Publication: Karpal tünel sendromunun cerrahi tedavisinde uygulanan alternatif metodların karşılaştırılması
Abstract
Amaç: Açık karpal tünel gevşetmesi (KTG), karpal tünel sendromunun (KTS) cerrahi tedavisinde altın standart olarak kabul edilmekle birlikte, bazı dezavantajlarının olduğu görülmüştür. Endoskopik ve mini açık yöntemler alternatif olarak bildirilmiştir. Kliniğimizde uygulanan üç yöntemin sonuçlarını karşılaştırdık. Hastalar ve Yöntem: İdiopatik KTS tanısı alan 62 hastanın 78 eli öpere edildi; 51(%65) ele açık, 19 (%24) ele endoskopik ve 8 (%11) ele mini açık KTG uygulandı. Yırmiikisi erkek, 40'ı kadın, ve yaş ortalamaları 42 (21-63 arası) olan hastalar, ortalama 25 ay (8-46 ay) takip edildi. Hastalar postoperatif, semptomların erken dönemde (ilk üç hafta) kaybolması, genel memnuniyet derecesi ve günlük aktivitelere dönüş zamanının uzunluğu açılarından değerlendirildi. Ayrıca, üç yöntemin komplikasyon ve rekürrens oranlan karşılaştırıldı. Bulgular: Postoperatif erken dönemde semptomlann kaybolma oranları açık, endoskopik ve mini açık yöntemler sonrası sırasıyla %92, %80 ve %89 olarak saptandı. Genel memnuniyet derecesi tüm gruplarda 'iyi' olarak belirlendi. Günlük aktivitelere dönüş, açık yöntem sonrası ortalama üç hafta iken, diğer iki yöntem sonrası iki hafta idi. Açık KTG sonrası %10 hastada skar hassasiyeti görülmesi dışında, tüm gruplarda başka komplikasyonla karşılaşılmadı. Açık grupta %2, endoskopik grupta ise %10 oranında rekürrens saptandı. Mini açık KTG sonrası rekürrens görülmedi. Sonuç: Endoskopik ve mini açık KTG sonrası hastaların günlük aktivitelere dönüş sürelerinin, açık yönteme kıyasla daha kısa olduğu gözlendi. Hasta tatmini tüm gruplarda iyiydi. Açık yöntemin postoperatif morbidité oranı, diğerlerine göre daha yüksek bulunurken, endoskopik KTG sonrası literatürde belirtilen komplikasyonların hiçbiriyle karşılaşılmadı. Endoskopik yöntemin rekürrens oranının diğerlerine göre daha yüksek olması, kliniğimizin bu yöntem için öğrenme eğrisinde bulunmasına bağlandı.
Purpose: It has been observed that there are some disadvantages of open carpal tunnel release (CTR), though it is accepted as the gold standart in the surgical treatment of carpal tunnel syndrome (CTS). Endoscopic and mini open procedures have been reported as alternatives. We compared our results after these three methods. Patients and Methods: We operated 78 hands of 62 patients with idiopathic CTS. To fifty-one (65%) open, 19 (24%) endoscopic, and 8 (11%) mini open procedures were performed. Mean follow-up time was 25 months (8-46 months). Patients were evaluated for resolution of the symptoms in the early postoperative period (in three weeks), and the time until return to daily activities. The degree of patient satisfaction was questioned. Complication and recurrence rates of the procedures were compared. Results: The ratios of resolution of the symptoms in the early postoperative period after open, endoscopic, mini open procedures were 92%, 80%, 89% respectively. Patient satisfaction was defined as 'good' in all groups. Returning back to daily activities was three weeks after open CTR, while it was two weeks after other two procedures. Except existance of scar tenderness in %10 of the cases in open group, no other complication was observed in all groups. Recurrence rates in open and endoscopic groups were 2%, 10% respectively. No recurrence was determined after mini open procedure. Conclusion: The period of returning back to daily activities was shorter after endoscopic and mini open CTR, than open procedure. Patient satisfaction was good in all groups. Postoperative morbidity rate inopen group was higher compared to other groups. Non of the complications mentioned in the literature after endoscopic CTR was observed. The explanation of the higher recurrence rate in the endoscopic group was proposed as our being in the learning curve for this procedure.
Purpose: It has been observed that there are some disadvantages of open carpal tunnel release (CTR), though it is accepted as the gold standart in the surgical treatment of carpal tunnel syndrome (CTS). Endoscopic and mini open procedures have been reported as alternatives. We compared our results after these three methods. Patients and Methods: We operated 78 hands of 62 patients with idiopathic CTS. To fifty-one (65%) open, 19 (24%) endoscopic, and 8 (11%) mini open procedures were performed. Mean follow-up time was 25 months (8-46 months). Patients were evaluated for resolution of the symptoms in the early postoperative period (in three weeks), and the time until return to daily activities. The degree of patient satisfaction was questioned. Complication and recurrence rates of the procedures were compared. Results: The ratios of resolution of the symptoms in the early postoperative period after open, endoscopic, mini open procedures were 92%, 80%, 89% respectively. Patient satisfaction was defined as 'good' in all groups. Returning back to daily activities was three weeks after open CTR, while it was two weeks after other two procedures. Except existance of scar tenderness in %10 of the cases in open group, no other complication was observed in all groups. Recurrence rates in open and endoscopic groups were 2%, 10% respectively. No recurrence was determined after mini open procedure. Conclusion: The period of returning back to daily activities was shorter after endoscopic and mini open CTR, than open procedure. Patient satisfaction was good in all groups. Postoperative morbidity rate inopen group was higher compared to other groups. Non of the complications mentioned in the literature after endoscopic CTR was observed. The explanation of the higher recurrence rate in the endoscopic group was proposed as our being in the learning curve for this procedure.