PM & R : the journal of injury, function, and rehabilitation · 2019
Ultrasound-Guided Incisionless Carpal Tunnel Release Using a Hook Knife: A Cadaveric Study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Mittal Nimish, Sangha Harpreet, Flannery John, Robinson Lawrence R, Agur Ann
Аннотация
BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy of the median nerve. In comparison to open surgical and endoscopic carpal tunnel release, a new ultrasound-guided hook knife carpal tunnel release (CTR) procedure was reported to have superior results in terms of reduced morbidity and early return to work.
OBJECTIVE: To evaluate the reproducibility of the hook knife CTR procedure when performed by musculoskeletal ultrasound trained physicians without prior experience in this technique.
DESIGN: Cadaveric study.
SETTING: Tertiary-level academic institute.
PARTICIPANTS: Sixteen lightly embalmed forearm and hand specimens.
METHODS: The ultrasound-guided CTR was done using a 1-mm proximal wrist puncture, creation of a tunnel, followed by the retrograde percutaneous release of the transverse carpal ligament (TCL) using a 3-mm hook knife.
MAIN OUTCOME MEASUREMENTS: Assessment of the completeness of TCL release, the integrity of the surrounding neurovascular structures, and the technical and subjective procedural difficulty encountered during the procedure.
RESULTS: In 14 of 16 specimens, complete release of the TCL was achieved. In two specimens with an incomplete release, the TCL resection was 52% and 55%, respectively. The integrity of the surrounding neurovascular structures and superficial anatomy volar to the dissection path was maintained in all specimens. The mean level of procedural difficulty was 2.6 (range 2-4) on a Likert 5-point rating scale.
CONCLUSIONS: In cadavers, the ultrasound-guided hook knife CTR procedure was found to be reproducible when performed by ultrasound-trained physicians with no experience in this technique. Further in vivo investigations are required.
OBJECTIVE: To evaluate the reproducibility of the hook knife CTR procedure when performed by musculoskeletal ultrasound trained physicians without prior experience in this technique.
DESIGN: Cadaveric study.
SETTING: Tertiary-level academic institute.
PARTICIPANTS: Sixteen lightly embalmed forearm and hand specimens.
METHODS: The ultrasound-guided CTR was done using a 1-mm proximal wrist puncture, creation of a tunnel, followed by the retrograde percutaneous release of the transverse carpal ligament (TCL) using a 3-mm hook knife.
MAIN OUTCOME MEASUREMENTS: Assessment of the completeness of TCL release, the integrity of the surrounding neurovascular structures, and the technical and subjective procedural difficulty encountered during the procedure.
RESULTS: In 14 of 16 specimens, complete release of the TCL was achieved. In two specimens with an incomplete release, the TCL resection was 52% and 55%, respectively. The integrity of the surrounding neurovascular structures and superficial anatomy volar to the dissection path was maintained in all specimens. The mean level of procedural difficulty was 2.6 (range 2-4) on a Likert 5-point rating scale.
CONCLUSIONS: In cadavers, the ultrasound-guided hook knife CTR procedure was found to be reproducible when performed by ultrasound-trained physicians with no experience in this technique. Further in vivo investigations are required.