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Karpal tünelin açık cerrahi yöntem ile gevşetilmesi sonrasında transvers karpal ligamanın ultrasonografik değerlendirmesi

Yıl 2013, Cilt: 47 Sayı: 2, 73 - 78, 26.04.2013

Öz

Amaç: Bu çalışmanın amacı karpal tünel sendromu (KTS) tedavisi için yapılan açık yöntem ile gevşetme cerrahisi sonrası transvers karpal ligamanda (TKL) meydana gelen değişikliklerin ultrasonografik olarak incelenmesi yeterli miktarda kesilmiş TKL tanısı için ultrasonografik kıstasların oluşturulması idi.
Çalışma planı: Açık cerrahi yöntem ile gevşetme yapılan 36 KTS’li hasta prospektif olarak incelendi. Hastalar fizik muayane ve ultrasonografi ile cerrahi işlem öncesinde ve sonrasında değerlendirildi.
Bulgular: Cerrahi işlem sonrasında tüm hastaların şikayetlerinin ortadan kalktığı görüldü. Cerrahi sonrası TKL’nin düzgün formunu kaybettiği ve diffüz olarak kalınlaştığı görüldü. Cerrahi sonrası kalınlığın cerrahi öncesine göre istatistiksel olarak anlamlı şekilde artmış olduğu saptandı (p<0.05).
Çıkarımlar: Ultrasonografi, açık yöntem ile yapılan gevşetme cerrahisi sonrasında TKL’yi yeterli derecede değerlendirebilecek bir görüntüleme yöntemidir. Ayrıca, ultrason, cerrahi gevşetme sonrasında şikayetleri geçmeyen olgularda yetersiz kesilmiş TKL tanısını dışlamada yardımcı bir yöntem olarak kullanılabilir.

Kaynakça

  • Canale ST. Carpal tunnel sydrome. In: Daugherty K, Jones L, Terry S, Campbell WC, Canale ST, editors. Campbell’s operative orthopaedics. St. Louis: Mosby-Year Book; 1998. p. 3685-94.
  • Turner A, Kimble F, Gulyás K, Ball J. Can the outcome of open carpal tunnel release be predicted? A review of the lit- erature. ANZ J Surg 2010;80:50-4.
  • Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treat- ment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci 2010;31:243-52
  • Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments - a systematic review. Arch Phys Med Rehabil 2010;91:981-1004.
  • 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: 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 review. Arch Phys Med Rehabil 2010;91:1005-24.
  • Shores JT, Lee WP. An evidence-based approach to carpal tunnel syndrome. Plast Reconstr Surg 2010;126:2196-204.
  • Abicalaf CA, de Barros N, Sernik RA, Pimentel BF, Braga- Baiak A, Braga L, et al. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverseee carpal ligament. Clin Radiol 2007;62:891-6.
  • Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003;27:26-33.
  • Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009;250:171-7.
  • Lee CH, Kim TK, Yoon ES, Dhong ES. Postoperative mor- phologic analysis of carpal tunnel syndrome using high-res- olution ultrasonography. Ann Plast Surg 2005;54:143-6.
  • Smidt MH, Visser LH. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 2008;38:987-91.
  • Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonogra- phy. Radiology 2004;232:93-9.
  • Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay BS, Ayhan Ç, et al. Reliability and validity of the Turkish version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. [Article in Turkish] Fizyoterapi ve Rehabili- tasyon 2006;17:99-107.
  • Nathan PA, Meadows KD, Keniston RC. Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy. J Hand Surg Am 1993;18:1044-50.
  • Steyers CM. Recurrent carpal tunnel syndrome. Hand Clin 2002;18:339-45.
  • Wu HT, Schweitzer ME, Culp RW. Potential MR signs of recurrent carpal tunnel syndrome: initial experience. J Comput Assist Tomogr 2004;28:860-4.
  • Botte MJ, von Schroeder HP, Abrams RA, Gellman H. Recurrent carpal tunnel syndrome. Hand Clin 1996;12:731-43.
  • Shurr DG, Blair WF, Bassett G. Electromyographic changes after carpal tunnel release. J Hand Surg Am 1986;11:876-80.
  • Van de Kar HJ, Jaquet JB, Meulstee J, Molenar CB, Schimsheimer RJ, Hovius SE. Clinical value of electrodiag- nostic testing following repair of peripheral nerve lesions: a prospective study. J Hand Surg Br 2002;27:345-9.
  • Sernik RA, Abicalaf CA, Pimentel BF, Braga-Baiak A, Braga L, Cerri GG. Ultrasound features of carpal tunnel syn- drome: a prospective case-control study. Skeletal Radiol 2008;37:49-53.
  • Aydin K, Cokluk C, Piskin A, Kocabiçak E. Ultrasono- graphically checking the sectioning of the transverseee carpal ligament during carpal tunnel surgery with limited uni skin incisions. Turk Neurosurg 2007;17:219-23.
  • Philippe L. Carpal tunnel release under high-frequency ultrasonography. A-0060. FESSH XV Congress Abstracts. J Hand Surg Eur Vol 2010;35E(Supplement 1):A-0060. [Abstract]

Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel

Yıl 2013, Cilt: 47 Sayı: 2, 73 - 78, 26.04.2013

Öz

Objective: The aim of this study was to sonographically evaluate the anatomy of the transverse carpal ligament (TCL) after open surgical release in the treatment of carpal tunnel syndrome (CTS) and to establish new ultrasonographic criteria for the completeness of TCL release.
Methods: Thirty-six patients who underwent open surgical release for CTS were recruited prospectively. Patients were evaluated with physical examination and ultrasonography before and after the operation.
Results: All patients’ symptoms resolved after surgery. TCL was found to be diffusely thickened and to have lost its smooth form after surgery. Postoperative TCL thickness showed a statistically significant increase when compared with preoperative values (p<0.05).
Conclusion: Sonography is a capable imaging method for assessment of the TCL after open release surgery. In addition, ultrasound may be considered as a complementary tool to exclude diagnosis of incomplete transection of TCL in patients with persistent symptoms.

Kaynakça

  • Canale ST. Carpal tunnel sydrome. In: Daugherty K, Jones L, Terry S, Campbell WC, Canale ST, editors. Campbell’s operative orthopaedics. St. Louis: Mosby-Year Book; 1998. p. 3685-94.
  • Turner A, Kimble F, Gulyás K, Ball J. Can the outcome of open carpal tunnel release be predicted? A review of the lit- erature. ANZ J Surg 2010;80:50-4.
  • Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treat- ment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci 2010;31:243-52
  • Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments - a systematic review. Arch Phys Med Rehabil 2010;91:981-1004.
  • 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: 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 review. Arch Phys Med Rehabil 2010;91:1005-24.
  • Shores JT, Lee WP. An evidence-based approach to carpal tunnel syndrome. Plast Reconstr Surg 2010;126:2196-204.
  • Abicalaf CA, de Barros N, Sernik RA, Pimentel BF, Braga- Baiak A, Braga L, et al. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverseee carpal ligament. Clin Radiol 2007;62:891-6.
  • Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003;27:26-33.
  • Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009;250:171-7.
  • Lee CH, Kim TK, Yoon ES, Dhong ES. Postoperative mor- phologic analysis of carpal tunnel syndrome using high-res- olution ultrasonography. Ann Plast Surg 2005;54:143-6.
  • Smidt MH, Visser LH. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 2008;38:987-91.
  • Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonogra- phy. Radiology 2004;232:93-9.
  • Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay BS, Ayhan Ç, et al. Reliability and validity of the Turkish version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. [Article in Turkish] Fizyoterapi ve Rehabili- tasyon 2006;17:99-107.
  • Nathan PA, Meadows KD, Keniston RC. Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy. J Hand Surg Am 1993;18:1044-50.
  • Steyers CM. Recurrent carpal tunnel syndrome. Hand Clin 2002;18:339-45.
  • Wu HT, Schweitzer ME, Culp RW. Potential MR signs of recurrent carpal tunnel syndrome: initial experience. J Comput Assist Tomogr 2004;28:860-4.
  • Botte MJ, von Schroeder HP, Abrams RA, Gellman H. Recurrent carpal tunnel syndrome. Hand Clin 1996;12:731-43.
  • Shurr DG, Blair WF, Bassett G. Electromyographic changes after carpal tunnel release. J Hand Surg Am 1986;11:876-80.
  • Van de Kar HJ, Jaquet JB, Meulstee J, Molenar CB, Schimsheimer RJ, Hovius SE. Clinical value of electrodiag- nostic testing following repair of peripheral nerve lesions: a prospective study. J Hand Surg Br 2002;27:345-9.
  • Sernik RA, Abicalaf CA, Pimentel BF, Braga-Baiak A, Braga L, Cerri GG. Ultrasound features of carpal tunnel syn- drome: a prospective case-control study. Skeletal Radiol 2008;37:49-53.
  • Aydin K, Cokluk C, Piskin A, Kocabiçak E. Ultrasono- graphically checking the sectioning of the transverseee carpal ligament during carpal tunnel surgery with limited uni skin incisions. Turk Neurosurg 2007;17:219-23.
  • Philippe L. Carpal tunnel release under high-frequency ultrasonography. A-0060. FESSH XV Congress Abstracts. J Hand Surg Eur Vol 2010;35E(Supplement 1):A-0060. [Abstract]
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Nuri Karabay Bu kişi benim

Murat Kayalar Bu kişi benim

Sait Ada Bu kişi benim

Yayımlanma Tarihi 26 Nisan 2013
Yayımlandığı Sayı Yıl 2013 Cilt: 47 Sayı: 2

Kaynak Göster

APA Karabay, N., Kayalar, M., & Ada, S. (2013). Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthopaedica Et Traumatologica Turcica, 47(2), 73-78.
AMA Karabay N, Kayalar M, Ada S. Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthopaedica et Traumatologica Turcica. Nisan 2013;47(2):73-78.
Chicago Karabay, Nuri, Murat Kayalar, ve Sait Ada. “Sonographic Assessment of Transverse Carpal Ligament After Open Surgical Release of the Carpal Tunnel”. Acta Orthopaedica Et Traumatologica Turcica 47, sy. 2 (Nisan 2013): 73-78.
EndNote Karabay N, Kayalar M, Ada S (01 Nisan 2013) Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthopaedica et Traumatologica Turcica 47 2 73–78.
IEEE N. Karabay, M. Kayalar, ve S. Ada, “Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel”, Acta Orthopaedica et Traumatologica Turcica, c. 47, sy. 2, ss. 73–78, 2013.
ISNAD Karabay, Nuri vd. “Sonographic Assessment of Transverse Carpal Ligament After Open Surgical Release of the Carpal Tunnel”. Acta Orthopaedica et Traumatologica Turcica 47/2 (Nisan 2013), 73-78.
JAMA Karabay N, Kayalar M, Ada S. Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthopaedica et Traumatologica Turcica. 2013;47:73–78.
MLA Karabay, Nuri vd. “Sonographic Assessment of Transverse Carpal Ligament After Open Surgical Release of the Carpal Tunnel”. Acta Orthopaedica Et Traumatologica Turcica, c. 47, sy. 2, 2013, ss. 73-78.
Vancouver Karabay N, Kayalar M, Ada S. Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthopaedica et Traumatologica Turcica. 2013;47(2):73-8.