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Transvers küçük cilt kesisiyle karpal tünel serbestleştirilmesi

Yıl 2017, Cilt: 39 Sayı: 2, 501 - 506, 16.05.2017

Densel Araç Hüseyin Bozkurt , Bilge Öztoprak

https://doi.org/10.7197/223.v39i29491.316372

Öz

Amaç: Karpal tünel sendromu
cerrahisinde mini cilt insizyonu tekniği popülerleşmektedir. Tekniğin ana
avantajı kısa iyileşme zamanı ve daha iyi kozmetik sonuçtur. Nörovasküler
zedelenme ihtimali mini cilt insizyonu tekniğinde hala tartışma konusudur.
Makalemizde transvers mini cilt insizyonu tekniğini karpal tünel sendromu
cerrahisindeki avantaj ve dezavantajları açısından tartıştık

Yöntem: 62 karpal tünel
cerrahisi mini cilt insizyonu ile uygulandı. Hastaların 52 si kadın 10 u erkek
idi. Ortalama yaş 62 (en küçük 38 en büyük 82) olarak izlendi.

Bulgular: Takipte
hastaların bulgu ve şikayetlerinde belirgin iyileşme izlendi. Hastaların hiç
birinde rekürrens veya nörovasküler yapılarda zedelenme izlenmedi.







Sonuç: Mini cilt insizyonu
tekniği etkili, basit ve cerrahi için pahalı ekipman gerektirmiyor. Cerrahi
sonrası iz ve iyileşme zamanında konvansyonel yönteme nazaran daha iyi sonuçlar
veriyor.

Anahtar Kelimeler

Karpal tünel sendromu mini cilt insizyonu iyi kozmetik sonuç

Kaynakça

  • 1. Eversman WW. Entrapment and compression neuropathies. In: Green DP, editor. Operative hand surgery. New York (NY): Churchill Livingstone; 1998: 1423-78.
  • 2. Gelberman HR. Carpal tunnel release. In: Gelberman RH, North ER, editors. Operative nerve repair and reconstruction. 2 vol. Philadephia (PA): JB Lippincott; 1991. p. 900-11.
  • 3. Young HA. Surgical management of peripheral entrapment neuropathy. In: Schmidek HH, Sweet WH, editors. Operative neurosurgical techniques. Indications, methods, and results. Philadephia (PA): WB Saunders, 1988: 1583-98.
  • 4. Açıkgöz B: Karpal Tünel Sendromu. TND Spinal ve Periferik Sinir Cerrahisi Grubu Yayınları: Periferik Sinir Cerrahisi Demircan N, Zileli M (ed). Ankara: Türk Nöroşirürji Derneği, 2008, 281-304.
  • 5. Brown RA, Helbernan RH, Seiler JG, Abrahamsson SO, Weiland AJ, Urbaniac JR, Schoenfeld DA, Furcolo D. Carpal Tunnel release: a prospective randomized assessment of open and endoscopic methods. J Bone Joint Surg 1993; 75: 1265.
  • 6. Sever C, Kulahcı Y, Oksuz S, Sahin C. The mini incision technique for Carpal Tunnel decompression using nasal instruments. Turkish Neurosurg 2010; 20: 353-57.
  • 7. Uygur F, Sever C, Yüksel F. Comparing the results of limited incision technique and standart longitudinal incision tecnique for carpal tunnel decompression by numerical grading system. Turkish Neurosurgery 2009; 19: 51-7.
  • 8. Aroori S, Spence RAJ. Carpal Tunnel Syndrome. Ulster Med J 2008, 77: 6-17
  • 9. Aydın K, Cokluk C, Cengiz N, Bilgici A: Microsurgical open mini uniskin incision technique in the surgical treatment of Carpal Tunnel Syndrome. Neurology India 2006; 54: 64-7.
  • 10. Aydın K, Cokluk C, Piskin A, Kocabıçak E: Ultrosonographically checking the sectioning of the transverse carpal ligament during Carpal Tunnel Surgery with limited uni skin incisions.Turkish Neurosurgery 2007; 17: 219-23.
  • 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.
  • 12. Phalen GS. The carpal tunnel syndrome. seventeen years' experience in diagnosis and treatment of 654 hands. J Bone Joint Surg Am 1966; 48: 211-28.
  • 13. Einhorn N, Leddy JP. Pitfalls of endoscopic carpal tunnel release. Orthop Clin North Am 1996; 27: 373-80.
  • 14. Lida J, Hirabayashi H, Nakase H, Sakaki T: Carpal Tunnel Syndrome: Electrophysiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir (Tokyo) 2008; 48: 554-9.
  • 15. Stancic MF, Eskinja N, Stosıc A. Anatomical variations of the median nerve in the carpal tunnel. Int Orthop 1995; 19: 30-34.
  • 16. Stancic MF, Mıcovic V, Potocnjak M. The anatomy of the Berrettini branch: implications for carpal tunnel release. J Neurosurg 1999; 91: 1027-30.
  • 17. Shinya K, Lanzetta M, Conolly WB. Risk and complications in endoscopic carpal tunnel release. J Hand Surg (Br) 1995; 20: 222-7.
  • 18. Palmer AK, Toivonen DA. Complications of endoscopic and open carpal tunnel release. J Hand Surg (Am) 1999; 24: 561-5.
  • 19. Ferdinand RD, MacLean JG: Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment. J Bone Joint Surg Br 2002; 84: 375-9.
  • 20. Nath RK, Mackinnon SE, Weeks PM. Ulnar nerve transection as a comolication of two-portal endoscopic carpal tunnel release: a case report . J Hand Surg (Am) 1993; 18: 896-8.
  • 21. Stancic MF, Burgic N, Mıcovic V. Marinacci comminication. Case report. J Neurosurg 92: 860-2, 2000
  • 22. Biyani A, Downes EM: An open twin incision technique of carpal tunnel decompression with reduced incidence of scar tenderness. J Hand Surg (Br) 1993; 18: 331-4.
  • 23. del Pinal F, Cruz-Camara A, Jado E. Total ulnar nerve transection during endoscopic carpal tunnel release. Arthroscopy 1997; 13: 235-7.
  • 24. Serra JM, Benito JR, Monner J: Carpal tunnel release with short incision. Plast Reconstr Surg 1997; 99: 129-35.
  • 25. Wilson KM: Double incision open technique for carpal tunnel release: an alternative to endoscopic release. J Hand Surg (Am) 1994; 19: 907-12.
  • 26. Zimmerli W: Double incision for operation of carpal tunnel syndrome- 14 years experience. Helv Chir Acta 1992; 58: 395-400.
  • 27. Badger SA, O’Donnel ME, Sherigor JM, Conolly P, Spence RA: Open Carpal Tunnel release, still safe and effective operation. Ulster Med J 2008; 77: 22-4.
  • 28. Franzini A, Broggi G, Servello D, Dones I, Pluchino MG: Transilluminationin minimally invasive surgery for Carpal Tunnel release. Technical note. J Neurosurg 1996; 85: 1184-6.
  • 29. Lee WP, Strickland JW. Safe carpal tunnel release via alimited palmar incision. Plast Reconstr Surg 1998; 101: 418-26.
  • 30. Vanni D, Sirabella FS, Galzio R, Salini V, Magliani V. The double tunnels technique: an alternative minimally invazive approach for carpal tunnel syndrome. J Neurosurg 2015; 123: 1230-37.
  • 31. Zhang X, Huang X, Wang X, Wen S, Sun J, Shao X: A randomized comparison od double small, standard and endoscopic approaches for carpal tunnel release. Plast Reconstr Surg 2016 doi:10.1097/PRS.0000000000002511
  • 32. Concannon MJ, Brownfield ML, Puckett CL. The incidence of recurrence after endoscopic carpal tunnel release. Plast Reconstr Surg 2000; 105:1662-5.
  • 33. Filippi R, Reisch R, El-Shki D, Grunert P: Uniportal endoscopic surgery of carpal tunnel syndrome: technique and clinical results. Minim Invasive Neurosurg 2002; 45: 78-83.
  • 34. Trumble TE, Diao E, Abrams RA, Gilbert- Anderson MM. Single – portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial. J Bone Joint Surg Am 2002; 84-A: 1107-15.
  • 35. Abdullah AF, WolberPH, Ditto EW: Squela of Carpal Tunnel surgery: Rationale for design of a surgical approach. Neurosurgery 1995; 37: 931-6.
  • 36. Nathan PA: Carpal tunnel release using minimally invasive technique.Plast Reconstr Surg 1997; 99: 1195-6.
  • 37. Schmidt W, Gruber AA, Hammer R: Results of different incisions in treatment of carpal tunnel syndrome. Handchir Mikrochir Plast Chir 2000; 32: 67-9.

Transverse mini skin incision for carpal tunnel release

Yıl 2017, Cilt: 39 Sayı: 2, 501 - 506, 16.05.2017

Densel Araç Hüseyin Bozkurt , Bilge Öztoprak

https://doi.org/10.7197/223.v39i29491.316372

Öz

Objective: Mini skin incision technique for median
nerve release have become popular recently for the treatment of carpal tunnel
syndrome. The main advantages of this technique are shorter recovery time and
better cosmetic results. Neurovascular injury still remains controversial. We
presented the advantages, disadvantages and results of transverse mini skin
incision technique to release carpal tunnel syndrome.

Method: 62 carpal tunnel releasing procedures
were performed.52 female and 10 male patients with mean age of 62 (ranging from
38 to 82) included in this study. All patients were operated by using
transverse mini skin incision technique.

Results: Significant improvement was observed in
symptoms and signs during the postoperative follow-up period. No recurrence or
injury to the neurovascular structures was noted.







Conclusions: The technique is simple and effective.
Without using expensive instruments better cosmetic results and better recovery
time can be achieved.

Anahtar Kelimeler

Carpal tunnel syndrome transverse mini skin incision better cosmetic results

Kaynakça

  • 1. Eversman WW. Entrapment and compression neuropathies. In: Green DP, editor. Operative hand surgery. New York (NY): Churchill Livingstone; 1998: 1423-78.
  • 2. Gelberman HR. Carpal tunnel release. In: Gelberman RH, North ER, editors. Operative nerve repair and reconstruction. 2 vol. Philadephia (PA): JB Lippincott; 1991. p. 900-11.
  • 3. Young HA. Surgical management of peripheral entrapment neuropathy. In: Schmidek HH, Sweet WH, editors. Operative neurosurgical techniques. Indications, methods, and results. Philadephia (PA): WB Saunders, 1988: 1583-98.
  • 4. Açıkgöz B: Karpal Tünel Sendromu. TND Spinal ve Periferik Sinir Cerrahisi Grubu Yayınları: Periferik Sinir Cerrahisi Demircan N, Zileli M (ed). Ankara: Türk Nöroşirürji Derneği, 2008, 281-304.
  • 5. Brown RA, Helbernan RH, Seiler JG, Abrahamsson SO, Weiland AJ, Urbaniac JR, Schoenfeld DA, Furcolo D. Carpal Tunnel release: a prospective randomized assessment of open and endoscopic methods. J Bone Joint Surg 1993; 75: 1265.
  • 6. Sever C, Kulahcı Y, Oksuz S, Sahin C. The mini incision technique for Carpal Tunnel decompression using nasal instruments. Turkish Neurosurg 2010; 20: 353-57.
  • 7. Uygur F, Sever C, Yüksel F. Comparing the results of limited incision technique and standart longitudinal incision tecnique for carpal tunnel decompression by numerical grading system. Turkish Neurosurgery 2009; 19: 51-7.
  • 8. Aroori S, Spence RAJ. Carpal Tunnel Syndrome. Ulster Med J 2008, 77: 6-17
  • 9. Aydın K, Cokluk C, Cengiz N, Bilgici A: Microsurgical open mini uniskin incision technique in the surgical treatment of Carpal Tunnel Syndrome. Neurology India 2006; 54: 64-7.
  • 10. Aydın K, Cokluk C, Piskin A, Kocabıçak E: Ultrosonographically checking the sectioning of the transverse carpal ligament during Carpal Tunnel Surgery with limited uni skin incisions.Turkish Neurosurgery 2007; 17: 219-23.
  • 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.
  • 12. Phalen GS. The carpal tunnel syndrome. seventeen years' experience in diagnosis and treatment of 654 hands. J Bone Joint Surg Am 1966; 48: 211-28.
  • 13. Einhorn N, Leddy JP. Pitfalls of endoscopic carpal tunnel release. Orthop Clin North Am 1996; 27: 373-80.
  • 14. Lida J, Hirabayashi H, Nakase H, Sakaki T: Carpal Tunnel Syndrome: Electrophysiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir (Tokyo) 2008; 48: 554-9.
  • 15. Stancic MF, Eskinja N, Stosıc A. Anatomical variations of the median nerve in the carpal tunnel. Int Orthop 1995; 19: 30-34.
  • 16. Stancic MF, Mıcovic V, Potocnjak M. The anatomy of the Berrettini branch: implications for carpal tunnel release. J Neurosurg 1999; 91: 1027-30.
  • 17. Shinya K, Lanzetta M, Conolly WB. Risk and complications in endoscopic carpal tunnel release. J Hand Surg (Br) 1995; 20: 222-7.
  • 18. Palmer AK, Toivonen DA. Complications of endoscopic and open carpal tunnel release. J Hand Surg (Am) 1999; 24: 561-5.
  • 19. Ferdinand RD, MacLean JG: Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment. J Bone Joint Surg Br 2002; 84: 375-9.
  • 20. Nath RK, Mackinnon SE, Weeks PM. Ulnar nerve transection as a comolication of two-portal endoscopic carpal tunnel release: a case report . J Hand Surg (Am) 1993; 18: 896-8.
  • 21. Stancic MF, Burgic N, Mıcovic V. Marinacci comminication. Case report. J Neurosurg 92: 860-2, 2000
  • 22. Biyani A, Downes EM: An open twin incision technique of carpal tunnel decompression with reduced incidence of scar tenderness. J Hand Surg (Br) 1993; 18: 331-4.
  • 23. del Pinal F, Cruz-Camara A, Jado E. Total ulnar nerve transection during endoscopic carpal tunnel release. Arthroscopy 1997; 13: 235-7.
  • 24. Serra JM, Benito JR, Monner J: Carpal tunnel release with short incision. Plast Reconstr Surg 1997; 99: 129-35.
  • 25. Wilson KM: Double incision open technique for carpal tunnel release: an alternative to endoscopic release. J Hand Surg (Am) 1994; 19: 907-12.
  • 26. Zimmerli W: Double incision for operation of carpal tunnel syndrome- 14 years experience. Helv Chir Acta 1992; 58: 395-400.
  • 27. Badger SA, O’Donnel ME, Sherigor JM, Conolly P, Spence RA: Open Carpal Tunnel release, still safe and effective operation. Ulster Med J 2008; 77: 22-4.
  • 28. Franzini A, Broggi G, Servello D, Dones I, Pluchino MG: Transilluminationin minimally invasive surgery for Carpal Tunnel release. Technical note. J Neurosurg 1996; 85: 1184-6.
  • 29. Lee WP, Strickland JW. Safe carpal tunnel release via alimited palmar incision. Plast Reconstr Surg 1998; 101: 418-26.
  • 30. Vanni D, Sirabella FS, Galzio R, Salini V, Magliani V. The double tunnels technique: an alternative minimally invazive approach for carpal tunnel syndrome. J Neurosurg 2015; 123: 1230-37.
  • 31. Zhang X, Huang X, Wang X, Wen S, Sun J, Shao X: A randomized comparison od double small, standard and endoscopic approaches for carpal tunnel release. Plast Reconstr Surg 2016 doi:10.1097/PRS.0000000000002511
  • 32. Concannon MJ, Brownfield ML, Puckett CL. The incidence of recurrence after endoscopic carpal tunnel release. Plast Reconstr Surg 2000; 105:1662-5.
  • 33. Filippi R, Reisch R, El-Shki D, Grunert P: Uniportal endoscopic surgery of carpal tunnel syndrome: technique and clinical results. Minim Invasive Neurosurg 2002; 45: 78-83.
  • 34. Trumble TE, Diao E, Abrams RA, Gilbert- Anderson MM. Single – portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial. J Bone Joint Surg Am 2002; 84-A: 1107-15.
  • 35. Abdullah AF, WolberPH, Ditto EW: Squela of Carpal Tunnel surgery: Rationale for design of a surgical approach. Neurosurgery 1995; 37: 931-6.
  • 36. Nathan PA: Carpal tunnel release using minimally invasive technique.Plast Reconstr Surg 1997; 99: 1195-6.
  • 37. Schmidt W, Gruber AA, Hammer R: Results of different incisions in treatment of carpal tunnel syndrome. Handchir Mikrochir Plast Chir 2000; 32: 67-9.
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Cerrahi Tıp Bilimleri Araştırma Yazıları
Yazarlar

Densel Araç

Hüseyin Bozkurt

Bilge Öztoprak

Yayımlanma Tarihi 16 Mayıs 2017
Kabul Tarihi 23 Mart 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 39 Sayı: 2

Kaynak Göster

AMA Araç D, Bozkurt H, Öztoprak B. Transverse mini skin incision for carpal tunnel release. CMJ. Mayıs 2017;39(2):501-506. doi:10.7197/223.v39i29491.316372