plasurВопросы реконструктивной и пластической хирургииIssues of Reconstructive and Plastic Surgery1814-1471АНО "НИИ микрохирургии"10.52581/1814-1471/82/05plasur-111Research ArticleНОВЫЕ ТЕХНОЛОГИИNEW TECHNOLOGIESОпыт применения эндоскопических технологий в хирургии туннельных синдромов верхней конечностиExperience in the use of endoscopic technology in surgery for tunnel syndromes of the upper limbБайтингерА. В.BaytingerA. V.

Байтингер Андрей Владимирович – канд. мед. наук, пластический хирург

634063, г. Томск, ул. Ивана Черных, д. 96

Andrey V. Baytinger, Cand. Med. sci., plastic surgeon

96, Ivan Chernykh st., Tomsk, 634063

drbaitinger@gmail.comНИИ микрохирургииРоссияInstitute of MicrosurgeryRussian Federation2022301020222533844Copyright © Байтингер А.В., 20222022Байтингер А.В.Baytinger A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://plasur.elpub.ru/jour/article/view/111

Синдромы карпального и кубитального каналов являются самыми распространенными компрессионными нейропатиями верхней конечности. С конца XX в. все большую популярность приобретают эндоскопические технологии в декомпрессионной хирургии компрессионных нейропатий. Начиная с 2017 г. на базе АНО ≪НИИ микрохирургии≫ (г. Томск) были прооперированы 194 пациента, из которых 154 с синдромом карпального канала (1-я группа) и 40 – с синдромом кубитального канала (2-я группа). Результаты хирургического вмешательства оценивали по изменению уровня нейропатической боли с помощью опросника PainDetect и степени нарушения функции кисти по данным опросника DASH, до и после проведенной операции. Кроме того, был выполнен анализ ранних и поздних послеоперационных осложнений. Полученные данные свидетельствуют о достоверном снижении уровня нейропатической боли и субъективном улучшении функции кисти у пациентов обеих групп через 1 мес после операции. Ранних послеоперационных осложнений в 1-й группе не выявлено, поздние отмечены у 7 (4,5%) пациентов. В 2-й группе в раннем послеоперационном периоде у 2 (5%) пациентов из 40 наблюдались ранние послеоперационные осложнения, поздних выявлено не было. Доказано, что эндоскопическая декомпрессия срединного нерва в карпальном канале и локтевого нерва в кубитальном канале являются эффективными и относительно безопасными видами оперативного вмешательства.

Carpal and cubital tunnel syndromes are the most common compressive neuropathies of the upper limb. Since the end of the 20th century, endoscopic technologies have become increasingly popular in decompression surgery for compression neuropathies. Since 2017, 194 patients have been operated on the basis of the Institute of Microsurgery (Tomsk, Russia), of which 154 with carpal tunnel syndrome (1st group) and 40 with cubital tunnel syndrome (2nd group). In the postoperative period, the results of the operation were assessed by changes in the level of neuropathic pain using the PainDetect questionnaire and the degree of hand dysfunction according to the DASH questionnaire, before and after the operation, and an analysis of early and late postoperative complications was also performed. The data obtained indicate a significant decrease in the level of neuropathic pain and a subjective improvement in hand function in patients of both groups 1 month after surgery. No early postoperative complications were detected in 1st group, late ones were noted in 7 patients, which amounted to 4.5%. In 2nd group, in the early postoperative period, 2 out of 40 patients had early postoperative complications, which amounted to 5%, late ones were not detected. It has been proven that endoscopic decompression of the median nerve in the carpal tunnel and the ulnar nerve in the cubital tunnel are effective and relatively safe types of surgery.

синдром карпального каналасиндром кубитального каналаэндоскопическая декомпрессиятуннельный синдромcarpal tunnel syndromecubital tunnel syndromeendoscopic decompressiontunnel syndromeReferencesGreen D., Hotchkiss R.N., Pederson W.C., Wolfe S.W. Green’s operative hand surgery. 5th ed., USA: Churchill Livingstone; 2005:1024-1043.Green D., Hotchkiss R.N., Pederson W.C., Wolfe S.W. Green’s operative hand surgery. 5th ed., USA: Churchill Livingstone; 2005:1024-1043.Asamoto S., Böker D.K., Jödicke A. Surgical treatment for ulnar nerve entrapment at the elbow. Neurol Med Chir (Tokyo). 2005;45:240-244.Asamoto S., Böker D.K., Jödicke A. Surgical treatment for ulnar nerve entrapment at the elbow. Neurol Med Chir (Tokyo). 2005;45:240-244.McPherson S.A., Meals R.A. Cubital tunnel syndrome. Orthop Clin North Am 1992;23:111-123.McPherson S.A., Meals R.A. Cubital tunnel syndrome. Orthop Clin North Am 1992;23:111-123.Morbidity and Mortality Weekly Report, 2011. Centers for Disease Control and Prevention. URL: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6049a4.htm?s_cid=mm6049a4_w. (accessed: 22.04.2022).Morbidity and Mortality Weekly Report, 2011. Centers for Disease Control and Prevention. URL: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6049a4.htm?s_cid=mm6049a4_w. (accessed: 22.04.2022).Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2017 Revision. (Medium-fertility variant). worldometers URL: http://www.worldometers.info/world-population/uspopulation/ (accessed: 22.04.2022).Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2017 Revision. (Medium-fertility variant). worldometers URL: http://www.worldometers.info/world-population/uspopulation/ (accessed: 22.04.2022).Mondelli M., Giannini F., Ballerini M., Ginanneschi F., Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234:5-10.Mondelli M., Giannini F., Ballerini M., Ginanneschi F., Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234:5-10.Szabo R.M., Madison M. Carpal tunnel syndrome. Orthop Clin North Am. 1992;23(1): 103-109.Szabo R.M., Madison M. Carpal tunnel syndrome. Orthop Clin North Am. 1992;23(1): 103-109.Goldberg B.J., Light T.R., Blair S.J. Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg Am. 1989;14:182-188.Goldberg B.J., Light T.R., Blair S.J. Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg Am. 1989;14:182-188.Kaplan S.J., Glickel S.Z., Eaton R.G. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. J Hand Surg Br. 1990;15:106-108.Kaplan S.J., Glickel S.Z., Eaton R.G. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. J Hand Surg Br. 1990;15:106-108.Gerritsen A.A., et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288:1245-1251.Gerritsen A.A., et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288:1245-1251.Hui A.C., et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074-2078.Hui A.C., et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074-2078.Jarvik J.G., et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009;374:1074-1081.Jarvik J.G., et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009;374:1074-1081.Ullah I. Local steroid injection or carpal tunnel release for carpal tunnel syndrome – which is more effective?: Abstract. J Postgrad Med Instit. 2013;27(2). URL: http://www.jpmi.org.pk/index.php/jpmi/article/view/1497 (accessed: 22.04.2018).Ullah I. Local steroid injection or carpal tunnel release for carpal tunnel syndrome – which is more effective?: Abstract. J Postgrad Med Instit. 2013;27(2). URL: http://www.jpmi.org.pk/index.php/jpmi/article/view/1497 (accessed: 22.04.2018).Andreu J.L., et al. Local injection versus surgery in carpal tunnel syndrome: neurophysiologic outcomes of a randomized clinical trial. Clin Neurophysiol. 2014;125:1479-1484.Andreu J.L., et al. Local injection versus surgery in carpal tunnel syndrome: neurophysiologic outcomes of a randomized clinical trial. Clin Neurophysiol. 2014;125:1479-1484.Cha S.M., et al. Differences in the postoperative outcomes according to the primary treatment options chosen by patients with carpal tunnel syndrome: conservative versus operative treatment. Ann Plast Surg. 2016;77:80-84.Cha S.M., et al. Differences in the postoperative outcomes according to the primary treatment options chosen by patients with carpal tunnel syndrome: conservative versus operative treatment. Ann Plast Surg. 2016;77:80-84.Wilder-Smith E.P., Rajendran K., Therimadasamy A.K. High-resolution Ultrasonography for Peripheral Nerve Diagnostics: A Guide for Clinicians Involved in Diagnosis and Management of Peripheral Nerve Disorders. USA, New Jersey: World Scientific, 2009. 72 p.Wilder-Smith E.P., Rajendran K., Therimadasamy A.K. High-resolution Ultrasonography for Peripheral Nerve Diagnostics: A Guide for Clinicians Involved in Diagnosis and Management of Peripheral Nerve Disorders. USA, New Jersey: World Scientific, 2009. 72 p.Larsen M.B., et al. Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg Eur. 2013;38:646-650.Larsen M.B., et al. Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg Eur. 2013;38:646-650.Rozanski M., et al. Symptoms during or shortly after isolated carpal tunnel release and problems within 24 hours after surgery. J Hand Microsurg. 2015;7:30-35.Rozanski M., et al. Symptoms during or shortly after isolated carpal tunnel release and problems within 24 hours after surgery. J Hand Microsurg. 2015;7:30-35.Faucher G.K., Daruwalla J.H., Seiler J.G. 3rd. Complications of surgical release of carpal tunnel syndrome: a systematic review. J Surg Orthop Adv. 2017;26:18-24.Faucher G.K., Daruwalla J.H., Seiler J.G. 3rd. Complications of surgical release of carpal tunnel syndrome: a systematic review. J Surg Orthop Adv. 2017;26:18-24.Means K.R. Jr., et al. Long-term outcomes following single-portal endoscopic carpal tunnel release. Hand (N Y). 2014;9:384-388.Means K.R. Jr., et al. Long-term outcomes following single-portal endoscopic carpal tunnel release. Hand (N Y). 2014;9:384-388.Kang H.J., Koh I.H., Lee T.J., Choi Y.R. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res. 2013 May;471(5):1548-54. doi: 10.1007/s11999-012-2666-z. Epub 2012 Oct 26. PMID: 23100191; PMCID: PMC3613542Kang H.J., Koh I.H., Lee T.J., Choi Y.R. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res. 2013 May;471(5):1548-54. doi: 10.1007/s11999-012-2666-z. Epub 2012 Oct 26. PMID: 23100191; PMCID: PMC3613542Sayegh E.T., Strauch R.J. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res. 2015;473(3):1120-1132.Sayegh E.T., Strauch R.J. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res. 2015;473(3):1120-1132.Gumustas S.A., et al. Similar effectiveness of the open versus endoscopic technique for carpal tunnel syndrome: a prospective randomized trial. Eur J Orthop Surg Traumatol. – 2015;25:1253-1260.Gumustas S.A., et al. Similar effectiveness of the open versus endoscopic technique for carpal tunnel syndrome: a prospective randomized trial. Eur J Orthop Surg Traumatol. – 2015;25:1253-1260.Vasiliadis H.S. et al. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014;1. The electronic version of the printing publication. URL: https://www.ncbi.nlm.nih.gov/pubmed/24482073 (access date: 05.07.2022).Vasiliadis H.S. et al. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014;1. The electronic version of the printing publication. URL: https://www.ncbi.nlm.nih.gov/pubmed/24482073 (access date: 05.07.2022).Chaise F. et al. Professional absenteeism and surgery for carpal tunnel syndrome. Results of a prospective series of 233 patients. Send to Chir Main. 2001;20(2):117-121.Chaise F. et al. Professional absenteeism and surgery for carpal tunnel syndrome. Results of a prospective series of 233 patients. Send to Chir Main. 2001;20(2):117-121.Aldekhayel S., Govshievich A., Lee J., et al. Endoscopic Versus Open Cubital Tunnel Release: A Systematic Review and Meta-Analysis. Hand (N Y). 2016 Mar;11(1):36-44. doi: 10.1177/1558944715616097. Epub 2016 Jan 14. PMID: 27418887; PMCID: PMC4920515Aldekhayel S., Govshievich A., Lee J., et al. Endoscopic Versus Open Cubital Tunnel Release: A Systematic Review and Meta-Analysis. Hand (N Y). 2016 Mar;11(1):36-44. doi: 10.1177/1558944715616097. Epub 2016 Jan 14. PMID: 27418887; PMCID: PMC4920515Ahcan U., Zorman P. Endoscopic decompression of the ulnar nerve at the elbow. J Hand Surg Am. 2007;32:1171-1176.Ahcan U., Zorman P. Endoscopic decompression of the ulnar nerve at the elbow. J Hand Surg Am. 2007;32:1171-1176.Dutzmann S., Martin K.D., Sobottka S., et al. Open vs retractorendoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome: a retrospective cohort study. Neurosurgery. 2013;72:605-616.Dutzmann S., Martin K.D., Sobottka S., et al. Open vs retractorendoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome: a retrospective cohort study. Neurosurgery. 2013;72:605-616.Flores LP. Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome. Acta Neurochir. 2010;152:619-625.Flores LP. Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome. Acta Neurochir. 2010;152:619-625.Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg Br. 2006;31:23-29.Hoffmann R, Siemionow M. The endoscopic management of cubital tunnel syndrome. J Hand Surg Br. 2006;31:23-29.

The authors declare that there are no conflicts of interest present.