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Iatrogene Nervenverletzungen

Teil 2: Fallstricke der endoskopischen Karpaltunneloperation—Folgerungen aus den Befunden offener Revisionsoperationen

Pitfalls of endoscopic carpal tunnel release

Part 2: Conclusions from findings of open surgery

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Zusammenfassung

Hintergrund

Ziel war es die Befunde offen revidierter fehlgeschlagener Karpaltunnelsyndromoperationen zu evaluieren, um besondere Gefahrenpotenziale zu erkennen. Hierzu wurden die intraoperativen Befunde von 10 offenen Revisionsoperationen retrospektiv ausgewertet.

Ergebnis

Von 1999–2001 wurden uns 10 Patienten nach endoskopisch durchgeführter Karpaltunnelsyndromoperation zugewiesen und offen, mikrochirurgisch revidiert. Hierbei war der N. medianus in 5 Fällen verletzt, 4-mal war eine Transplantation notwendig. In 2 Fällen erfolgte eine aufwändige Neurolyse. Zweimal war der Hauptstamm des Nervs geschädigt, 3-mal der motorische Ast, 3-mal ein Digitalnerv und 1-mal der sensible R. palmaris. Bei 4 Patienten war das Retinaculum flexorum nicht gespalten, in 2 Fällen nur inkomplett. Ein wieder vereinigtes, verdicktes Ligamentum war 2-mal erkennbar. Bei 3 Patienten scheinen postoperative Hämatome an der Symptomatik beteiligt gewesen zu sein.

Folgerung

In der Hand des Unerfahrenen birgt die endoskopische CTS-Operation weiterhin ein hohes Risiko für neurovaskuläre Verletzungen.

Abstract

Background

The objective of this study was to evaluate the causes of failed endoscopic carpal tunnel release (CTR) in order to detect potentially hazardous operative steps. The intraoperative findings of 10 microsurgically revised cases were retrospectively analyzed.

Results

From January 1999 to October 2001, ten patients underwent open revision surgery after being referred because of failed endoscopic carpal tunnel release (CTR). The median nerve had been injured in five cases, necessitating autologous sural nerve grafting in four. Two other patients underwent extensive (external and internal) neurolysis. The lesions were located twice in the main nerve trunk, three times in the recurrent motor branch, three times in a digital nerve, and once in the sensory palmar branch. The transverse carpal ligament (TCL) had not been sectioned in four cases and was incomplete in two. In another two cases, previously sectioned TCLs were closed again by firm fibrous tissue. In three cases, postoperative hematomas after the initial release were described and possibly contributed to symptoms.

Conclusion

Endoscopic CTR in the hand of the inexperienced bears major risks for iatrogenic neurovascular injury.

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Authors and Affiliations

  1. Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg

    T. Kretschmer, G. Antoniadis, W. Börm & H.-P. Richter

  2. Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Ludwig-Heilmeyer-Straße 2, 89312 , Günzburg

    T. Kretschmer

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  1. T. Kretschmer
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  2. G. Antoniadis
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  3. W. Börm
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  4. H.-P. Richter
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Correspondence to T. Kretschmer.

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Kretschmer, T., Antoniadis, G., Börm, W. et al. Iatrogene Nervenverletzungen. Chirurg 75, 1207–1209 (2004). https://doi.org/10.1007/s00104-004-0880-2

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