Karpal Tünel Sendromu Dekompresyon Cerrahisinde Diyabetes Mellitus’un Sonuçlara Etkisi

Year 2018, , 430 - 437, 28.09.2018

Uygar Daşar , Tansel Mutlu

https://doi.org/10.17098/amj.463198

Abstract

Amaç: Kiniğimizde Karpal Tünel Sendromu (KTS)
nedeniyle cerrahi olarak müdahale edilenlerinin sonuçlarının diyabetes
mellituslu (DM) olup olmamaya göre karşılaştırılması.

Materyal ve Metot: 2009-2013 yılları arasında Karabük Üniversitesi Tıp Fakültesi Eğitim
Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği’ne başvuran KTS tanısı
almış hastalar bu retrospektif araştırmanın çalışma grubunu oluşturdu. Çalışma
grubu 3 ayrı gruba ayrıldı; DM teşhisi olmayan grup (Grup 1, n=50), DM teşhisi
olup polinöropatisi bulunmayan grup (Grup 2, n=45), DM teşhisi olup
polinöropatisi olan grup (Grup 3, n=28). Hastaların semptomları operasyon
öncesi ve sonrası kaydedilerek karşılaştırmalar yapıldı.

Bulgular:
Çalışmamızdaki gruplar yaş, cinsiyet, eğitim durumu, semptomların dağılımı
açısından ameliyat öncesinde benzer bulundu. Hastaların semptomlarının son bir
yıl içerisindeki değişimleri incelendiğinde, ağrı sempromunun Grup 1 (p=0,001)
ve Grup 2’de (p=0,004) anlamlı seviyede azaldığı görülürken, Grup 3’te (p=0,581)
değişmediği görüldü. Parestezi semptomunun, Grup 1 (p=0,001) ve Grup 2’de (p=0,017)
anlamlı seviyede azaldığı görülürken, Grup 3’te (p=0,344) değişmediği görüldü.
Ayrıca, güçsüzlük semptomunun Grup 1’de (p=0,029) anlamlı seviyede azaldığı
izlenirken, Grup 2 (p=0,064) ve Grup 3’te (p=0,057) değişmediği izlendi.

Sonuç: Çalışmada
DM teşhisli hastaların polinöropatisinin olup olmamasının KTS sonucuna anlamlı
derecede etki ettiğini izlenmiştir. Operasyon öncesinde ve sonrasında kişiler
DM’li olsalar bile nöropati düzeylerinin izlemi yararlı olabilir.

Keywords

Diyabetik polinöropati, karpal tünel sendromu, Diabetes Mellitus

The Effect of Diabetes Mellitus on Decompression Surgery in Carpal Tunnel Syndrome

Abstract

Objectives: Our aim in our study is
to compare the postoperative results of surgery between diabetic and
non-diabetic patients with carpal tunnel syndrome (CTS) who are treated in our
clinic.

Materials and Methods: Between 2009 and 2013,
patients who were diagnosed with CTS who applied to the Orthopedics and
Traumatology Clinic of Karabük University Faculty of Medicine Training and
Research Hospital constituted the study group of this retrospective study. The
study group was divided into 3 groups; non-diabetic group (Group 1, n=50),
diagnosed with diabetes mellitus without polyneuropathy group (Group 2, n=45),
diabetes mellitus with polyneuropathy group (Group 3,n=28). Symptoms of the
patients were recorded before and after the operation and compared.

Results: The groups were similar
in terms of age, sex, educational status, distribution of symptoms before
surgery. When the symptoms of the patients were analyzed within one year, it
was observed that the symptom of pain decreased in Group 1 (p=0.001) and Group
2 (p=0.004) but not in Group 3 (p=0.581). The symptom of paresthesia decreased
in the group 1 (p=0.001) and in the group 2 (p=0.017) but not in the group
3(p=0.344). In addition, the symptom of weakness decreased in Group 1
(p=0.029), but not in Group 2 (p=0.064) and Group 3 (p=0.057).

Conclusion: We found that the
presence of polyneuropathy in patients with diabetes diagnosed during the study
significantly affected the CTS result. Before and after the operation, we were
of the opinion that monitoring of neuropathy levels would be beneficial even if
people were diabetic.

Keywords

Diabetic polyneuropathy, carpal tunnel syndrome, diabetes mellitus

References

• 1. Atroshi I, Englund M, Turkiewicz A, Tagil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med 2011;171:943-4.
• 2. Gelfman R, Melton LJ, 3rd, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome. Neurology 2009;72:33-41.
• 3. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. Jama 1999;282:153-8.
• 4. de Krom MC, Kester AD, Knipschild PG, Spaans F. Risk factors for carpal tunnel syndrome. American journal of epidemiology 1990;132:1102-10.
• 5. Amirfeyz R, Gozzard C, Leslie IJ. Hand elevation test for assessment of carpal tunnel syndrome. Journal of hand surgery (Edinburgh, Scotland) 2005;30:361-4.
• 6. Bland JD. Carpal tunnel syndrome. Current opinion in neurology 2005;18:581-5.
• 7. van Dijk MA, Reitsma JB, Fischer JC, Sanders GT. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review. Clinical chemistry 2003;49:1437-44.
• 8. Katz JN, Keller RB, Simmons BP, et al. Maine Carpal Tunnel Study: outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort. Journal of Hand Surgery 1998;23:697-710.
• 9. Dahlin LB, Salö M, Thomsen N, Stütz N. Carpal tunnel syndrome and treatment of recurrent symptoms. Journal of Plastic Surgery and Hand Surgery 2010;44:4-11.
• 10. Dyck PJ, Kratz K, Karnes J, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population‐based cohort The Rochester Diabetic Neuropathy Study. Neurology 1993; 43:817.
• 11. Barkut K, Pazarci Nk, Taşpinar Ş, Çelik M. Karpaltünel Sendromu Klinik Tanili Diabetik Hastalarda Elektrofizyolojik Bulgular. İstanbul Tıp Fakültesi Dergisi 2006;69(3):70-4.
• 12. Pagnanelli DM, Barrer SJ. Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome. Journal of neurosurgery 1991;75:77-81.
• 13. Bromley GS. Minimal-incision open carpal tunnel decompression. Journal of Hand Surgery 1994; 19:119-20.
• 14. Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occupational Medicine 2007;57:57-66.
• 15. Sidenius P, Jakobsen J. Axonal transport in early experimental diabetes. Brain research 1979;173:315-30.
• 16. Tomlinson D, Mayer JH. Defects of axonal transport in diabetes mellitus—a possible contribution to the aetiology of diabetic neuropathy. Autonomic and Autacoid Pharmacology 1984;4:59-72.
• 17. Ozkul Y, Sabuncu T, Kocabey Y, Nazligul Y. Outcomes of carpal tunnel release in diabetic and non‐diabetic patients. Acta neurologica scandinavica 2002;106:168-72.
• 18. Thomsen NO, Rosén I, Dahlin LB. Neurophysiologic recovery after carpal tunnel release in diabetic patients. Clinical Neurophysiology 2010;121:1569-73.
• 19. Thomsen N, Cederlund R, Björk J, Dahlin L. Health‐related quality of life in diabetic patients with carpal tunnel syndrome. Diabetic Medicine 2010; 27:466-72.
• 20. Mondelli M, Padua L, Reale F, Signorini AM, Romano C. Outcome of surgical release among diabetics with carpal tunnel syndrome1. Archives of physical medicine and rehabilitation 2004;85:7-13.
• 21. Zyluk A, Puchalski P. A comparison of outcomes of carpal tunnel release in diabetic and non-diabetic patients. Journal of Hand Surgery (European Volume) 2013;38:485-88.
• 22. Jenkins P, Duckworth A, Watts A, McEachan J. The outcome of carpal tunnel decompression in patients with diabetes mellitus. J Bone Joint Surg Br 2012;94:811-4.
• 23. Thomsen NO, Cederlund R, Rosén I, Björk J, Dahlin LB. Clinical outcomes of surgical release among diabetic patients with carpal tunnel syndrome: prospective follow-up with matched controls. Journal of Hand Surgery 2009;34:1177-87.
• 24. Haupt W, Wintzer G, Schop A, Löttgen J, Pawlik G. Long-term results of carpal tunnel decompression: assessment of 60 cases. Journal of Hand Surgery 1993;18:471-4.
• 25. Gulabi D, Cecen G, Guclu B, Cecen A. Carpal tunnel release in patients with diabetes result in poorer outcome in long-term study. European Journal of Orthopaedic Surgery & Traumatology 2014;24:1181-4.
• 26. Kagan Ozer SM, Toker S, Chung KC. Minimal clinically important difference of carpal tunnel release in diabetic and non-diabetic patients. Plastic and reconstructive surgery 2013;131:1279.
• 27. Chang M-H, Liu L-H, Lee Y-C, Hsieh PF. Alteration of proximal conduction velocity at distal nerve injury in carpal tunnel syndrome: demyelinating versus axonal change. Journal of Clinical Neurophysiology 2008;25:161-6.
• 28. Güdemez E. Compression Neuropathies In The Upper Extremity. Turkish Journal of Family Practice 2007;11:5-12.