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
Merve ÖRÜCÜ ATARa, Evren YAŞARb, Özge TEZENb, Esra BİLGİNc,
Şükran YURTOĞULLARIa, Özlem KÖROĞLUa, Eda GÜRÇAYa
aClinic of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Türkiye
bClinic of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Türkiye
cDepartment of Physical Medicine and Rehabilitation, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
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.
Anahtar Kelimeler: Karpal tünel sendromu; ultrason; hidrodiseksiyon; steroid enjeksiyonu
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.
Keywords: Carpal tunnel syndrome; ultrasound; hydrodissection; steroid injection
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