骨科手术早知道109:腕管松解术(Carpal Tunnel Release)
腕管综合征是腕部的正中神经压力过高引起的手腕部疾病。神经受压通常引起拇指、示指、中指和环指的麻木和刺痛，也会出现手和腕部的疼痛。腕管松解术用于减轻正中神经的压迫以缓解症状。
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Carpal Tunnel Release
腕管松解术
Introduction（介绍）
Carpal tunnel syndrome is a condition in the hand and wrist caused by excessive pressure on the median nerve in the wrist. Compression of the nerve typically causes numbness and tingling in the thumb, index finger, middle finger, and ring finger. Pain in the hand and wrist may also occur. Carpal tunnel release is a surgical procedure that reduces the pressure on the median nerve to alleviate symptoms.
腕管综合征是腕部的正中神经压力过高引起的手腕部疾病。神经受压通常引起拇指、示指、中指和环指的麻木和刺痛，也会出现手和腕部的疼痛。腕管松解术用于减轻正中神经的压迫以缓解症状。
What Causes Carpal Tunnel Syndrome（腕管综合征是怎么引起的）
The median nerve controls thumb movement and provides sensation from the palm side of the thumb to half of the ring finger. This nerve runs from the forearm into the hand, along with flexor tendons, through the carpal tunnel, which is a narrow tunnel formed by the transverse carpal ligament and carpal bones in the wrist. If the median nerve is compressed or pinched, numbness and tingling in the thumb, index, middle, and ring finger are typically present. Pain in the wrist may also occur and may even radiate up the forearm. In severe cases of carpal tunnel syndrome, the muscles of the thumb may become weak and decrease in size. Compression of the nerve may be the result of any number of factors that narrow the carpal tunnel or cause changes in the median nerve.
正中神经支配拇指活动和拇指到半个环指的掌侧的感觉。正中神经与屈肌腱相伴，从前臂分布到手部，在腕部穿过腕管，这是个由腕横韧带和腕骨构成的狭窄的隧道。如果正中神经受压，通常出现拇指、示指、中指和环指的麻木和刺痛，也可能出现腕部疼痛，并可能有前臂放射痛。在严重的腕管综合征，拇指肌肉乏力萎缩。神经受压可能是多种引起腕管狭窄或正中神经改变的因素的造成的。
Fluid retention or swelling at the wrist, such as occurs during pregnancy or after trauma or injury; flexor tendon irritation from excessive or repetitive hand use; nerve changes resulting from diabetes, hypothyroidism, or alcoholism; wrist inflammation due to rheumatoid and other forms of inflammatory arthritis; bone changes from arthritis or an overactive pituitary gland; and cysts or tumors may all lead to carpal tunnel syndrome.
腕部液体滞留或肿胀，比如在妊娠期间或创伤后出现的；过度或反复用手造成屈肌腱激惹；因糖尿病、甲状腺机能减退、酒精中毒引起的神经改变；因类风湿性关节炎或其它类型的关节炎症镇江起的腕关节炎症；因关节炎或垂体腺功能亢进引起的骨骼改变；以及囊肿或肿瘤都会引起腕管综合征。
Surgery Options and Preparation（手术方式及准备）
Carpal tunnel release may be performed either as an open procedure or an endoscopic procedure. The open procedure typically involves a small incision on the palm of your hand to expose the carpal ligament. Alternatively, the procedure may be performed endoscopically, which involves one or two small incisions and the use of a special surgical camera and instruments to perform the surgery beneath the tissues. Both procedures are described in this animation.
腕管松解可以开放手术，也可以在内窥镜下手术。开放手术一般需要在手的掌侧作一个小切口以显露腕部韧带。如果在内窥镜下进行手术，可以作1～2个小切口，使用特殊的手术摄像机和器械在组织下进行手术。本视频对这两种手术方法都进行介绍。
Each procedure may be done under local, regional, or general anesthesia. The type chosen will be determined by your surgeon based on a variety of factors. If local anesthesia is used, the surgeon will inject medication into your wrist or hand to numb the incision area. Prior to this injection you are often given medication so you are relaxed during the procedure. Regional anesthesia with IV sedation involves injecting medication into vein and nerves in your arm to numb your entire arm and hand, and you may be relaxed but not entirely asleep. If general anesthesia is used, you will be given medication so that you are asleep during the procedure.
每种手术都可以在局部麻醉、区域麻醉或全身麻醉下实施。根据不同因素，医生会决定选择哪种麻醉。如果选择局部麻醉，术者会在你的腕部或手部注射药物，使切口部位麻木。在注射之前，通常会给药使你在术中放松。区域麻醉联合静脉镇静是将药物注入静脉和上肢的神经，使你整个手臂都麻木，并使你放松，但并没有完全睡着。如果使用全麻，麻醉医师会给药使你在整个手术过程中完全睡着。
Prior to the procedure, a tourniquet will be carefully placed on your arm. This will temporarily stop blood flow to the hand so that the surgeon can clearly visualize the nerve in the hand and wrist area during the short surgical procedure.
术前，在胳膊上会小心地绑上止血带。这可以暂时阻断到手部的血流，这样外科医生在短暂的手术过程中能够清楚地看到手和腕部的神经。
Open Procedure（开放手术）
To begin the open procedure, an incision is made at the base of the palm of the hand in line with the ring finger. Instruments known as retractors are used to pull the skin and fat apart and expose the underlying tissue, called the superficial palmar fascia. Another incision is made through the fascia to expose the transverse carpal
ligament. The ligament is then carefully cut to relieve the pressure on the median nerve. The fascia that is connected to the carpal ligament is then loosened and cut to further open the carpal tunnel.
开放手术开始时，在手的基底部的掌侧正对环指处作一切口。使用叫做拉钩的器械将皮肤和皮下脂肪拉开以显露下方的组织，称为掌浅筋膜。切开掌浅筋膜，显露腕横韧带。然后将该韧带小心地切开，以减轻正中神经的压迫。与腕韧带相连的筋膜松解切除，进一步打开腕管。
The surgeon will inspect the carpal tunnel, nerve, and flexor tendons. If a cyst or other mass is present, or if significant tendon inflammation is present, the surgeon may extend the original incision to address these problems. Once the carpal tunnel is completely released, the tourniquet is removed and the incision is closed with sutures or special wound tape. A medication is typically injected to numb the area for several hours after surgery and a bandage is placed over the wound. A splint may be applied to limit wrist motion after surgery.
术者检查腕管、神经及屈肌腱。如果有囊肿或其它肿块，或肌腱存在明显炎症，术者会延长原始的切口，处理这些问题。腕管一旦彻底松解，将止血带去除，缝合或用特殊的伤口夹关闭切口。通常注射药物使局部在术后数小时麻木，绷带包扎伤口，术后可能会使用夹板限制腕关节活动。
Endoscopic Procedure（内窥镜下手术）
To begin the endoscopic procedure in a single incision technique, a small incision is made in the wrist. In a double incision technique, which is described in this animation, incisions are made in the wrist and in the palm of the hand. A thin tube with a camera attached, called an endoscope, is gently guided through the incision in the wrist, allowing the surgeon to visualize the tissues beneath the skin. A special surgical knife is inserted into the incision under the transverse carpal ligament which is then cut to relieve the pressure on the median nerve. The instruments are withdrawn and reinserted in the opposite direction. This allows visualization of the fascia that is connected to the carpal ligament. The fascia is loosened and cut to further open the carpal tunnel.
如果用单切口技术做内窥镜下手术，在腕部作一个小切口。在本动画片里叙述的双切口技术，在腕部和手的掌侧各作一切口，将附有摄像头的细管（称为内窥镜），轻柔地通过腕关节的切口插入，使术者能看到皮肤下面的组织。用特殊的手术刀插入切口，到腕横韧带的下方，然后将其切断，以缓解正中神经的压迫。手术器械在相反的方向上撤出或重新插入，允许看清与腕韧带相连的筋膜。将筋膜松解切除，进一步打开腕管。
Once the carpal tunnel is completely released, the tourniquet is removed and the incision is closed with sutures or special wound tape. A medication is typically injected to numb the area for several hours after surgery and a bandage is placed over the wound. A splint may be applied to limit wrist motion after surgery.
一旦腕管充分解压，将止血带去除，用缝线缝合或用特殊的切口夹关闭切口。通常注射药物使局部在术后数小时麻木，绷带包扎伤口，术后可能会使用夹板限制腕关节活动。
Recovery（恢复）
Immediately following the procedure, you can expect to have some pain, swelling, and possibly stiffness around the wrist and hand that may last for several weeks. You will likely be advised to keep your hand elevated for a few weeks after the surgery to reduce swelling. Sutures will typically be removed between 10 days and two weeks. Your surgeon will likely suggest hand and finger exercises after surgery and may also recommend hand therapy if necessary. You will consult with your surgeon about when to resume other activities.
手术刚结束，你的腕和手会有一些疼痛、肿胀，并可能僵硬，这可能会持续数周。医生往往会建议你在术后数周内抬高患肢以减轻肿胀。通常在术后10天到2周左右拆线。你的医生可能会建议你在术后做一些手部和手指的练习，还会建议在必要时进行手法治疗。你可以找你的医生了解何时能够恢复其它活动。
Carpal tunnel release provides complete or nearly complete relief of numbness, tingling, and pain depending on your age, the severity of your condition, and other medical conditions.
腕管松解术是否能彻底或几乎彻底地缓解麻木、刺痛和疼痛，这取决于你的年龄、病情的严重程度以及其它身体状况。
QUESTIONS FOR YOUR DOCTOR
1. What guidelines should I follow prior to my procedure? Will I need other tests or evaluations before the procedure?
在手术之前应遵循哪些指南？术前需要其它检查和评估吗？
2. What will happen if I don’t undergo the procedure now?
如果现在不手术会有什么影响？
3. Which type of repair will you perform and why is it the appropriate procedure for my condition?
医生将用哪种修复方法，为什么这种手术适合我的情况？
4. How long will the procedure last and will I be under anesthesia?
手术和麻醉需要多久？
5. Will I have dressings, bandages, or stitches after surgery? When should they be removed?
术后需要缝合、包扎吗？什么时候换药、折线？
6. How long of a recovery period can I expect, and what kind of help will I need during my recovery? Are there special instructions for eating, sleeping, or bathing?
术后恢复需要多久？恢复期间需要什么样的帮助？吃饭、睡觉、洗浴等有什么特殊指令吗？
7. When can I return to work, resume normal activity, drive, and exercise?
我什么时候可以上班、恢复正常的活动、开车及锻炼？
8. Will I need to come back for appointments after the surgery?
术后是否需要复诊？
9. Will I have scars? Are the results permanent?
手术会留疤吗？结果是持久的吗？
10. Will I need physical therapy?
需要物理治疗吗？
（胡佰文 译）
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