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ORIJINAL ARAŞTIRMA

Karpal Tünel Sendromunda Kortikosteroid Enjeksiyonu ile Ultrason Kılavuzluğunda Hidrodiseksiyon
Ultrasound-Guided Hydrodissection with Corticosteroid Injection for Carpal Tunnel Syndrome
Received Date : 16 Jan 2022
Accepted Date : 02 Aug 2022
Available Online : 11 Aug 2022
Doi: 10.31609/jpmrs.2022-88198 - Makale Dili: EN
J PMR Sci. 2022;25(3):299-306
ÖZET
Amaç: Kortikosteroid enjeksiyonları kısa vadede karpal tünel sendromunun (KTS) tedavisinde oldukça etkilidir. Bu çalışmada, KTS’de ultrason (US) kılavuzluğunda hidrodiseksiyonlu veya hidrodiseksiyonsuz kortikosteroid enjeksiyonunun semptom şiddeti, fonksiyonel durum, kavrama gücü, yaşam kalitesi ve medyan sinirin kesit alanı [cross-sectional area (CSA)] üzerine etkilerini belirlemek amaçlandı. Gereç ve Yöntemler: KTS’li hastaların prospektif bir kohortu retrospektif olarak değerlendirildi. Hidrodiseksiyon grubu olarak US kılavuzluğunda hidrodiseksiyonlu triamsinolon enjeksiyonu (3 mL) yapılan ve kontrol grubu olarak US kılavuzluğunda triamsinolon enjeksiyonu (1 mL) yapılan toplam 28 hasta verilerden rastgele seçildi (vaka-kontrol oranı 1:1). Sonuç ölçümleri; el kavrama kuvveti [hand grip strength (HGS)], medyan sinirin CSA’sı, Boston Karpal Tünel Anketi [Boston Carpal Tunnel Questionnaire (BCTQ)] ve Kısa Form 12 idi. Değerlendirmeler başlangıçta, enjeksiyonlardan 1 hafta ve 4 hafta sonra kaydedildi. Bulgular: Değerlendirme noktaları boyunca her iki grupta da HGS anlamlı olarak iyileşirken; medyan sinirin CSA’sı, BCTQ’nun Semptom Şiddet Ölçeği ve Fonksiyonel Durum Ölçeği [Functional Status Scale (FSS)] skorları anlamlı olarak azaldı (her değişken için p<0,01). Başlangıç ve 1. hafta sonuçlarındaki yüzde değişiklikler gruplar arasında karşılaştırıldığında, hidrodiseksiyon grubunda BCTQ’nun FSS skoru iyileşme gösterdi (-47.46% vs. -13.97%, p=0.016); fakat bu fark 4 hafta sonra mevcut değildi (-53.25% vs. -33.33%, p=0.053). Sonuç: Hidrodiseksiyonlu kortikosteroid enjeksiyonu 1. haftadaki fonksiyonel skorlarda iyileşme dışında ek bir klinik etki sağlamadı.
ABSTRACT
Objective: Corticosteroid injections are remarkably effective as a treatment for carpal tunnel syndrome (CTS) in the short term. This study aimed to determine the effects of ultrasound (US)-guided corticosteroid injection with or without hydrodissection on symptom severity, functional status, grip strength, quality of life, and the cross-sectional area (CSA) of the median nerve in CTS. Material and Methods: A prospective cohort of patients with CTS was retrospectively evaluated. A total of 28 patients were randomly selected who received US-guided triamcinolone injection with hydrodissection (3 mL) as the hydrodissection group and US-guided triamcinolone injection (1 mL) as the control group, from the data (case-control ratio 1:1). Outcome measures were the hand grip strength (HGS), CSA of the median nerve, Boston Carpal Tunnel Questionnaire (BCTQ), and Short Form 12. We recorded the assessments at baseline, 1 and 4 weeks after injections. Results: HGS significantly improved, CSA of the median nerve, Symptom Severity Scale, and Functional Status Scale (FSS) scores of BCTQ significantly decreased in both groups throughout the assessment points (p<0.01 for each variable). Percent changes in baseline and 1st-week results between groups showed improvement in the FSS score of BCTQ in the hydrodissection group (-47.46% vs. -13.97%, p=0.016) but this was not available after 4 weeks (-53.25% vs. -33.33%, p=0.053). Conclusion: Corticosteroid injection with hydrodissection did not provide an additional clinical effect except for an improvement in functional scores in 1st week.
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