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Endoscopic (Arthroscopic) treatment of Cubital Tunnel Syndrome - Endoskopische Behandlung Kubitaltunnelsyndrom | Behandlung
Endoskopische Behandlung des Kubitaltunnelsyndroms

Behandlung


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Die chirurgische Behandlung des Kubitaltunnelsyndrom ist angezeigt, wenn einfache Massnahmen wie Schienung und Polsterung zu keiner Besserung geführt haben


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traditionelle Operationsmethode

Die traditionell angewandten Operationsmethoden erfordern lange Schnitte, sehr invasive Gewebspräparation und häufig wird der Nerv aus seiner normalen anatomischen Position verlagert oder sogar ein Teil des inneren Ellenbogenknochens entfernt. Diese Technik führt zu Vernarbungen und nicht selten zu wochen- und monatelanger Gebrauchsbehinderung des Armes.


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Endoskopische Operationstechnik

Dr. Reimer Hoffmann aus Oldenburg, Deutschland, hat die Behandlung des Kubitaltunnelsyndrom modifiziert durch die Einführung einer endoskopischen Operationstechnik.


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Das Endoskop im Kubitaltunnel

Das Endoskop im Kubitaltunnel


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Klicken Sie auf die Bilder für eine vergrößerte Ansicht.

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Die Technik der endoskopischen Operation erfordert lediglich einen sehr kleinen Schnitt (15 bis 20 mm), erlaubt aber eine ausgedehnte Dekompression des Nerven (25 bis 30 cm), was zu sehr guten Behandlungsergebnissen geführt hat (siehe auch Abbildungen).
Die funktionelle Behinderung nach der Operation ist gering und ein Verband wird nur für 2 Tage getragen. Für die meisten akademischen Berufstätigen (Ärzte, Zahnärzte, Journalisten, Ingenieure und im Büro Tätigen) kann die Arbeit in den meisten Fällen am Tag nach der Operation wieder aufgenommen werden.





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Häufig gestellte Fragen.

Bei der endoskopischen Behandlung des Nervus ulnaris am Sulcus wird ja nur ein sehr kleiner Hautschnitt angelegt. Führt dies nicht dazu, dass bei der endoskopischen Technik der Ellennerv nur unvollständig vom Druck entlastet wird?

Das Gegenteil ist der Fall. Mit der endoskopischen Methode der Ulnaris-Dekompression am Ellennerv eine wesentlich bessere Dekompression erreichen als in konventioneller offener Technik.

Wie ist dies zu erklären?

Bei der offenen Nerven-Dekompression wird im unmittelbaren Bereich des Ellenbogens eine Spaltung jener Gewebe, die auf den Nerv drücken können, von etwa 10-12 cm Länge erreicht.
Bei der von Dr. Hoffmann eingeführten endoskopischen Operationstechnik des Nervus ulnaris kann jedoch der Nerv mit dem langen Endoskop viel weiter von auf ihn drückenden Strukturen wie Muskeln oder Faszien befreit werden. Und das auf sehr sanfte, gewebeschonende Weise.
Nicht nur in Richtung Schulter sondern vor allen Dingen in Richtung Hand erlaubt die Methode eine Entlastung des Nervs von bis zu 15 cm unterhalb des Ellenbogens. So wird insgesamt eine entlastung über 23-30 cm erreicht.

Was heisst genau endoskopisch?

Die Operation benötigt ein spezielles Instrumenten-Set. Es werden Instrumente benutzt, wie sie in der endoskopischen Gynäkologie und Bauchchirurgie schon seit langem bewährt sind, nämlich ein Spekulum und ein Endoskop (Fa. KARL STORZ Endoskope, Tuttlingen). Mit dem Spekulum wird im Inneren die Wunde weit gespreizt, sodass eine sehr gute Sicht auf alle hier befindlichen Gewebe möglich ist. Das Endoskop in Kombination mit bestimmten Instrumenten erlaubt dann präzise diese Strukturen unter Schonung hier verlaufender Nervenbahnen zu spalten.

Sind die Ergebnisse der endoskopischen Operationstechnik denn vergleichbar mit der offenen Spaltung des Nervendaches?

Die endoskopische Methode der Behandlung des Kubitaltunnelsyndroms zeigt sich der offenen Technik sogar überlegen. Die Erholung des Nervs geschieht rascher und besser als in der offenen Technik. Dies hat gleich mehrere Gründe: In der offenen Technik, besonders wenn der Nerv verlegt wird, ist es unvermeidbar, kleinere Blutgefäße, die den Nerv ernähren, zu unterbrechen, um eine Verlegung des Nervs zu ermöglichen.
Bei der endoskopischen Technik werden alle Blutgefäße, die den Nerv ernähren, aber sorgfältig geschont.
Ein weiterer wesentlicher Grund ist jedoch, dass häufig bei einem Kompressionssyndrom am Ellennerv nicht eine einzelne auf die Ellenbogenrinne beschränkte Kompression vorliegt, sondern diese Kompression sich sehr langstreckig auch bis in den Unterarm hinein erstrecken kann. Trotz des kleinen Schnittes ist es ja bei der endoskopischen Technik möglich, wesentlich weiter in Richtung Hand den Nerv von allen einengenden Geweben zu befreien.

Worin besteht der wichtigste Vorteil der endoskopischen Behandlung des Sulcus ulnaris Syndroms?

Der wichtigste Vorteil der endoskopischen Technik besteht darin, dass die Patienten trotz einer langstreckigen und effektiven Nervendruckentlastung den Arm sofort wieder bewegen und einsetzen können, so als hätte eine Operation kaum stattgefunden.

Wie rasch kann ich nach der Operation wieder arbeiten?

Patienten, die im Büro arbeiten, Lehrer, Architekten, Ärzte, können meistens nach 2-3 Tagen wieder zurück in den Beruf. Bei manueller, körperlicher Tätigkeit 2-3 Wochen.

Ist Physiotherpapie nach der Operation erforderlich?

In der Regel ist das nicht nötig, obwohl eine Krankengymnastik nach einer Armoperation immer nützlich ist.

Wie lange muss ich in Oldenburg bleiben, wenn ich von auswärts komme?

Unsere auswärtigen Patienten reisen meistens am Tag vor der Operation an und können in aller Regel am Tag nach dem Eingriff wieder abfahren.

Videos


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Downloads für Ärzte


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Interessierte Ärzte können hier weitere Informationen abrufen. weiter…



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© 2007 | Dr. med. Reimer Hoffmann | Marienstraße 1 | 26121 Oldenburg | Telefon: 0441 4086855 | E-Mail