DİABETİK GEBELERDE KARPAL TÜNELİN ULTRASONOGRAFİK DEĞERLENDİRİLMESİ

Öz

Amaç: Diabetik gebelerde karpal tünel sendromu tanısı için median sinir alanının ultrasonografik olarak değerlendirilmesi. Gereçler ve yöntem: Tip 1, tip 2 diabetes mellitus (DM) ve gestasyonel diabetes mellitus (GDM) tanısı olan gebeler prospektif olarak değerlendirildi. GDM tanısı için tek basamaklı 75 gr oral glukoz tolerans testi kullanıldı. Median sinir el bileğinin distal seviyesinde karpal tünel giriş seviyesinde USG kullanılarak tespit edildi ve en büyük sinir alanı ölçümü yapıldı. Ölçüm sonrası hastalara ellerinde ağrı, uyuşukluk ve parastezi olup olmadığı soruldu. Diabetik grup yaş, gebelik haftası, gebelikte alınan kilo, median sinir alanı ve şikayetler açısından kontrol grubu gebe hastalarla karşılaştırıldı. Bulgular: DM grubunda 107 gebe hasta ve kontrol grubunda 113 gebe hasta bulunmakta idi. DM grupta median sinir alanı kontrol grubuna göre anlamlı olarak artmış bulundu (p< 0,001). Diabetik subgruplar ve insülin kullanımı açısından median sinir alanı alçümlerinde farklılık saptanmadı. Elde ağrı diabetik grupta anlamlı olarak daha sık idi ve median sinir alanı ile gebelikte alınan kilo arasında pozitif ilişki mevcuttu. Sonuç: USG diabetik gebelerde genel popülasyonda olduğu gibi karpal tünel sendromu tanısında ilk tercih olarak kullanılabilecek bir yöntemdir. Hem gebelik hem de diabet karpal tünel sendromu için risk faktörü olduğu için bu hastalara özellikle şikayetleri mevcut ise rutin gebelik takipleri sırasında yapacakları basit bir median sinir alanı ölçümü ile güncel yaklaşım olan basit koruyucu tavsiyelerde bulunarak hayat kalitelerinde artış sağlayabilir.

Anahtar Kelimeler

• karpal tünel
• diabetes mellitus
• gebelik
• ultrason

ULTRASONOGRAPHIC EVALUATION OF CARPAL TUNNEL IN PREGNANT WOMEN WITH DIABETES MELLITUS

Öz

Objective: To determine the ultrasonography (USG) values of median nerve cross-sectional area (MN-CSA) in pregnant women with and without diabetes mellitus (DM) to confirm carpal tunnel syndrome (CTS). Methods: We prospectively studied pregnant women who have been diagnosed with pregestational type 1 and type 2 DM or gestational DM (GDM) due to positive GDM screening tests. One-step GDM screening (2 h - 75 g oral glucose tolerance test (OGTT)) was used at 24–28 weeks of gestation and diagnosis of GDM. MN was identified at the level of distal wrist crease in transverse sections with USG and maximal MN-CSA was calculated then, asked the patient complaints about her hand (paraesthesia, pain, numbness). The DM group was compared to the control group according to age, week of pregnancy, weight gain during pregnancy, MN-CSA, and presence of compliments. Results: There were 107 DM pregnant women and 113 controls in the study group. The median value of MN-CSA was higher in the DM group than in the control group (p< 0,001). There was no difference between groups in terms of DM subgroups and insulin requirement. Hand pain is significantly frequent in the DM group than in controls. There has been a positive correlation between weight gain during pregnancy and MN-CSA (p =0,011; r=0,245). Conclusion: USG can be a first-line diagnostic test for CTS in the diabetic pregnant population, as recommended for the general population before. Both pregnancy and DM are stated as risk factors for CTS, these patients must be evaluated more carefully about this issue and proper advices should be given to improve their life quality.

Anahtar Kelimeler

• Carpal tunnel syndrome
• diabetes mellitus
• ultrasonography
• median nerve

Kaynakça

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