Sindrom karpalnog tunela - suvremena dijagnostika i liječenje

Autor: Tomislav Crnković, Ranko Bilić, Robert Kolundžić
Jazyk: chorvatština
Rok vydání: 2008
Předmět:
Zdroj: Medica Jadertina
Volume 38
Issue 3-4
ISSN: 1848-817X
0351-0093
Popis: Sindrom karpalnog tunela najcešca je kompresivna neuropatija na ljudskom tijelu koja se manifestira ispadima u inervacijskom podrucju živca medianusa s ucestalošcu izmedu 50 i 150 slucajeva na 100.000 stanovnika. Simptomatika ovisi o trajanju i jacini kompresije živca. Smetnje senzibilnosti prvi su i najstalniji simptom, dok motoricke smetnje nastaju u bolesnika s dugotrajnom kompresijom živca. Elektroneurofiziološka dijagnostika "zlatni je standard” u postavljanju dijagnoze, a potrebno ju je uciniti kod svake klinicke sumnje na sindrom karpalnog tunela. Kao dodatna dijagnosticka sredstva u atipicnim slucajevima mogu poslužiti ultrazvuk i magnetska rezonancija karpalnog tunela. Neoperacijsko lijecenje rezervirano je za lakše oblike kompresije živca, te kod pojave sindroma u tranzitornim stanjima, kao što su trudnoca, laktacija, korištenje oralnih kontracepcijskih sredstava i sl. Metoda izbora za perzistentne i progresivne oblike sindroma karpalnog tunela, kao i za one koji ne reagiraju na konzervativnu terapiju, operacijsko je lijecenje. Dekompresija živca medianusa efikasan je i siguran zahvat koji u najvecem broju slucajeva oslobada pacijenta od tegoba. Sam zahvat može se izvršiti metodom "otvorenog polja” ili endoskopski, iako za sada nema pokazatelja o prednosti endoskopske tehnike u odnosu na klasicnu tehniku "otvorenog polja”, a jatrogena oštecenja živca medianusa daleko su cešca pri endoskopskoj tehnici. U svakodnevnoj praksi najvece znacenje ima rano prepoznavanje sindroma karpalnog tunela, te njegovo pravodobno i adekvatno lijecenje. U suprotnom dolazi do nepotrebno dugog trajanja smetnji za pacijenta i težeg oštecenja živca, što smanjuje izglede uspješnog lijecenja, te dovodi do nepotrebnih ekonomskih gubitaka.
Carpal tunnel syndrome is the most common compressive neuropathy in the human body, which is expressed by a deficit in the median nerve innervation area, with prevalence of 50 to 150 cases per 100.000 inhabitants. Symptoms depend on nerve compression duration and intensity. Sensibility disorders are the first and one of the most persistent symptoms, while motoric disorders arise in patients with prolonged nerve compression. Electroneurophysiological diagnostics is a "golden standard” in diagnosis setting, and it is necessary to be done in every patient with a clinical doubt on carpal tunnel syndrome. Additional diagnostics means in atypical cases can be performed by ultrasound and magnetic resonance of the carpal tunnel. Non-surgical treatment is reserved for mild forms of nerve compression, and in cases of syndrome in temporary conditions like pregnancy, lactation, taking oral contraceptives etc. The method of choice for persistent and progressive forms of carpal tunnel syndrome, as well for those who don't respond to the conservative treatment, is surgery. Decompression of median nerve is an efficient and secure procedure, which, in most cases, releases the patient from its symptoms. Procedure can be performed by an "open field” method or via endoscopy, although, for now, no indicators on advantages of endoscopic technique vs. classical technique of an "open field” have been found, and iatrogenous damage of the median nerve are much more frequent in surgery via endoscopy. In everyday practice, the most important is early recognition of the carpal tunnel syndrome, and its timely and adequate treatment. On the contrary, unnecessaryprolongation of the condition leads to much more severe nerve damage, which diminishes chances for a successful treatment and causes necessary economy losses.
Databáze: OpenAIRE
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