Artikel
Carpal tunnel and median nerve volumes changes before and after carpal tunnel surgery (Comparision of endoscopic and mini open technique)
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Autoren
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Nazmi Bulent Alp
- Bursa Uludag University, Orthopedics and Traumatology Dept., Hand Surgery Division, Bursa, Turkey
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: To compare carpal tunnel volume and n.medianus volume changes in preoperative and postoperative MRI of patients who were operated with 2 different techniques.
Methods: In Bahçelievler State Hospital/ISTANBUL, 17 wrists of 13 patients who were diagnosed with carpal syndrome were included to our study.
In open technique, the transverse carpal ligament was cut by inserting a 1 cm longitudinal incision 1 cm distal to the distal wrist crease. It was noted that the incision tunnel passed through the middle of the 4th finger.
Microaire Smart release system was used for endoscopic surgery. In a single portal technique, 1 cm transvers incision was made between palmaris longus and flexor carpi ulnaris tendons over most detechable proximal wrist crease. The direction of the blade was again aimed at the 4th finger center. Transverse carpal ligament was cut distal to proximal and inferior to superior direction.
Median nerve volume and carpal tunnel volume were measured in T2 fat-printed images. The distal and proximal borders of the carpal tunnel (pisiform bone and hook of hamatum) were identified on the coranal plane [1].
The cross-sectional widths varied between 2 mm/3 mm according to the MRI. Depending on the length of the carpal tunnel, 4 to 11 axial sections were taken from the MRI. The image was enlarged and the area of the median nerve and carpal tunnel was marked to find the axial cross-sectional area (mm2). Each section was measured 3 times and the average of 3 numerical values was taken (mean axial area mm2). Each mean axial carpal tunnel and median nerve area was multiplied by the width to find the estimated volume (OAA * Width).
Total of all gave us estimated carpal tunnel and median nerve volume.
Results and Conclusions: There was a significant difference between preoperative carpal tunnel volumes and median nerve volumes, postoperative carpal tunnel volumes and median nerve volumes. p<0,0001 When we compared the two methods in terms of volume increments, a significant difference was found.
When techniques are compared with each other, we can t see significant difference between pre- and post-operative cts volumes or n. medianus volume.
In our study, we found that 2 different techniques succeeded in increasing the carpal tunnel and median nerve volumes, but they did not have any superiority to each other.
References
- 1.
- Crnković T, Trkulja V, Bilić R, Gašpar D, Kolundžić R. Carpal tunnel and median nerve volume changes after tunnel release in patients with the carpal tunnel syndrome: a magnetic resonance imaging (MRI) study. Int Orthop. 2016 May;40(5):981-7.
