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

Öz

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.

Anahtar Kelimeler

• 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?

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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