Karpal tünel sendromu tedavisinde splint, splint ile lokal steroid enjeksiyonu ve cerrahinin karşılaştırılması

Comparison of splinting, splinting plus local steroid injection and surgery in carpal tunnel syndrome treatment

Halil UÇAN, Lale YILMAZ, Fırat YAĞMURLU, Esra Dilek KESKİN, Hatice BODUR, İlker YAĞCI

Özet

Amaç: Bu çalışmada, karpal tünel sendromu (KTS) tedavisinde splint, splint ile lokal steroid enjeksiyonu ve cerrahinin kısa dönemdeki etkinliklerinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Çalışmaya hafif veya orta dereceli, idiyopatik KTS'li 57 el alındı ve 23 ele splint, 23 ele splint ile enjeksiyon, 11 ele ise cerrahi uygulandı. Hastalar, tedavi öncesi ve tedavi sonrası 90. günde elektrofizyolojik ölçümler ve Boston Anketi (BA) ile değerlendirildi. Bulgular: BA, semptom şiddet (SŞ) skorunda, fonksiyonel kapasite (FK) skorunda, elektrofizyolojik parametrelerden; median motor sinir distal latansı, bilek seviyesinde median motor sinir bileşik kas aksiyon potansiyeli (BKAP) amplitüdü, dirsek seviyesinde median motor sinir BKAP amplitüdü, ikinci parmak bilek segmenti median duyusal sinir iletim hızı, ikinci parmak bilek segmenti median sinir duyusal aksiyon potansiyeli amplitüdü ölçümlerinde tüm tedavi gruplarında anlamlı iyileşme saptandı (p0,05). Bununla birlikte SŞ'de 90. günde splint ve splint ile enjeksiyon yönteminin cerrahi grubuna göre, FK'de ise splint ile enjeksiyon grubu, splint ve cerrahi grubuna göre istatistik olarak daha iyi bulundu (p

Abstract

Objective: This study was designed to compare the short term efficacy of splinting, splinting plus local steroid injection and surgery in mild or moderate idiopathic carpal tunnel syndrome (CTS) treatment. Materials and Methods: Fifty-seven hands were divided into three groups in which 23 hands were splinted, 23 hands were splinted and one time steroid injection was applied, and 11 hands were operated. The patients were evaluated before and 90 days after treatment with electrophysiological studies and Boston Questionnaire (BQ). Results: In BQ symptom severity (SS) and functional capacity (FC) scores, median motor nerve distal latency, median motor nerve compound muscle action potential amplitude at wrist, and ankle, median sensorial nerve velocity at 2nd digit-wrist segment, and median sensorial nerve action potential amplitude at 2nd digit-wrist segment measures statistically significant improvements were found in both of three methods (p0.05). However the SS score of splinting and splinting plus injection were statistically lower than surgery at 90th day and the FC score of splinting plus injection was lower than splinting and surgery. In median sensorial nerve velocity at palm-wrist segment all treatments were increased the velocity (p