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Table of Content - Volume 13 Issue 2 - February 2020
A Study of carpal tunnel release by endoscopic method at tertiary health care center
Sanjay Manohar Patil1*, Milind Nivrutti Kolhe2
1Assistant Professor, 2Assistant Professor, Department of ORTHOPEDICS, Dr Ulhas Patil Medical College, Jalgaon, Maharashtra, INDIA. Email: dr.sanjay.patil61@gmail.com , kolhe_milind@yahoo.co.in
Abstract Background: Open carpal tunnel release (OCTR) remains standard practice in many centres in Europe. Endoscopic carpal tunnel release (ECTR) is presently the main competitor to the open technique; its major benefits are claimed to be earlier return to work or activities of daily living . Aims and Objective: to Study of carpal tunnel release by endoscopic method at tertiary health care center. Methodology :This was a cross-sectional study in the patients with clinical features of Carpel tunnel syndrome at tertiary health care center during the year December 2018 to December 2019 .The patients closely clinically examined and investigated; those who fulfilled all clinical parameters were classified as patients with carpel tunnel syndrome, After written explained consent explaining about both the procedures ; the patients were randomly divided into the Open and Endoscopic surgery group . The parameters related to operation like Mean Operation Duration (minutes), Mean Scar Length (millimeters), Mean time until return to daily activity (days), Pain at 4th Wk. of Post-operative by (Visual Analog Scale/ mean score ) was noted. The statistical analysis done by the unpaired t-test calculated by SPSS software version 19. Result : The majority of the patients were female i.e. 60 % followed by Male i.e. 40% The parameters like Mean Operation Duration (minutes) were 24 ± 9.87 and 8.54 ± 5.12 (P<0.001); Mean Scar Length (millimeters)-51.23 ± 5.83 and 15.64 ± 6.53 (P<0.05)Mean time until return to daily activity (days) -56.43 ± 23.19 and 31.16± 17.43 (P<0.01); Pain at 4th Wk. of Post-operative -(Visual Analog Scale)- 4.87± 3.45 and 2.12 ± 0.98 (P<0.01) significantly differed in Open Surgery group as compared to Endoscopic Surgery respectively. Conclusion: It can be concluded from our study that endoscopic approach found to be superior to traditional open approach with respect to less Mean Operation Duration , less Mean Scar Length Less Mean time until return to daily activity Pain etc. respectively so, this approach should be used if facilities are available. Key words: carpal tunnel release, carpal tunnel syndrome, VAS-score. INTRODUCTION Open carpal tunnel release (OCTR) remains standard practice in many centres in Europe. Endoscopic carpal tunnel release (ECTR) is presently the main competitor to the open technique; its major benefits are claimed to be earlier return to work or activities of daily living 1,2. Others report variable success with ECTR with no significant difference between ECTR and OCTR . However, there is consensus that both techniques are effective in shortand long-term effects on various types of carpal tunnel syndrome (CTS) symptoms, and overall complication rates seems to be similar for OCTR and ECTR, although the risk of transient neurological problems is higher for ECTR 3,4,5. Since the introduction of ECTR a modification of the classic incision for OCTR, extending from the mid-palm angulated over the flexion crease of the wrist, has been introduced to try to reduce surgical trauma and hence recovery time , but no randomized controlled trial comparing ECTR versus OCTR with a modified incision has, to our knowledge, addressed return to work, and only two studies in various they have examined the time to return to work by comparing OCTR versus OCTR with a modified incision 6,7,8,9,10. We have done study with objective of whether carpal tunnel release by endoscopic method is effective as compred to open method at tertiary health care center
METHODOLOGY This was a cross-sectional study in the patients with clinical features of Carpel tunnel syndrome at tertiary health care center during the year December 2018 to December 2019 .The patients closely clinically examined and investigated; those who fulfilled all clinical parameters were classified as patients with carpel tunnel syndrome, After written explained consent explaining about both the procedures ; the patients were randomly divided into the Open and Endoscopic surgery group . The parameters related to operation like Mean Operation Duration (minutes), Mean Scar Length (millimeters), Mean time until return to daily activity (days), Pain at 4th Wk. of Post-operative by (Visual Analog Scale/ mean score ) was noted. The statistical analysis done by the unpaired t-test calculated by SPSS software version 19.
RESULT Table 1: Distribution of the patients as per the Age
The majority of the patients were from the age group of 45-60 were 46 %, followed by 30-45 -26%, 15-30 -20%, >60 -8s%.
Table 2: Distribution of the patients as per the sex
The majority of the patients were female i.e. 60 % followed by Male i.e. 40%
Table 3: Distribution of the Open Surgery and Endoscopic Surgery patients as per the various parameters
The parameters like Mean Operation Duration (minutes) were 24 ± 9.87 and 8.54 ± 5.12 (P<0.001); Mean Scar Length (millimeters)-51.23 ± 5.83 and 15.64 ± 6.53 (P<0.05)Mean time until return to daily activity (days) -56.43 ± 23.19 and 31.16± 17.43 (P<0.01); Pain at 4th Wk. of Post-operative -(Visual Analog Scale)- 4.87± 3.45 and 2.12 ± 0.98 (P<0.01) significantly differed in Open Surgery group as compared to Endoscopic Surgery respectively.
DISCUSSION Endoscopic carpal tunnel release has yet to be as widely adopted as open release 7 but offers the theoretical advantages of reduced postoperative pain, faster recovery of grip strength, earlier return to work and activities of daily living, and fewer wound-related complications associated with open release such as scar tenderness and pillar pain in the thenar and hypothenar eminences 11, 14. These putative benefits are achieved, in part, by avoiding the traditional midpalmar incision used in the open approach. However, pragmatic concerns relating to endoscopic release include its relative technical difficulty 13,14,15, cost-effectiveness 16, time requirement 19, and potential risk of iatrogenic injury to neurovascular structures 18 . Although endoscopic carpal tunnel release has been practiced for more than two decades, controversy persists regarding its safety and overall patient outcomes relative to open release. In our study we have seen The majority of the patients were from the age group of 45-60 were 46 %, followed by 30-45 -26%, 15-30 -20%, >60 -8s%. The majority of the patients were female i.e. 60 % followed by Male i.e. 40% The parameters like Mean Operation Duration (minutes) were 24 ± 9.87 and 8.54 ± 5.12 (P<0.001); Mean Scar Length (millimeters)-51.23 ± 5.83 and 15.64 ± 6.53 (P<0.05)Mean time until return to daily activity (days) -56.43 ± 23.19 and 31.16± 17.43 (P<0.01); Pain at 4th Wk. of Post-operative -(Visual Analog Scale)- 4.87± 3.45 and 2.12 ± 0.98 (P<0.01) significantly differed in Open Surgery group as compared to Endoscopic Surgery respectively. These findings are similar to Rajkumar Suryawanshi et al. 19 they found average age Yrs. of Endoscopic Surgery Group was 45 ± 3.54 and Open Surgery Group was 46 ± 4.32 Yrs. and no of Male and Female were comparable in both the groups ( t=1.21,=df=58,p>0.05) and (χ2=0.277,df=1,p>0.05) respectively. The Pain measured by VAS score was significantly higher in the open surgery group as compared to Endoscopic Surgery Group i.e. 3.42 ± 2.1 and 6.13 ± 3.42 (t=3.69,df=58,p<0.005); 2.1± 3.12 and 5.23± 2.92 (t=4.92,df=58,p<0.001); 1.92 ± 2.23 and 3.76± 2.61 (t=5.21,df=58,p<0.001); 1.32± 1.98 and 3.52±1.39 (t=3.12,df=58,p<0.01) ; 1.12± 1.62 and 2.92 ± 2.54 (t=5.97,df=58,p<0.001); 0.92 ± 0.43 and 2.12 ± 1.73 (t=4.47,df=58,p<0.001) respectively in Endoscopic Surgery Group and Open Surgery Group.
CONCLUSION It can be concluded from our study that endoscopic approach found to be superior to traditional open approach with respect to less Mean Operation Duration, less Mean Scar Length Less Mean time until return to daily activity Pain at 4th Wk. respectively so, this approach should be used if facilities are available.
REFERENCES
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