Omurilik Yaralanmalarında Üst Ekstremite Tuzak Nöropatileri

Nurten UZUN, Derya ULUDÜZ, Azar RAHİMPANAH, Şafak Sahir KARAMEHMETOĞLU
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Öz


Özet Omurilik yaralanmal› hastalarda üst ekstremitelerde tuzak nöropatileri normal popülasyondan daha s›k gözlenmektedir. Ça- l›flmam›z›n amac›, omurilik yaralanmal› hastalar›m›zda üst ekstremite tuzak nöropati varl›¤› ve s›kl›¤›n› araflt›rmakt›r. Bu çal›flmaya, 4 aydan uzun süre önce travmatik omurilik yaralanmas› geçirmifl yafllar› 11 ila 56 aras›nda de¤iflen 31 hasta dahil edildi. Tüm hastalar›n hastal›k öyküsü, hastal›k süresi, yafl, cinsiyet, lezyon seviyesi, lezyon tipi (tam/k›smi) kaydedildi. Hastalar klinik ve e- lektrofizyolojik aç›dan de¤erlendirildi. Tuzak nöropatisi saptanan ve saptanmayan hastalar bu parametreler aç›s›ndan karfl›laflt›r›ld›. Hastal›k süreleri ortalama 22.8 ay (SD=19.5) olan 31 hastan›n 9’unda (% 29) tuzak nöropatisi saptand›. Tuzak nöropatisi olan hastalarda hastal›k süresi anlaml› olarak daha uzundu (p=0.045). Tuzak nöropatisi, hastalar›n 5’inde median, 5’inde ise ulnar sinirde el bile¤i seviyesinde saptand›. Median sinir lezyonlar› hastalar›n 3’ünde sa¤, 1’inde sol, 1’inde ise bilateral Karpal Tünel Sendromu idi. Ulnar sinirin el bile¤i düzeyinde etkilendi¤i hastalar›n 2’sinde sa¤ (Tip IV), 1’inde sol (Tip IV), 2’sinde bilateral (birinde Tip I, ikincisinde sol a¤›rl›kl› Tip IV) tuzaklanma saptand›. Semptomatik olan tek hastam›z, bilek seviyesinde hem median hem de ulnar sinirde tuzaklanman›n oldu¤u hasta idi. Günlük aktivitelerinde ileri derecede ellerine ba¤l› olarak yaflayan paraplejik hastalar›n üst ektremite tuzak nöropatileri aç›s›ndan elektrofizyolojik testlerle araflt›r›lmas›, oluflabilecek tuzak nöropatilerine ait klinik sendromlar›n önlenmesi ve erken tedavi edilmesi aç›s›ndan önemlidir.
Anahtar Kelimeler: Omurilik yaralanmalar›, tuzak nöropatileri, elektrofizyoloji, karpal tünel sendromu Cerrahpafla T›p Derg 2007; 38: 81 - 84

Upper extremity entrapment neuropathies in patients with spinal cord injury

Abstract Upper extremity entrapment neuropathies are more common in patients with spinal cord injury. The purpose of this study is to determine the presence and the prevalence of upper extremity entrapment neuropathies in patients with spinal cord injury. 31 patients (22 male, 9 female), who have spinal cord injury for more than 4 months, between the ages of 11 and 56 years (me- an 32.8 ± 11.1) were enrolled. The patients were evaluated in regards to demographic, clinical and electrophysiological data. The parameters in patients with entrapment neuropathies were compared with the patients without entrapment neuropathy. Out of 31 patients studied, 9 had electrophysiologically Carpal Tunnel Syndrome (29 %). Disease duration was significantly longer in CTS patients (p=0.045). 5 patients showed median and 5 showed ulnar nerve pathology. Median nerve pathologies were Car- pal Tunnel Syndrome in all patients. 3 had right (one in moderate sensorial fibers, one had severe sensorial and moderate motor nerve, last had moderate motor and sensorial nerve fiber pathologies), 1 had left (with severe motor and sensorial nerve fiber invol- vement) and 1 had bilateral (severe motor and sensorial nerve fibers involvement in right and moderate involvement in left side) Carpal Tunnel Syndrome findings. Among patients with ulnar nerve neuropathy, 2 had right (Type IV), 1 had left (Type IV) and 2 had bilateral pathologies. It is our belief that the high prevalence of Carpal Tunnel Syndrome in patients with spinal cord injury is the result of excessive use of their hands. This study documents the prevalence of entrapment neuropathies and emphasizes the need for early and periodic electrophysiological evaluations for prevention and early treatment for these syndromes.
KeyWords: Spinal cord injury, entrapment neuropathies, electrophysiology, carpal tunnel syndrome Cerrahpasa J Med 2007; 38: 81 - 84


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