Karpal Tünel Cerrahisinde Mini İnsizyonun Sınırlı İnsizyondan Üstün Olduğuna Dair Herhangi Bir Kanıt Var Mı?

Abstract

Bu çalışmanın amacı, karpal tünel cerrahisinde 1-2 cm uzunluğunda tek mini insizyon ile 2-3 cm tek sınırlı insizyonu fonksiyonel sonuç ve komplikasyonlar açısından karşılaştırılarak hangi yöntemin diğerine üstün olduğunu belirlemekti. Mart 2017 ile Nisan 2021 tarihleri arasında karpal tünel cerrahisi geçiren toplam 93 hasta çalışmaya dahil edildi. Mini açık kesi grubundaki 51 hastanın 60 eli ve sınırlı cerrahi grubundaki 42 hastanın 51 eli değerlendirildi. Tüm hastalar postoperatif skar ağrısı, pillar ağrısı ve komplikasyonlar açısından değerlendirildi. Hastalar ortalama 10,05±2,82 ay takip edildi. Mini kesi grubunda ortalama kesi uzunluğu 1,49±0,15 cm iken, sınırlı kesi grubunda ortalama kesi uzunluğu 2,57±0,22 cm idi ve iki grup arasında istatistiksel olarak anlamlı fark vardı (p=0,0001). Ancak skar ağrısı ve pillar ağrısı açısından iki grup arasında istatistiksel olarak anlamlı fark yoktu (sırasıyla p=0,465 ve p=0,519). Mini kesi grubunda hastaların kısıtlı gruba göre daha kısa sürede günlük fiziksel aktivitelerine döndükleri görüldü (p=0,0001). Takip süresi boyunca mini kesi grubunda sadece bir hasta tekrar ameliyat edildi ve sınırlı kesi grubunda tekrar ameliyat gerekmedi. Sonuç olarak, her iki yaklaşım da benzer sonuçlar gösterdi ve karpal tünel gevşetme cerrahisinde güvenli ve etkiliydi. Mini insizyonun daha kısa kesi uzunluğu nedeniyle günlük aktivitelerine dönüşü daha hızlı olmasına rağmen, mini kesi ile tedavi edilen bir hastada yetersiz TKL gevşetilmesi nedeniyle revizyon cerrahisi gerekti. Cerrahlar, mini insizyon tekniği sırasında TKL’nin tam olarak gevşetildiğinin farkında olmalıdır.

Keywords

• Karpal tünel sendromu
• mini insizyon
• sınırlı insizyon
• pillar ağrısı
• günlük aktiviteye dönüş
• yetersiz transvers karpal ligament gevşetilmesi.

Is There Any Evidence That Mini Incision Is Superior to Limited Incision in Carpal Tunnel Release?

Abstract

The purpose of this study was to compare single mini-incision with a 1-2 cm length and single limited incision with a 2-3 cm in terms of functional outcome and complications in carpal tunnel surgery and determine which method was superior to the other one. A total of 93 patients who underwent carpal tunnel surgery between March 2017 and April 2021 were included in the study. 60 hands of 51 patients in the mini-open incision group and 51 hands of 42 patients in the limited surgery group were evaluated. All patients were evaluated for postoperative scar pain, pillar pain, and complications. The patients were followed for a mean of 10.05±2.82 months. While the mean incision length was 1.49±0.15 cm in the mini-incision group, the mean incision length was 2.57±0.22 cm in the limited incision group, and there was a statistically significant difference between the two groups (p=0.0001). However, there was no statistical difference between the two groups in terms of scar pain and pillar pain (p=0.465 ve p=0.519, respectively). In the mini incision group, patients were found to return to their daily physical activities in a shorter time compared to the limited group (p=0.0001). During the follow-up period, only one patient in the mini incision group was reoperated, and no reoperation was required in the limited incision group. In conclusion, both approaches showed similar results and were safe and effective in performing carpal tunnel release. Although the mini-incision had a shorter return to their daily activities due to shorter incision length, one patient treated with mini-incision required revision surgery owing to incomplete TCL release. Surgeons should be aware of the complete TCL release performed during the mini-incision technique.

Keywords

• Carpal tunnel syndrome
• mini-incision
• limited incision
• pillar pain
• return to daily activity
• incomplete transverse carpal ligament release.

References

1. Reference1. Khoshnevis J, Layegh H, Yavari N, Eslami G, Afsharfard A, Reza Kalantar-Motamedi SM, Zarrintan S. Comparing open conventional carpal tunnel release with mini-incision technique in the treatment of carpal tunnel syndrome: A non-randomized clinical trial. Ann Med Surg (Lond). 2020 May 16;55:119-123.
2. Reference2. Urits I, Gress K, Charipova K, Orhurhu V, Kaye AD, Viswanath O. Recent Advances in the Understanding and Management of Carpal Tunnel Syndrome: a Comprehensive Review. Curr Pain Headache Rep. 2019 Aug 1;23(10):70.
3. Reference3. van den Broeke LR, Theuvenet WJ, van Wingerden JJ. Effectiveness of mini-open carpal tunnel release: An outcome study. Arch Plast Surg. 2019 Jul;46(4):350-358.
4. Reference4. Kim PT, Lee HJ, Kim TG, Jeon IH. Current approaches for carpal tunnel syndrome. Clin Orthop Surg. 2014 Sep;6(3):253-7.
5. Reference5. Zhang D, Blazar P, Earp BE. Rates of Complications and Secondary Surgeries of Mini-Open Carpal Tunnel Release. Hand (N Y). 2019 Jul;14(4):471-476.
6. Reference6. Kim JK, Kim YK. Predictors of scar pain after open carpal tunnel release. J Hand Surg Am. 2011 Jun;36(6):1042-6.
7. Reference7. Mirza MA, King ET Jr, Tanveer S. Palmar uniportal extrabursal endoscopic carpal tunnel release. Arthroscopy. 1995 Feb;11(1):82-90.
8. Reference8. Concannon MJ, Brownfield ML, Puckett CL. The incidence of recurrence after endoscopic carpal tunnel release. Plast Reconstr Surg. 2000 Apr;105(5):1662-5.

9. Reference9. Lee WP, Strickland JW. Safe carpal tunnel release via a limited palmar incision. Plast Reconstr Surg. 1998 Feb;101(2):418-24; discussion 425-6.
10. Reference10. Abouzahr MK, Patsis MC, Chiu DT. Carpal tunnel release using limited direct vision. Plast Reconstr Surg. 1995 Mar;95(3):534-8.
11. Reference11. Cellocco P, Rossi C, Bizzarri F, Patrizio L, Costanzo G. Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am. 2005 May;30(3):493-9.
12. Reference12. Eroğlu A, Sarı E, Topuz AK, Şimşek H, Pusat S. Recurrent carpal tunnel syndrome: Evaluation and treatment of the possible causes. World J Clin Cases. 2018 Sep 26;6(10):365-372.
13. Reference13. Zyluk A, Strychar J. A comparison of two limited open techniques for carpal tunnel release. J Hand Surg Br. 2006 Oct;31(5):466-72.
14. Reference14. Bal E, Pişkin A, Ada S, Ademoğlu Y, Toros T, Kayalar M. Açik karpal tünel gevşetmesinde iki farkli mini kesi yönteminin karşilaştirilmasi [Comparison between two mini incision techniques utilized in carpal tunnel release]. Acta Orthop Traumatol Turc. 2008 Aug-Oct;42(4):234-7.
15. Reference15. Klein RD, Kotsis SV, Chung KC. Open carpal tunnel release using a 1-centimeter incision: technique and outcomes for 104 patients. Plast Reconstr Surg. 2003 Apr 15;111(5):1616-22.
16. Reference16. Bulut G. Median Nerve Decompression Using Mini-Skin Incision in Carpal Tunnel Syndrome: Surgical Technique and Clinical Results. September 2020, 163-171.
17. Reference17. Bai J, Kong L, Zhao H, Yu K, Zhang B, Zhang J, Tian D. Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study. Int J Surg. 2018 Apr; 52:105-109.
18. Reference18. Murthy PG, Goljan P, Mendez G, Jacoby SM, Shin EK, Osterman AL. Mini-open versus extended open release for severe carpal tunnel syndrome. Hand (N Y). 2015 Mar;10(1):34-9.
19. Reference19. Gaba S, Bhogesha S, Singh O. Limited incision carpal tunnel release. Indian J Orthop. 2017 Mar-Apr;51(2):192-198.
20. Reference20. Kang HJ, Koh IH, Lee TJ, Choi YR. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res. 2013 May;471(5):1548-54.
21. Reference21. Teng X, Xu J, Yuan H, He X, Chen H. Comparison of Wrist Arthroscopy, Small Incision Surgery, and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Retrospective Study at a Single Center. Med Sci Monit. 2019 Jun 3;25:4122-4129.
22. Reference22. Higgins JP, Graham TJ. Carpal tunnel release via limited palmar incision. Hand Clin. 2002 May;18(2):299-306.
23. Reference23. Cho YJ, Lee JH, Shin DJ, Park KH. Comparison of short wrist transverse open and limited open techniques for carpal tunnel release: a randomized controlled trial of two incisions. J Hand Surg Eur Vol. 2016 Feb;41(2):143-7.
24. Reference24. Wong KC, Hung LK, Ho PC, Wong JM. Carpal tunnel release. A prospective, randomised study of endoscopic versus limited-open methods. J Bone Joint Surg Br. 2003 Aug;85(6):863-8.
25. Reference25. Mackenzie DJ, Hainer R, Wheatley MJ. Early recovery after endoscopic vs. short-incision open carpal tunnel release. Ann Plast Surg. 2000 Jun;44(6):601-4.
26. Reference26. Carmo JD. 'INSIGHT-PRECISION': a new, mini-invasive technique for the surgical treatment of carpal tunnel syndrome. J Int Med Res. 2020 Jan;48(1):300060519878082.
27. Reference27. Yung PS, Hung LK, Tong CW, Ho PC. Carpal tunnel release with a limited palmar incision: clinical results and pillar pain at 18 months follow-up. Hand Surg. 2005 Jul;10(1):29-35.
28. Reference28. Serra JM, Benito JR, Monner J. Carpal tunnel release with short incision. Plast Reconstr Surg. 1997 Jan;99(1):129-35.
29. Reference29. Uçar BY, Demirtaş A, Bulut M, Azboy I, Uçar D. Carpal tunnel decompression: two different mini-incision techniques. Eur Rev Med Pharmacol Sci. 2012 Apr;16(4):533-8.
30. Reference30. Shapiro S. Microsurgical carpal tunnel release. Neurosurgery. 1995 Jul;37(1):66-70.