دانلود مقاله رها سازی تونل کارپال با هدایت سونوگرافی
چکیده
نکات کلیدی
ملاحظات قبل از عمل
گزینه های درمان جراحی
تجربه نویسنده
تکنیک جراحی
عواقب
نتایج
بحث
نکات مراقبتی کلینیک ها
افشای
داده های تکمیلی
منابع
Abstract
Key points
Preoperative considerations
Surgical treatment options
Author experience
Surgical technique
Outcomes
Results
Discussion
Clinics care points
Disclosure
Supplementary data
References
چکیده
نکات کلیدی
این یک تکنیک جدید برای رهاسازی تونل کارپال به لطف بهبود اخیر در کیفیت دستگاه های اولتراسوند است.
تکنیک جراحی به خوبی توصیف شده است و شامل یک رویکرد مچ دست به روش رتروگراد است
تحت کنترل دقیق اولتراسوند برای قطع کامل رباط عرضی کارپ.
نتایج 150 بیمار اول، نکات و ترفندها ارائه شده و مورد بحث قرار گرفته است.
با یک ابزار اختصاصی، این یک روش ایمن و قابل تحمل، کارآمد و بدون هزینه است.
ملاحظات قبل از عمل
سندرم تونل کارپال (CTS) یکی از شایع ترین نوروپاتی های اندام فوقانی است که عمدتاً کارگران یدی را تحت تأثیر قرار می دهد. شیوع آن تقریباً 5٪ از جمعیت است و معمولاً در آخرین سالهای فعال (50-60 سالگی) با افزایش بروز در زنان (4:1) تشخیص داده می شود. آتروشی و همکاران 1 نشان دادند که شیوع کلی علائم نوروپاتی در توزیع عصب مدیان 14.4٪ است (95٪ CI، 13.0٪ - 15.8٪).
توجه! این متن ترجمه ماشینی بوده و توسط مترجمین ای ترجمه، ترجمه نشده است.
KEY POINTS
- This is a new technique for carpal tunnel release thanks to recent improvement in the quality of ultrasound devices.
- The surgical technique is well described and consists in a wrist approach in a retrograde fashion under strict ultrasound control to transect completely the transverse carpal ligament.
- Outcomes of the first 150 patients, tips and tricks are presented and discussed.
- With a dedicated instrument, this is a safe and well-tolerated procedure, efficient, costless.
Preoperative considerations
Carpal tunnel syndrome (CTS) is one of the most common neuropathies of the upper limb, and affects mainly manual workers. Its prevalence is approximately 5% of the population, and usually is diagnosed in the last active years (50–60 years old), with an increased incidence in women (4:1). Atroshi and colleagues1 showed that the overall prevalence of neuropathy signs in the median nerve distribution is 14.4% (95% CI, 13.0%– 15.8%).
They also determined that clinically certain CTS prevalence confirmed by electrodiagnostic tests (4.6% for women and 2.8% for men) was close to or somewhat lower than the true prevalence. CTS diagnosis is clinical, with typical symptoms including paresthesia, pain, and weakness in the median motor nerve distribution, often increasing in intensity at night. Ultrasound (US) and electromyography are used as means of additional evaluation and in poor clinically defined cases, if a differential diagnosis is needed. Once a diagnosis is confirmed, either medical or interventional treatment strategies can be used, the choice depending on the severity of the condition and the patient’s decision. Among accepted severity criteria, authors find permanent amyotrophy of the thenar eminence due to its interrupted median nerve innervation, paralysis of thumb opposition, permanent paresthesia, and all forms of hyperalgesia.2 For severe CTS patients (presence of clinical criteria, activity limitations, presentation of poor prognosis factors, and decreased quality of life) and for those who medical treatment failed, interventional options are preferred.
Discussion
At the end of the follow-up period, significant recovery of grip strength was observed in the studied population. Additionally, pain and acroparesthesias resolved promptly after surgery, normal activities took less than 2 weeks to resume for a large majority of patients, and no serious complications were observed during the first postoperative month. Procedural subjective satisfaction was high in approximately 98% of operated patients, indirectly reflecting good tolerance and functional results of US-guided release of TCL using a new compact scalpel.