赤坂 朋代

PURPOSE: This study aimed to introduce a novel technique using the extensor pollicis brevis and extensor indicis proprius tendons as power sources for thumb opposition reconstruction in cases of severe carpal tunnel syndrome (CTS) associated with thenar muscle atrophy. Furthermore, the efficacy of this novel method and the traditional Camitz technique was compared. METHODS: Patients with severe CTS and thumb opposition dysfunction who underwent surgery using the novel technique (n = 7 and 9 surgeries) or the Camitz technique (n = 8 and 8 surgeries) were included in the analysis. The pre- and postoperative palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score were assessed. The repeated measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. RESULTS: The novel technique was associated with a significant postoperative improvement in palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score. In particular, the thumb-ring finger opposition angle of patients who underwent surgery using this technique was superior to that of patients who underwent surgery using the Camitz technique. Therefore, the novel technique was highly effective in improving thumb pronation. CONCLUSION: The novel technique using the extensor pollicis brevis and extensor indicis proprius tendons is promising for thumb opposition reconstruction in severe CTS cases. Unlike the traditional Camitz technique, this approach promotes stable thumb opposition function without requiring a pulley, thereby yielding satisfactory outcomes. Nevertheless, further studies with a larger sample size should be conducted to validate these findings. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic 4; Surgical technique.

MRIのCT-like bone contrastであるPhilips社のFRACTUREは,骨のみならず腱の描出にも優れる.さらにこれを元にVR画像を作成すると患者そのものの解剖図を得られる.これらの画像が手指腱損傷の診断に有用であるか検証した.対象は当院でMRI検査を行った腱損傷患者12名で,撮影条件はFRACTURE(VR像も作成),T2WI,3D PDWI,STIR等とし,手術に関与しなかった整形外科医3名が,FRACTURE MPR像,FRACTURE VR像,FRACTURE以外のシークエンスの3種類の方法で読影した.1.読影の正確性,2.読影に要した時間,3.読影しやすさに関して検討すると,FRACTUREは他のシークエンスと比較し全ての評価項目で優れていた.また手術症例ではFRACTURE VR像と術野の断裂部は概ね一致した.母指・小指の腱についてはmagic angle effectによるアーチファクトを考慮する必要があるが,撮像肢位を工夫することで回避できる.FRACTUREは手指腱の描出能が高く,手外科領域の臨床において有用と考える.(著者抄録)