Şenol AKMAN, Erden ERTÜRER, Münevver ÇELİK, Bülent AKSOY, Bülent GÜR, İrfan ÖZTÜRK

Karpal tünel sendromunda açık cerrahi gevşetme sonuçları ve takip kriterlerinin karşılaştırılması

Amaç: Karpal tünel sendromlu (KTS) hastalarda açık cerrahi gevşetme sonuçları değerlendirildi ve ameliyat sonrası izlemde klinik skorlama ile elektromiyografi (EMG) incelemesinin gerekliliği araştırıldı. Çalışma planı: Klinik ve EMG incelemeleri sonucu KTS tanısı konan 15 hastanın (9 kadın, 6 erkek; ort yaş 49.2; dağılım 23-70) 24 el bileği çalışmaya alındı. Açık cerrahi gevşetme sonrasında hastalar ortalama 21.5 ay (dağılım 7-40 ay) izlendi. İzlemde klinik skorlama olarak Boston skalası (BS) kullanıldı ve EMG incelemeleri yapıldı. Tedavi sonrası BS ve EMG bulguları karşılaştırılarak, bu yöntemlerin hastaların takip dönemindeki değerlendirilmesinde kullanımları değerlendirildi. Sonuçlar: Ameliyat öncesi ve izlem sonrası EMG parametrelerinin incelenmesinde motor distal latans, duysal latans, motor bileşik kas potansiyelleri amplitüdleri ve duysal yanıt amplitüdlerine ait değerlerin tümünün anlamlı değişim gösterdiği belirlendi (p

Anahtar Kelimeler:

Karpal tünel sendromu, Sinirsel iletim, Elektromiyografi, Median sinir, Anketler, Hastalık ciddiyet indeksi

The results of open surgical release in Carpal tunnel syndrome and evaluation of follow-up criteia

We evaluated the results of open surgical release in patients with carpal tunnel syndrome (CTS) and assessed the necessity of a clinical scoring system and electromyography (EMG) in the postoperative follow-up. Methods: The study included 24 wrists of 15 patients (9 females, 6 males; mean age 49.2 years; range 23 to 70 years) in whom a diagnosis of CTS was made by clinical examination and EMG. The patients underwent open surgical release and were followed-up for a mean of 21.5 months (range 7 to 40 months), during which they were evaluated by the Boston scale (BS) for clinical scoring and EMG. Postoperative findings of BS and EMG were compared in terms of their utility during follow-up. Results: Statistically significant differences were found between preoperative and follow-up EMG values of motor distal latency, sensorial latency, combined motor muscle potential amplitudes, and sensorial latency amplitudes (p<0.05). Of twenty-four wrists, 16 (66.6%) showed improvement, and eight (33.3%) showed marked improvement. Similarly, preoperative and follow-up BS scores showed significant differences in favor of treatment results (p<0.05). The Boston scale scores and EMG results were found consistent in showing treatment outcome. Conclusion: Open surgical release of CTS provides favorable results that can be sufficiently evaluated by the clinical scoring system alone. Electromyographic studies do not seem to add extra benefits to the postoperative evaluation of patients with CTS.

Keywords:

Carpal Tunnel Syndrome, Neural Conduction, Electromyography, Median Nerve, Questionnaires, Severity of Illness Index,

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1.Szabo RM. Entrapment and compression neuropathies. In: Green DP, Hotchkiss RN, Pederson WC, editors. Green's operative hand surgery. 4th ed. Philadelphia: Churchill Livingstone; 1999. p. 1404-47.
2. Heyman VB. Electrophysiological testing. In: Gelberman RH, editor. Operative nerve repair and reconstruction. 2nd ed. Philadelphia: J.B. Lippincott; 1991. p. 170-81.
3. Nuzumlalı E, Nuzumlalı D, Gür S, Özdemir H. Karpal tünel sendromu: Ameliyat öncesi ve sonrası klinik ve nörofizyolojik bir değerlendirme. Acta Orthop Traumatol Turc 1992;26: 186-9.
4. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg [Am] 1993;75: 1585-92.
5. Katz JN, Gelberman RH, Wright EA, Abrahamsson SO, Lew RA. A preliminary scoring system for assessing the outcome of carpal tunnel release. J Hand Surg [Am] 1994;19:531-8.
6. Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve 1997;20:1477-86.
7. Brown RA, Gelberman RH, Seiler JG 3rd, Abrahamsson SO, Weiland AJ, Urbaniak JR, et al. Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods. J Bone Joint Surg [Am] 1993;75:1265-75.
8. Jacobsen MB, Rahme H. A prospective, randomized study with an independent observer comparing open carpal tunnel release with endoscopic carpal tunnel release. J Hand Surg [Br] 1996;21:202-4.
9.Cobb TK, Amadio PC. Reoperation for carpal tunnel syndrome. Hand Clin 1996;12:313-23.
10. Chow JC. Endoscopic release of the carpal ligament for carpal tunnel syndrome: 22-month clinical result. Arthroscopy 1990;6:288-96.
11. Tüzüner S, Turan A, Altınel E. Endoskopik teknikle karpal kanal gevşetilmesi: Cerrahi deneyim ve komplikasyonların değerlendirilmesi. Acta Orthop Traumatol Turc 1993;29:290-310.
12. Memik R, Yel M, Arazi M, Kapıcıoğlu MS. Endoskopik karpal tünel gevşetme: Erken dönem sonuçları. Hacettepe Ortopedi Dergisi 1998;8:96-100.
13. Boeckstyns ME, Sorensen AI. Does endoscopic carpal tunnel release have a higher rate of complications than open carpal tunnel release? An analysis of published series. J Hand Surg [Br] 1999;24:9-15.
14. Heybeli N, Özerdemoğlu RA, Aksoy OG, Mumcu FA. Karpal tünel sendromu: Cerrahi tedavi izleminde fonksiyonel ve semptomatik skorlama. Acta Orthop Traumatol Turc 2001; 35:147-51.
15. Dudley Porras AF, Rojo Alaminos P, Vinuales JI, Ruiz Villamanan MA. Value of electrodiagnostic tests in carpal tunnel syndrome. J Hand Surg [Br] 2000;25:361-5.
16. Shurr DG, Blair WF, Bassett G. Electromyographic changes after carpal tunnel release. J Hand Surg [Am] 1986;11 :876-80.
17. White JC, Hansen SR, Johnson RK. A comparison of EMG procedures in the carpal tunnel syndrome with clinical-EMG correlations. Muscle Nerve 1988;11:1177-82.
18.Glowacki KA, Breen CJ, Sachar K, Weiss AP. Electrodiagnostic testing and carpal tunnel release outcome. J Hand Surg [Am] 1996;21:117-21.