カルディオトロフィン - 1 ト ソノ インセイ フィードバック キコウ ノ シン ケッカンケイ ニ オケル サヨウ ノ カイメイ ニ カンスル ケンキュウ

京都大学0048新制・課程博士博士(医学)甲第10040号医博第2550号新制||医||817(附属図書館)UT51-2003-H461京都大学大学院医学研究科内科系専攻(主査)教授 北 徹, 教授 野間 昭典, 教授 中尾 一和学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

Endoscopic tarsal tunnel syndrome surgery using the Universal Subcutaneous Endoscope system

Background/objective: Tarsal tunnel syndrome is a relatively rare entrapment neuropathy with the lateral and medial plantar nerves entrapped inside of the tarsal tunnel. When conservative treatment fails, standard open decompression of the nerve can be achieved by releasing the flexor retinaculum of the foot through a several-centimetre-long skin incision made along the tarsal tunnel. By contrast, we made a 1-cm portal incision at the proximal part of the medial ankle, and endoscopic tarsal tunnel release of the flexor retinaculum of the foot and part of the abductor hallucis muscle was achieved using the Universal Subcutaneous Endoscope (USE) system. Methods: Our procedure was performed under local anaesthesia without a pneumatic tourniquet on an outpatient basis. The USE system was inserted into the tarsal tunnel at the proximal part of the medial ankle; the nerves, vessels, flexor retinaculum, tendons of the foot, and the abductor hallucis muscle were then endoscopically identified. Decompression of the lateral and medial plantar nerves entrapped inside of the tarsal tunnel was then achieved by releasing the flexor retinaculum of the foot and part of the abductor hallucis muscle with a push knife under complete endoscopic observation. Results: Results from eight feet of five patients were compiled and analyzed. All showed improved clinical signs compared with their preoperative condition. Conclusion: Our less invasive endoscopic management for tarsal tunnel syndrome using the USE system produces sufficient results

Minimally invasive endoscopic ulnar nerve assessment and surgery for cubital tunnel syndrome patients—Relation between endoscopic nerve findings and clinical symptoms

AbstractTo minimize damage to healthy tissues, we have been performing endoscopically assisted cubital tunnel syndrome surgery based on endoscopic nerve findings since 1995. This is the first study to focus on endoscopic surgery for cubital tunnel syndrome based on endoscopic ulnar nerve findings and the subsequent postoperative clinical results. We analysed 82 upper extremities of 74 cubital tunnel syndrome patients who had undergone endoscopically assisted release surgery using the Universal Subcutaneous Endoscope system. Endoscopic observations of the ulnar nerve were made from a single 1- to 3-cm endoscopic portal incision at the cubital tunnel to 10 cm proximal and 10 cm distal. The abnormal nerve areas were identified and released based on nerve degeneration findings under endoscopic observation. The abnormal areas spread eccentrically from the entrapment point(s). In 82 diseased upper extremities, ulnar nerve entrapment occurred at the cubital tunnel. However, one extremity suffered from entrapment at the arcade of Struthers' in addition to the cubital tunnel. All patients showed improved clinical symptoms following surgery. There is no statistical relation between pre- and postoperative clinical scores of Dellon's Staging and abnormal nerve length findings. Cubital tunnel syndrome is usually caused by entrapment at the cubital tunnel; however, in some cases, there are other point entrapment(s). Our endoscopically assisted procedure avoids any damage to healthy tissues because the surgeon can observe the entrapment point(s) prior to release. Postoperative clinical recovery results clearly indicate that endoscopic nerve findings reveal entrapment points and ulnar nerve degeneration can spread maximally 10 cm distally and proximally from the entrapment point(s), even in clinically mild severity cases. All other possible entrapment points should, therefore, be observed and released using our procedure