NEW MINIMALLY INVASIVE TECHNIQUE OF TREATING PATIENTS WITH CARPAL TUNNEL SYNDROME

Objective. Carpal Tunnel Syndrome (CTS) is a compression-ischemic neuropathy of the median nerve at the level of the wrist. Between 3.7 to 5.0% of the human population suffers from this condition. This makes it the most widely spread tunnel syndrome of the upper limb. This illness leads to sudden deterioration of the upper limb function, work-decrement and significant decrease in the quality of life. Both conservative and surgical treatments can be used in order to treat CTS. Surgical treatment includes classical release through the longitudinal access as well as multiple minimally invasive procedures. There exist multiple miniinvasive techniques. However, they are not widespread amongst professionals because of difficulties in performing these procedures and the high prices of the expendable materials. The goal of this research was to improve the results and to shorten the terms of treatment of patients with carpal tunnel syndrome by creating and introducing a new, cheap and easily reproducible minimally invasive procedure. Material and methods. The research consisted of two parts - anatomical and clinical. In the anatomical part of the research (12 upper extremities of 6 unfixed corpses) safe accesses to the carpal tunnel were proposed and the anatomic peculiarities of this area for procedure applied to the minimally invasive decompression of the nerve were studied. In the clinical part of the work the results of the treatment of 46 people aged 28 to 89 with the II stage of the CTS by Szabo's scale were analysed. All patients received minimally invasive ligamentotomy of the transverse ligament of the wrist in the outpatient setting under local anaesthesia. A new technique, the “carpal hook” was used (56 surgeries). Average length of the operation was from 5 to 15 minutes. The wounds averagely healed within 7 days after the surgery. No stitches were used. Results. The observation period lasted for 6 to 18 months. Before the surgical treatment functioning of the hand of all patients was assessed by the Boston Carpal Tunnel Questionnaire and by VAS and qDASH scales in order to evaluate the results of the treatment in dynamics. The assessment of scar tissues was conducted by Vancouver Scar Scale suggested by T. Sullivan 6 months after the operation. All patients got good and excellent clinical and esthetical results after treatment. Conclusion. Received data illustrates the high efficiency of the usage of minimally invasive ligamentotomy of the palmar ligament of the wrist with the help of a new tool. One of the major merits of this technique is the minimal damage to the superficial tissues. This allows for a reduction of the rehabilitation period and it improves the quality of the scar tissue. Another positive factor of the operation is the lower cost of treatment, the duration of the operation is shorter and the absence of hospitalization. There is no need for expensive equipment in order to use "carpal hook". The only equipment which is needed is an ultrasonic apparatus. Minimally invasive ligamentotomy of the palmar ligament of the wrist with the help of a new tool can be used in the practice of the hand surgeons and neurosurgeons that have the experience with the conduction of open operations and the basic skills of ultrasonic diagnostics.

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