Karpal tünel sendromunda gevşetme cerrahisi sonrasında ısrarcı ve tekrarlayıcı hastalıkta ultrasonografik bulgular ve cerrahi korelasyonu

Yıl 2015, , 126 - 132, 22.05.2015

Nuri Karabay Tulgar Toros Erkin Cetinkol Sait Ada

https://doi.org/10.3944/AOTT.2015.14.0198

Öz

 

Amaç: Karpal tünel sendromunda (KTS), karpal tünelin cerrahi yöntemle gevşetilmesi şikayetlerin ortadan kaldırılmasında oldukça etkili bir tedavi yöntemidir. Ancak cerrahiye rağmen şikayetlerin devam etmesi nadir bir durum değildir. Bu çalışmanın amacı KTS’da cerrahi girişim sonrası devam eden semptomların olası nedenlerini saptamada ultrasonografinin gücünü belirlemektir.

 

Çalışma planı: Otuz dört hasta geriye dönük olarak değerlendirilmiştir.

 

Bulgular: Ultrasonografi 25 hastada (%74.5) devam eden şikayetlerin nedenini belirlemede başarılı olmuştur. En yaygın patolojik bulgu median sinirde ödem (%70.6), transvers karpal ligamanın yetersiz gevşetilmesi (%23.5) ve perinöral fibrozis (%17.6) idi. Bununla birlikte dokuz (%26.5) hastada ultrasonografi şikayetleri açıklayabilecek herhangi bir patoloji ortaya koyamamıştır.

 

Çıkarımlar: Çalışmaya dahil olan vakaların çoğunda ultrasonografi cerrahiye sonrası var olan şikayetlerin etiyolojisini ortaya koyabilmiştir. Bu sonuç cerrahi girişime rağmen ısrarcı veya tekrarlayan şikayetlerin değerlendirilmesinde ve tedavinin şekillendirilmesinde ultrasonografinin tamamlayıcı bir yöntem olarak kullanılabileceğini göstermektedir.

 

Anahtar Kelimeler

Karpal tünel sendromu; karpal tünel gevşetme cerrahisi; ultrasonografi.

Correlations between ultrasonography findings and surgical findings in patients with refractory symptoms after primary surgical release for carpal tunnel syndrome

Öz

Objective: Surgical carpal tunnel release is very effective for symptom relief in carpal tunnel syndrome, and it remains the preferred choice of treatment. However, refractory symptoms following surgical release are not uncommon. We aimed to assess the usefulness of ultrasonography for determining the potential causes of ongoing symptoms following surgical release.

Methods: This retrospective study included 34 patients (32 women; mean age, 54.7±16.65 years;range: 30 to 81 years) with carpal tunnel syndrome who underwent surgical carpal tunnel release.

Results: A pathology related to the cause of the ongoing symptoms was detected by ultrasonography in 25 (74.5%) patients. The most common pathological findings were median nerve swelling (70.6%), incomplete transection of the transverse carpal ligament (23.5%) and perineural fibrosis (17.6%).

Conclusion: In the majority of the patients the pathology related to the ongoing symptoms was detected by ultrasonography, suggesting that ultrasonography could be used as a complementary imaging method for identifying the causes of failure following surgical carpal tunnel release. Detection of an ongoing pathology might help clinicians in managing persistent disease cases and aid in planning an exploration.

Anahtar Kelimeler

Carpal tunnel release surgery, carpal tunnel syndrome, refractory symptoms, ultrasonography

Kaynakça

• Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci 2010;31:243–52.
• Dahlin LB, Salö M, Thomsen N, Stütz N. Carpal tunnel syndrome and treatment of recurrent symptoms. Scand J Plast Reconstr Surg Hand Surg 2010;44(1):4–11.
• Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments--a systematic re- view. Arch Phys Med Rehabil 2010;91:1005–24.
• Turner A, Kimble F, Gulyás K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg 2010;80:50–4.
• Hulsizer DL, Staebler MP, Weiss AP, Akelman E. The results of revision carpal tunnel release following previ- ous open versus endoscopic surgery. J Hand Surg Am 1998;23(5):865–9.
• Stütz N, Gohritz A, van Schoonhoven J, Lanz U. Revision surgery after carpal tunnel release--analysis of the pathol- ogy in 200 cases during a 2 year period. J Hand Surg Br 2006;31:68–71.
• Campagna R, Pessis E, Feydy A, Guerini H, Le Viet D, Corlobé P, et al. MRI assessment of recurrent carpal tun- nel syndrome after open surgical release of the median nerve. AJR Am J Roentgenol 2009;193:644–50.
• Botte MJ, von Schroeder HP, Abrams RA, Gellman H. Recurrent carpal tunnel syndrome. Hand Clin 1996;12:731–43.
• Steyers CM. Recurrent carpal tunnel syndrome. Hand Clin 2002;18:339–45.
• Faour-Martín O, Martín-Ferrero MA, Almaraz-Gómez A, Vega-Castrillo A. The long-term post-operative elec- tromyographic evaluation of patients who have under- gone carpal tunnel decompression. J Bone Joint Surg Br 2012;94(7):941–5.
• Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assess- ment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009;250:171–7.
• Karabay N, Kayalar M, Ada S. Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthop Traumatol Turc 2013;47:73– 8.
• Mhoon JT, Juel VC, Hobson-Webb LD. Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electro- diagnostic abnormality. Muscle Nerve 2012;46:871–8.
• Bagatur AE. Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reopera- tion. [Article in Turkish] Acta Orthop Traumatol Turc 2002;36:346–53.
• Karabay N, Toros T, Ademoğlu Y, Ada S. Ultrasono- graphic evaluation of the iatrogenic peripheral nerve inju- ries in upper extremity. Eur J Radiol 2010;73:234–40.