Neurological Surgery 脳神経外科46巻12号

2018年12月発行

症例

鏡視下手根管開放術における不全開放と皮下断端神経腫形成が複合性局所疼痛症候群を生じた1例

著者： 清水曉¹ 大澤成之¹ 檀充¹ 田中理² 望月崇弘¹ 根本充³ 岡秀宏⁴⁵ 隈部俊宏⁵

所属機関： ¹横浜市立脳卒中・神経脊椎センター脳神経外科 ²横浜市立脳卒中・神経脊椎センター臨床検査部 ³北里大学医学部形成外科・美容外科 ⁴北里大学メディカルセンター脳神経外科 ⁵北里大学医学部脳神経外科

ページ範囲：P.1093 - P.1101

Ⅰ．はじめに
　手根管症候群（carpal tunnel syndrome：CTS）への外科治療は，1930年代の直視下手根管開放術（open carpal tunnel release：OCTR）に始まり¹⁴⁾，1980年代後半には鏡視下手根管開放術（endoscopic carpal tunnel release：ECTR）が加わった．ECTRは，汎用型内視鏡を用いるコンセプトの発案以後²⁵⁾，前腕遠位部のポートと専用器具を用いるsingle-portal technique¹⁾，前腕遠位部と手掌にポートを設けるdual-portal techniqueが登場し⁵⁾，OCTRでみられる有痛性の手掌瘢痕を生じないことから，1990年代に急速に普及した．しかし合併症リスク，高コスト，適応が手術歴のない特発性CTSに限定される¹¹⁾などの理由から，近年は否定的な風潮にあり，ECTRとOCTRを合併症率，患者満足度，術後疼痛などで比較したメタ解析でも，ECTRがOCTRに対して優位なのは術後疼痛の弱さのみと結論されている³⁷⁾．
　今回われわれは，ECTRにおける手根管の不全開放および尺骨神経掌枝の断端神経腫形成が，難治性の慢性疼痛症候群である複合性局所疼痛症候群（complex regional pain syndrome：CRPS）の発生に関与した1例を経験したので報告し，これらの合併症を考察する．

参考文献

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