэктомию, особенно при идиопатическом синдроме канала запястья" -
Это очень серьезный аргумент, высокого уровня доказательности, после которого я готов пересмотреть все свои взгляды на хирургию кисти:)" -
Очень приятно, что Вы собираетесь пересматривать все свои взгляды на хирургию кисти. Взгляды эти желательно основывать на данных серьезной литературы,например:
Shum C, Parisien M, Strauch RJ, Rosenwasser MP. The role of flexor tenosynovectomy in the operative treatment of carpal tunnel syndrome.// J Bone Joint Surg Am. 2002; 84:221-225. –
“We used a prospective, randomized study design. In addition to our finding that tenosynovectomy provided no additional benefit, we found that the gross and histologic appearance of the tenosynovium had no predictive value. The results of the present study support the theories proposed by Phalen (9) in his landmark article of 1966. In that article, Phalen noted that “thickening or fibrosis of the flexor synovialis within the carpal tunnel was the most common cause of the,syndrome, being found in 203 of 212 wrists.” Later in the article, however, he stated that “routine synovectomy is not advisable.” Our findings support the position that routine tenosynovectomy is unnecessary, although not harmful.
Conclusions: We observed neither an added benefit nor an increased rate of morbidity in association with the performance of a flexor tenosynovectomy at the time of carpal tunnel release. We identified no clinical correlations that might predict which individuals would benefit from flexor tenosynovectomy on the basis of either the gross (intraoperative) or histologic evaluation of the flexor tenosynovium. Our findings suggest that routine flexor tenosynovectomy offers no benefit compared with sectioning of the transverse carpal ligament alone for the treatment of idiopathic carpal tunnel syndrome.”
Alao U, O’Brien O, Browne TJ, Suleiman B, Fleming P (2011) Carpel Tunnel Synovium: Does Clinical Abnormality Correspond with Histological Abnormality? J Cytol Histol 2:117. doi:10.4172/2157-7099.1000117 –
“The functional outcome score described by Levine et al is particularly useful as it has been validated for carpal tunnel decompression. We found the mean score between the tenosynovectomy group (study group) and the control group that underwent open decompression without tenosynovectomy was 10 and 11.7 respectively. Between Tests comparative analysis showed this to be statistically insignificant (p 0.065).”
M. W. Keith, V. Masear, K. C. Chung et al. American Academy of Orthopaedic Surgeons Clinical Practice Guideline on The Treatment of Carpal Tunnel Syndrome.// J Bone Joint Surg Am. 2010;92:218-219. doi:10.2106/JBJS.I.00642 -
“Recommendation 6: We suggest that surgeons do not routinely use the following procedures when performing carpal tunnel release: skin nerve preservation (Grade B, Level I), epineurotomy (Grade C, Level II). The following procedures carry no recommendation for or against use: flexor retinaculum lengthening, internal neurolysis, tenosynovectomy, ulnar bursa preservation (Inconclusive, Level II and V).”
Это все существует в свободном доступе. Читайте и делайте выводы.
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